Hepatic encephalopathy
Call 999 or go to A&E if
- If you have been diagnosed with cirrhosis, call 999 or go to A&E if you suddenly become confused or have slurred speech, you are vomiting blood, or your poo is very dark or black.
Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance. Bring any medicines you take with you.
Hepatic encephalopathy is a change in how the brain works that can happen when the liver is damaged. It can cause confusion.
It is one of the ways liver disease can suddenly get worse. The others are yellowing of the skin and eyes, fluid in the tummy, and bleeding from swollen veins.
Where this came from
Page 2, note (1) Presentation of Acute Decompensation of Cirrhosis · status: current, verified 2026-09-01
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Presentation of Acute Decompensation of Cirrhosis: Jaundice; Ascites; Hepatic Encephalopathy; Suspected Variceal Haemorrhage
The usual first treatment is lactulose. This is a syrup that works through the bowel. An enema may be used instead.
Where this came from
Page 1, Symptoms/signs of Hepatic Encephalopathy section · status: current, verified 2026-09-01
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Lactulose 20-30mls QDS or phosphate enema. If clinical doubt, CT head to rule out a subdural haematoma
Confusion in someone with liver disease is not always caused by the liver. A scan of the head may be done to rule out other causes, such as bleeding after a fall.
Where this came from
Page 1, Symptoms/signs of Hepatic Encephalopathy section · status: current, verified 2026-09-01
Open
Lactulose 20-30mls QDS or phosphate enema. If clinical doubt, CT head to rule out a subdural haematoma
Related
- Cirrhosis — can arise as a complication of
- Acute decompensation — can be a presentation of
- CT head — is assessed using
- Lactulose — is treated with
- Variceal bleeding — related through acute decompensation
- Alcohol-related liver disease — related through cirrhosis
What we have not established
Relationships involving Hepatic encephalopathy that we have not evidenced are listed, never drawn — a line would read as a weak relationship, which is a different and false claim.
- Detoxification and clearance → Hepatic encephalopathy — not established
- Variceal bleeding → Hepatic encephalopathy — not established
- Hepatic encephalopathy → Brain and nervous system — not established
- Hepatic encephalopathy → West Haven criteria — not established
- Ammonia metabolism and neurotoxicity → Hepatic encephalopathy — not established
Evidence search date: 2026-09-01
Content reviewed and approved
What we have not established here
Known gaps on this concept:
BLOCKED: no specialist resolution. West Haven grading, the covert/overt distinction, precipitant identification, refractory and recurrent disease, rifaximin, and transplant implications all require the EASL 2022 hepatic encephalopathy guideline, which returns HTTP 403 to automated requests.
BLOCKED: no research resolution. Ammonia metabolism, neuroinflammation and astrocyte dysfunction require translational literature that Phase 3 has not reached. The research resolution is currently unauthorable for ANY topic in this repository.
The 2014 joint AASLD-EASL guideline would supply West Haven grading, but its status is unresolved (EASL lists it while also publishing a 2022 replacement), so it cannot support published content.
No claim yet states what hepatic encephalopathy IS at a clinical level - the orientation sentence rests on an NHS complication list, which is a plain-language source.
No precipitants content: infection, gastrointestinal bleeding, constipation, dehydration and sedatives are all standard, and none is claim-bound.
Rifaximin appears in NHS trust-level patient material but not in any national source acquired so far.
What has changed here
2026-09-01 — Concept created at plain and clinical resolutions.
Phase 5 proof topic: to test whether one claim set renders at multiple resolutions without divergence, and to establish whether the specialist and research resolutions are authorable from current sources.