A Comprehensive Review on Hepatic Encephalopathy: Pathophysiology, Symptoms, Epidemiology, Classification, Diagnosis and Treatment

Abstract

The condition known as hepatic encephalopathy (HE) is a state of impaired brain function that can be reversed and is experienced by patients who are suffering from severe liver diseases. Neurotoxins, decreased neurotransmission as a result of metabolic anomalies in liver failure, changes in brain energy metabolism, systemic inflammatory response, and alterations of the blood brain barrier are the primary hypotheses that are still being explored in relation to the precise pathophysiology of hepatic encephalopathy (HE). There is a wide spectrum of severity regarding the neurological and mental symptoms that can be brought on by HE. For the purpose of diagnosing limited HE, abnormal psychometric tests are utilised. Alterations in personality, altered states of consciousness, gradual spatial and temporal disorientation, lethargy, stupor, and coma are some of the characteristics of HE that are clinically noticeable. For the purpose of diagnosis, specific testing is not required outside of clinical studies. HE is classified according to the underlying disease, the severity of symptoms, the length of time it has been present, and whether or not there are triggers that cause it to occur. Hepatic encephalopathy refers to a collection of neuropsychiatric illnesses that can be treated and are characterised by the presence of symptoms in individuals who have liver disease or who have undergone portosystemic shunting. Entephalopathy, a disabling result of cirrhosis, affects thirty-five percent to forty-five percent of cirrhotic patients. Before recently, the treatment choices for HE that were available in hospitals were depending on anecdotal evidence, the availability of medication, and the norms of the relevant institutions. An increasing number of randomised controlled trials (RCTs) are providing further confirmation of the central significance of the basic HE therapy techniques (lactulose, branched-chain amino acids, and rifaximin), as well as the rising body of evidence showing the large beneficial advantages associated with these strategies. The liver transplantation and embolisation of large PSSs are two treatments that have proven to be effective for a select group of patients who have been carefully selected. Not only does it have a significant influence on the day-to-day lives of patients and carers, but it is also associated with increased rates of sickness and death and consumes a significant amount of resources in the healthcare system. In this article, we examine the history of hepatic encephalopathy, as well as the current understanding of the condition and the potential treatments for it.