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Staging of hepatic encephalopathy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

West Haven criteria is used to grade the severity of hepatic encephalopathy


Clinical description

covert HE

Minimal hepatic encephalopathy (MHE)

evidence of cognitive impairment on neuropsychology
evidence of altered psychomotor speed or executive function
requires psychometric tests to make the diagnosis

grade I

trivial lack of awareness
euphoria or anxiety
shortened attention span
impairment of addition or subtraction (for example, serial 7s test)
altered sleep rhythm

overt HE

grade II

lethargy or apathy
disorientation for time
obvious personality change
inappropriate behaviour

grade III

somnolence to semi-stupor
response to stimuli
gross disorientation
bizarre behaviour

grade IV



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