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Portosystemic Encephalopathy

by Steven K. Herrine, MD

Portosystemic encephalopathy is a neuropsychiatric syndrome. It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with portosystemic shunting. Symptoms are mainly neuropsychiatric (eg, confusion, asterixis, coma). Diagnosis is based on clinical findings. Treatment is usually correction of the acute cause, a diet that includes vegetable protein as the primary protein source, oral lactulose, and nonabsorbable antibiotics such as rifaximin.

(See also the American College of Gastroenterology’s practice guideline Hepatic Encephalopathy .) Portosystemic encephalopathy better describes the pathophysiology than hepatic encephalopathy or hepatic coma, but all 3 terms are used interchangeably.

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