A nomenclature for hepatic encephalopathy (HE) was proposed at the 11th World Congresses of Gastroenterology that met in Vienna, Austria in 1998.




associated with acute liver failure


associated with portal-systemic bypass, with no intrinsic hepatocellular disease


associated with cirrhosis, with portal hypertension and/or portal-systemic shunts



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



• 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


To read more or access our algorithms and calculators, please log in or register.