HE

Mbare Regional Referral Hospital, Department of Internal Medicine

Hepatic encephalopathy is a reversible neuropsychiatric syndrome occurring in patients with liver insufficiency or portosystemic shunting, ranging from subtle cognitive changes to coma. The presentation outlines its epidemiology, noting a prevalence of up to 58.8% among cirrhotic patients in Africa, and details the ammonia‑driven pathophysiology linked to gut bacterial metabolism. Diagnostic criteria emphasize clinical assessment, West Haven grading, and exclusion of other causes, with investigations such as serum ammonia, EEG, and imaging. Management focuses on lactulose and rifaximin, alongside monitoring and secondary prophylaxis, while highlighting complications like cerebral edema and the overall poor prognosis.