The Signs and Symptoms of Hepatic Encephalopath in Hospice

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Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, after exclusion of brain disease.

Signs of Hepatic Encephalopathy

  • Flapping tremor or asterixis (early stages)
  • Stupor (late stage)
  • Coma (late stage)

Symptoms of Hepatic Encephalopathy

The following and should be documented:

  • Decreased awareness of environment
  • Sleep disturbance
  • Depression
  • Emotional lability
  • Somnolence
  • Slurred speech
  • Obtundation


Warrell DA, Cox TA, Firth JD & Benz EJ, Oxford Textbook of Palliative Medicine, 4th ED. Oxford University Press, UK 2003.


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