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.
Hepatic encephalopathy is one of the four recognised presentations of acute decompensation of cirrhosis, alongside jaundice, ascites and suspected variceal haemorrhage.
British Society of Gastroenterology, British Association for the Study of the Liver and Society for Acute Medicine — Page 2, note (1) Presentation of Acute Decompensation of Cirrhosis
The exact wording of the source
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 UK admission care bundle specifies lactulose 20-30 ml four times daily, or a phosphate enema.
British Society of Gastroenterology, British Association for the Study of the Liver and Society for Acute Medicine — Page 1, Symptoms/signs of Hepatic Encephalopathy section
The exact wording of the source
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
Where there is clinical doubt, image the head to exclude a subdural haematoma. Confusion in a person with cirrhosis is not automatically hepatic encephalopathy, and falls are common in this group.
British Society of Gastroenterology, British Association for the Study of the Liver and Society for Acute Medicine — Page 1, Symptoms/signs of Hepatic Encephalopathy section
The exact wording of the source
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.