|
Features
|
Type
|
|
associated with acute liver failure
|
A
|
|
associated with portal-systemic bypass, with no intrinsic hepatocellular disease
|
B
|
|
associated with cirrhosis, with portal hypertension and/or portal-systemic shunts
|
C
|
Subtypes of HE Type C:
(1) episodic: develops over a short period of time and fluctuates in severity
(2) persistent: more long term, impacting social and occupational functioning
(3) minimal: should be used rather than the term "subclinical"
Subtypes of episodic HE Type C:
(1) precipitated: secondary to gastrointestinal hemorrhage, uremia, psychoactive medication related, diuretic use, dietary indiscretion, infection, constipation, dehydration, hyperkalemia, hypokalemia, hyponatremia or other identifiable cause
(2) spontaneous: depends on exclusion of known precipitating causes
(3) recurrent: indicates 2 or more episodes in 1 year
Subtypes of persistent HE Type C:
(1) mild (grade 1)
(2) severe (grades 2, 3 or 4)
(3) treatment dependent: overt symptoms develop shortly after discontinuing medication
where:
• It appears that the subtypes for HE Type C reflect 2 separate concepts - temporal (episodic vs persistent) and overt vs minimal. In this case, severity subtypes of persistent HE Type C might be minimal, mild and severe.
• It appears that the subtypes for persistent HE Type C reflect 2 separate concepts - severity (mild vs severe) and relation to treatment
