Hepatic encephalopathy classification
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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. Minimal hepatic encephalopathy is associated by mild cognitive of attention impairment, response inhibition and executive function.
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]
- Grade 1 - Trivial lack of awareness; euphoria or anxiety; shortened attention span; impaired performance of addition. 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 - Coma (unresponsive to verbal or noxious stimuli)
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.