Mechanisms, diagnosis and management of hepatic encephalopathy

Hepatic encephalopathy is an important neuropsychiatric complication of liver disease that in severe cases can lead to coma and death. This Review describes the pathogenesis of hepatic encephalopathy including the role of ammonia, inflammation, neurosteroids and manganese in the development of this disorder. The authors also discuss how best to clinically manage patients with hepatic encephalopathy by highlighting the clinical scales and tests used to grade the disorder and the different treatment strategies available.