Knowledge Portal
Encephalopathy and cerebral complications
Hepatic encephalopathy describes brain dysfunction associated with liver failure or portosystemic shunting, but its clinical context matters. In cirrhosis it is a diagnosis of exclusion that requires a search for precipitants and alternative causes of altered consciousness. Acute liver failure is different: rapid hyperammonaemia may lead to cerebral oedema and intracranial hypertension. The resources below deliberately cover both syndromes while keeping that distinction clear.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
EASL Clinical Practice Guidelines on hepatic encephalopathy
EASL · guideline · 2022
Evidence-based recommendations on definition, diagnosis, differential diagnosis and treatment.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Hepatic encephalopathy: Part 1, a diagnostic approach
Ntuli Y, et al. Frontline Gastroenterology. 2026;17(4):331–344.
A practical diagnostic framework that emphasises clinical characterisation, precipitants and competing diagnoses.
Open resource →Hepatic encephalopathy: Part 2, inpatient management
Kronsten VT, et al. Frontline Gastroenterology. 2026;17(4).
An unusually useful inpatient review that separates cirrhosis, ACLF and acute liver failure management.
Open resource →What every Intensivist should know about the role of ammonia in liver failure
Duarte T, et al. Journal of Critical Care. 2024;81:154456.
An ICU-specific review of ammonia measurement, prognostic meaning and ammonia-targeted treatments.
Open resource →Hepatic encephalopathy
Deranged Physiology · ICU revision chapter · updated 2025
A detailed physiology and critical-care revision resource.
Open resource →Why shouldn’t ammonia be used in the diagnosis and management of hepatic encephalopathy?
AASLD Liver Fellow Network · clinical explainer · 2023
A clear account of when ammonia measurement is—and is not—clinically informative in cirrhosis.
Open resource →Hepatic Encephalopathy: underdiagnosed and underestimated
EASL Studio · expert discussion
An accessible discussion of recognition, burden and management across the HE spectrum.
Open resource →