1) Spontaneous (no obvious precipitating factor)

2) Precipitated:

– Factors causing increase in ammonia (infection, hypokalemia, metabolic alkalosis, GI bleed, excess protein intake)

– Hypovolemic state (diuretic overdose, large volume paracentesis, diarrhea, vomiting)

– Drugs (benzodiazepines, opioids, alcohol), malignancy (primary hepatocellular carcinoma)

– Vascular occlusion (portal and hepatic vein thrombosis), portosystemic shunts 

1) Type A: HE associated with acute liver failure

2) Type B: HE associated with portosystemic shunting/bypass in absence of intrinsic hepatocellular disease

3) Type C: HE associated with cirrhosis 

1) West Haven criteria: 0/MHE, 1, 2, 3, 4 (see table 7.3-4)

2) ISHEN:

– Cover hepatic encephalopathy: West Haven criteria grades 0/MHE and 1

– Overt hepatic encephalopathy: West Haven criteria grades 2, 3, 4

1) Episodic: 1 episode in 6 months

2) Recurrent: >1 episode in 6 months

3) Persistent: Persistent altered behavior interspersed with relapses of OHE