Abstract
Hepatic encephalopathy (HE) is a complex condition that arises as a complication of
chronic liver disease and portosystemic shunting. Its pathophysiology involves several
factors, including impaired ammonia metabolism, portosystemic shunting, sarcopenia,
and systemic inflammation. The symptoms of HE can vary significantly, with manifestations
ranging from subclinical signs to a comatose state. The West Haven classification
system is most commonly used to grade the severity of HE. There is a broad differential
for the presenting symptomatology of HE and other causes of altered mental status
must be excluded during the workup. HE is a well-known complication of transjugular
intrahepatic portosystemic shunt (TIPS) placement. Even though newer stent designs
help reduce the risk of HE with smaller diameter shunts, it is essential that patients
are counseled regarding this potential risk prior to the procedure. Once a diagnosis
of HE has been confirmed, the mainstay of therapy is lactulose and rifaximin. In cases
where a patient has received a TIPS placement and continues to experience refractory
HE despite medical therapy, it may be necessary to consider shunt reduction or closure.
Keywords
TIPS - hepatic encephalopathy - cirrhosis
