Hepatic Encephalopathy-the Old and the New

Crit Care Clin. 2016 Jul;32(3):311-29. doi: 10.1016/j.ccc.2016.03.001.


Hepatic encephalopathy occurs ubiquitously in all causes of advanced liver failure, however, its implications on mortality diverge and vary depending upon acuity and severity of liver failure. This associated mortality has decreased in subsets of liver failure over the last 20 years. Aside from liver transplantation, this improvement is not attributable to a single intervention but likely to a combination of practical advances in critical care management. Misconceptions surrounding many facets of hepatic encephalopathy exists due to heterogeneity in presentation, pathophysiology and outcome. This review is intended to highlight the important concepts, rationales and strategies for managing hepatic encephalopathy.

Keywords: Acute liver failure; Acute-on-chronic liver failure; Chronic liver failure; Fulminant hepatic failure; Hepatic encephalopathy.

Publication types

  • Review

MeSH terms

  • Hepatic Encephalopathy / classification
  • Hepatic Encephalopathy / complications
  • Hepatic Encephalopathy / diagnosis*
  • Hepatic Encephalopathy / therapy*
  • Humans
  • Intracranial Hypertension / etiology
  • Intracranial Hypertension / prevention & control
  • Intracranial Hypertension / therapy*
  • Intracranial Pressure
  • Liver Failure / complications
  • Magnetic Resonance Imaging
  • Monitoring, Physiologic / methods
  • Neuroimaging
  • Neurologic Examination
  • Risk Factors
  • Tomography, X-Ray Computed