Causes of Hepatic Encephalopathy

In this article, we will discuss various Causes of Hepatic Encephalopathy. So, let’s get started.

Acute hepatic encephalopathy is a clinical syndrome of neuropsychiatric manifestations developing within a period of 8 weeks in a patient with acute fulminant hepatitis as a result of massive acute hepatocellular necrosis without any evidence of previous liver disease. Chronic hepatic encephalopathy develops between 8 weeks and 6 months after the onset of acute liver disease. Acute on chronic liver failure refers to acute deterioration of liver function in a person with pre-existing liver disease. This is due to entry of nitrogenous products and gut derived neurotoxins in the circulation and the brain. These nitrogenous products and neurotoxins normally originate in the intestine and are inactivated and metabolized in the liver. In hepatic failure, they bypass the diseased liver and reach the CNS through circulation leading to encephalopathy.


  • Infection: Viral hepatitis (B and D), yellow fever, leptospirosis
  • Hepatotoxic drugs: Anaesthetics (halothane), NSAIDs, acetaminophen overdose, antitubercular drugs, antiepileptics, etc.
  • Vascular: Hepatic vein thrombosis (Budd-Chiari syndrome), veno-occlusive disease.
  • Poisons: Carbon tetrachloride, poisonous fungi (amantia phalloides), phosphorus.
  • Miscellaneous: Wilson’s disease, Reye’s syndrome, fatty liver of pregnancy, autoimmune hepatitis, etc.
  • Chronic hepatitis or cirrhosis due to any cause such as alcoholism, etc.

NYHA (New York Heart Association) functional classification of Heart Failure

In this article, we will discuss the NYHA (New York Heart Association) functional classification of Heart Failure. So, let’s get started.


Class I (Asymptomatic): No limitation on physical activity. Ordinary physical activity does not cause symptoms of Heart Failure (Patient with cardiac disease but no symptoms).

Class II (Symptomatic with moderate activity): Patients with cardiac disease are comfortable at rest and after mild activity, but moderate activity results in dyspnea, palpitation, and fatigue.

Class III (Symptomatic with mild activity): Patients with cardiac disease have marked limitation of physical activity. Comfortable at rest, but less than normal activity results in fatigue, dyspnea, and palpitation.

Class IV (Symptomatic at rest): Patients have symptoms of cardiac insufficiency at rest, and any physical activity further increases the discomfort. They are unable to carry out any physical activity without discomfort.