**9. Conclusion**

The early and proper treatment of IBDI is very important, because it can prevent serious complications and improve quality of life in patients. Non-invasive methods are used as initial treatment. When it is not effective, surgical management should be considered. Surgical treatement includes different types of reconstructions.

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**24** 

*Pakistan* 

**Hepatic Encephalopathy** 

*Aga Khan University, Karachi* 

Om Parkash, Adil Aub and Saeed Hamid

The liver is the most important organ for the well-functioning of other organs because of its vital role in nutrition, metabolism and secretion. Any disturbance in normal homeostasis of liver as it happens in acute liver failure (ALF) and chronic liver disease (cirrhosis) will lead to extra hepatic manifestations of liver disease, among them one is encephalopathy. And this encephalopathy caused by liver abnormality is known as Hepatic encephalopathy (HE).(1) HE occurs in 50-70% of patients with chronic liver disease and this is one of the sign of decompensated chronic liver disease. Occurrence of HE associated with poor prognosis

Hepatic encephalopathy(HE) is defined as a reversible and metabolically induced neuropsychiatric complication, most commonly associated with cirrhosis, but may also be a complication of acute or chronic liver disease.(3) The affected patients exhibit alterations in psychomotor functions, personality changes, cognitive impairment and disturbed sleep pattern. Although, precise pathophysiologic mechanisms are not well understood, severe liver damage or the presence of Porto-systemic shunts are thought to be the major

According to the classification proposed by the working party in 1998, HE can be graded

2. Type B HE (observed in patients with Porto-systemic bypass and no intrinsic hepato-

3. Type C HE (associated with cirrhosis or portal-hypertension or Porto-systemic shunt).

Overt HE (OHE) is a syndrome of neuropsychiatric abnormalities that can be detected by bedside clinical tests in contrast to minimal HE (MHE) that requires specific psychometric tests for detection.(5) Defining type-C HE into minimal or overt, episodic or persistent and

**1. Introduction** 

**1.1 Definition** 

into 3 types:

mechanisms involved.(4)

cellular disease);

iii. Minimal or Overt HE(3)

with survival of approximately 42% at 1 year.(2)

1. Type A HE (associated with acute liver failure);

Type C HE can be further divided into three categories: i. Episodic HE (Spontaneous; recurrent; precipitated) ii. Persistent HE (Mild; Severe; Treatment dependent)

