GI / HepatologyNeurology
Hepatic Encephalopathy
Identify precipitants, lactulose to titrate to 2–3 soft stools/day, rifaximin for prevention, transplant referral.
Source: EASL 2014; West Haven criteria
Step 1 of ~4
info
Recognise — West Haven Grading
Cirrhosis or acute liver failure + altered mental state.
• Grade 1: trivial loss of awareness, sleep reversal.
• Grade 2: lethargy, subtle disorientation, asterixis.
• Grade 3: somnolence, severe confusion, gross disorientation.
• Grade 4: coma.
ABCDE; airway protection if grade 3–4. Bloods: FBC, U&E, LFTs, glucose, ammonia (supportive but not diagnostic), CRP, blood culture, septic screen, paracentesis if ascites. Exclude alternative causes (CT head if focal signs / trauma).
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Lactulose · Osmotic laxative / Ammonia reduction (hepatic encephalopathy)
- Lactulose (Hepatic Encephalopathy) · Osmotic Laxative / Ammonia-Reducing Agent
- Rifaximin · Non-Absorbable Antibiotic (Hepatic Encephalopathy / IBS-D)
- Lactulose (Paediatric) · Osmotic Laxative — Constipation / Hepatic Encephalopathy
- Thiamine (IV/IM — Pabrinex) · Vitamin B1 (Thiamine) — deficiency treatment / Wernicke's encephalopathy prevention
- Liquid paraffin with white soft paraffin and wool alcohols · Emollient
Pathways
- Lower Gastrointestinal Bleed · BSG 2019; NICE NG141
- Variceal Upper GI Bleed · BSG 2015; Baveno VII (2022)
- Spontaneous Bacterial Peritonitis (SBP) · BSG / EASL 2018
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Acute Severe Ulcerative Colitis · BSG 2019; ECCO 2022
Decision support only. Always apply local guidelines and clinical judgement.