Hepatic encephalopathy (HE) is a serious complication of cirrhosis with significant mortality.1It can present with various stages and can be recurrent. Once cirrhosis is established, several factors can precipitate HE, notable about them being infections, gastrointestinal bleeding and constipation. 2 Sometimes more than one factor may be present.3
Although complete pathogenesis of HE is unclear, there is general consensus that there are synergistic effects of excess ammonia and inflammation cause astrocyte swelling and cerebral edema.4 Diagnosis is based on clinical setting, although several neuropsychiatric tests have been used. Various clinical scales including well known West Haven criteria have been used.
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