Hepatic encephalopathy classification: Difference between revisions
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===Grading=== | ===Grading=== | ||
The evaluation of severity of persistent hepatic [[encephalopathy]] is based on the West Haven Criteria for semi-quantitative grading of [[mental status]], referring to the level of impairment of autonomy, changes in [[consciousness]], intellectual function, behavior, and the dependence on therapy.<ref name="pmid11870389">{{cite journal| author=Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT| title=Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. | journal=Hepatology | year= 2002 | volume= 35 | issue= 3 | pages= 716-21 | pmid=11870389 | doi=10.1053/jhep.2002.31250 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11870389 }} </ref><ref name="Conn">Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977; 72: 573-83.</ref> | The evaluation of severity of persistent hepatic [[encephalopathy]] is based on the West Haven Criteria for semi-quantitative grading of [[mental status]], referring to the level of impairment of autonomy, changes in [[consciousness]], intellectual function, behavior, and the dependence on therapy.<ref name="pmid11870389">{{cite journal| author=Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT| title=Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. | journal=Hepatology | year= 2002 | volume= 35 | issue= 3 | pages= 716-21 | pmid=11870389 | doi=10.1053/jhep.2002.31250 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11870389 }} </ref><ref name="Conn">Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977; 72: 573-83.</ref> | ||
'''West Haven Criteria''' | |||
* Grade 1: | * Grade 1: | ||
**Trivial lack of awareness | **Trivial lack of awareness | ||
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* Grade 4: | * Grade 4: | ||
**[[Coma]] (unresponsive to verbal or [[noxious]] stimuli) | **[[Coma]] (unresponsive to verbal or [[noxious]] stimuli) | ||
'''World Health Congress of Gastroenterology Criteria''' | |||
Type A (acute) | |||
* HE associated with acute liver failure, typically with cerebral edema | |||
Type B (bypass) | |||
* HE caused by portal-systemic shunting (without associated intrinsic liver disease) | |||
Type C (cirrhosis) | |||
* HE in patients with cirrhosis - subdivided into episodic, persistent and minimal encephalopathy | |||
==References== | ==References== | ||
Revision as of 14:09, 12 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Hepatic encephalopathy may be classified into three types: type A (Acute), Type B (Bypass) and type C (Cirrhosis) .
Classification
In the world congress of Gastroenterology 1998 in Vienna, a proposed classification of hepatic encephalopathy was presented to standardize the subclasses. According to this classification, hepatic encephalopathy is subdivided in type A, B and C.[1]
- Type A (Acute) describes hepatic encephalopathy associated with acute liver failure;
- Type B (Bypass) is caused by portal-systemic shunting without associated intrinsic liver disease;
- Type C (Cirrhosis) occurs in patients with cirrhosis.
In addition, the duration and characteristics of hepatic encephalopathy were classified into episodic, persistent and minimal.[2]
- Episodic hepatic encephalopathy has a short time span and fluctuates in severity.
- Persistent hepatic encephalopathy occurs as a chronic clinical condition of cognitive deficits.
- The term minimal encephalopathy (MHE) is defined by patients with cirrhosis who do not demonstrate clinically overt cognitive dysfunction, but who show a cognitive impairment on neuropsychological studies. This is still an important finding, as minimal encephalopathy has been demonstrated to increase the rate of road traffic accidents and violations.[3]
Grading
The evaluation of severity of persistent hepatic encephalopathy is based on the West Haven Criteria for semi-quantitative grading of mental status, referring to the level of impairment of autonomy, changes in consciousness, intellectual function, behavior, and the dependence on therapy.[4][5]
West Haven Criteria
- Grade 1:
67% of cirrhotic patients may have 'minimal hepatic encephalopathy'.[6]
- Grade 2:
- Lethargy or apathy
- Minimal disorientation for time or place
- Subtle personality change; inappropriate behavior
- Impaired performance of subtraction
- Grade 3:
- Somnolence to semistupor, but responsive to verbal stimuli
- confusion
- gross disorientation
- Grade 4:
World Health Congress of Gastroenterology Criteria
Type A (acute)
- HE associated with acute liver failure, typically with cerebral edema
Type B (bypass)
- HE caused by portal-systemic shunting (without associated intrinsic liver disease)
Type C (cirrhosis)
- HE in patients with cirrhosis - subdivided into episodic, persistent and minimal encephalopathy
References
- ↑ Leise MD, Poterucha JJ, Kamath PS, Kim WR (2014). "Management of hepatic encephalopathy in the hospital". Mayo Clin Proc. 89 (2): 241–53. doi:10.1016/j.mayocp.2013.11.009. PMC 4128786. PMID 24411831.
- ↑ Al Sibae MR, McGuire BM (2009). "Current trends in the treatment of hepatic encephalopathy". Ther Clin Risk Manag. 5 (3): 617–26. PMC 2724191. PMID 19707277.
- ↑ Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K (2007). "Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations". Am J Gastroenterol. 102 (9): 1903–09. doi:10.1111/j.1572-0241.2007.01424.x. PMID 17640323.
- ↑ Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002). "Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998". Hepatology. 35 (3): 716–21. doi:10.1053/jhep.2002.31250. PMID 11870389.
- ↑ Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977; 72: 573-83.
- ↑ Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R (2007). "Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy". Hepatology. 45 (3): 549–59. doi:10.1002/hep.21533. PMID 17326150.