Hepatic encephalopathy

Hepatic encephalopathy (HE) is a neurocognitive disorder associated with both acute and chronic liver injury. It manifests as a wide spectrum of neuropsychological abnormalities ranging from subtle impairments in executive higher functions through to coma. In acute liver failure, the central role of ammonia in the development of brain oedema remains undisputed. However, the gut microbiome and the presence of systemic inflammation or the development of infection have become increasingly recognized as drivers for developing HE in cirrhosis.