Un episodio de encefalopatía hepática manifiesta en un paciente con enfermedad hepática subyacente. El manejo de primera línea se centra en determinar rápidamente la causa del episodio y corregirla antes de considerar cualquier intervención adicional.
El paso primario consiste en una búsqueda sistemática y corrección de los factores precipitantes reconocidos. Este enfoque precede al tratamiento específico anti-EH y aborda la enfermedad hepática subyacente de forma simultánea.
The primary intervention in patients with overt HE is a search for, and correction of, any precipitating factors.
This exercise always precedes specific anti-HE treatment and up to 90% of the patients can be expected to recover from episodic overt HE by correction of one or more precipitating factors.
Finally, rapid removal of blood from the gastrointestinal tract and rapid resolution of constipation have been shown to improve recovery from an episode of overt HE.
In patients with HE, all measures to control progression of the underlying liver disease should be undertaken (LoE 4, strong recommendation, 100% consensus).
Recognised precipitating events are constipation, gastrointestinal bleeding, infections, hyponatremia, and dehydration/diuretic overdose.
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