Hepatic Encephalopathy Essay

Hepatic encephalopathty (HE) produces a wide spectrum of neurological and psychiatric manifestations ranging from subclinical alterations to coma of varying severity with profound influence on the quality of life and treatment decisions 1. For assessment of severity of HE, West Haven's criteria and Glasgow coma scale are most widely used. The International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) has suggested that severity assessment of hepatic encephalopathy in patients with cirrhosis, whether made clinically or more objectively, should be continuous rather than categorical2 and the term Covert Hepatic encephalopathy was coined which included Minimal Hepatic Encephalopathy (MHE) and Grade 1 West- Haven criteria.
The concept of Minimal hepatic encephalopathy (MHE) was developed in the 1970s as investigators found …show more content…
Paper and pencil tests include Psychometric Hepatic Encephalopathy Score (PHES) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) . The existing paper-pencil tests include line tracing test (LTT), serial dotting test (SDT), digit symbol test (DST) and number connection test A and B (NCT A and B). This battery measures psychomotor speed and precision, visual perception, visuo-spatial orientation, visual construction, concentration, attention and memory are simple to perform and can be completed in less than 20 minutes 4 . These tests are however limited by their inconsistencies in diagnosis of MHE due to lack of consensus regarding diagnostic criteria, increased reliabiliy on motor functions, increased time required in conducting the tests, limitation of application due to poor educational qualifications of the patients and lack of reproducibility. Moreover, these tests assess only few discrete domains of impairment including attention span and some psychomotor skills.