What are symptoms of hepatic encephalopathy (HE) in acute liver failure (ALF)?

Updated: May 18, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Hepatic encephalopathy, accompanying the acute onset of severe hepatic synthetic dysfunction, is the hallmark of acute liver failure (ALF). Symptoms of encephalopathy in ALF are graded using the same scale used to assess encephalopathy symptoms in cirrhosis. The encephalopathy of cirrhosis and ALF share many of the same pathogenic mechanisms. However, brain edema plays a much more prominent role in ALF than in cirrhosis. The brain edema of ALF is attributed to an increased permeability of the blood-brain barrier, impaired osmoregulation within the brain, and increased cerebral blood flow. The resulting brain cell swelling and brain edema are potentially fatal. In contrast, brain edema is rarely reported in patients with cirrhosis. See Acute Liver Failure for more detailed information on the encephalopathy of ALF.

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