It is important to diagnose hepatic encephalopathy
which is common and reversibl complication seen in cirrhotic patients. A wide
range of clinical presentations can be observed, starting from minimal hepatic
encephalopathy to overt hepatic encephalopathy. Diagnosis and management of
hepatic encephalopathy in elderly is difficult due to comorbidities, medical
treatments used and their adverse effects. Hepatic encephalopathy is graded
from 0 to 4 (from minimal hepatic encephalopathy to coma) by using West Haven
criteria. Increased serum ammonia levels play a crucial role in pathogenesis
however current advancements showed that disease pathogenesis is
multifactorial.Clinical presentation of patients can range from attention
deficit to comatose situation. Diagnosis is made by clinical evaluation of
patients with the support of laboratory tests and exclusion of other potential
causes. The clinician must be extra careful to diagnose hepatic encephalopathy
in elderly patients. Mental illness, intracranial lesions, metabolic
encephalopathies, Wernicke Encephalopathy, delirium, Parkinson disease should
be evaluated in differential diagnosis. Treatment aims improving cognitive
functions by managing underlying disease, lowering serum ammonia levels and
should be tailored.
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