症例 challenge · Gastroenterology / Hepatology / Emergency · teaching

Hepatic Encephalopathy — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on ACG 2026 / West Haven

Case #1Gastroenterology / Hepatology / Emergency

📋 Case data

West Haven gradeGrade 1–2 (mild–moderate)

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · West Haven grade

West Haven grade (overt HE = grade 2–4)?

💡 On a background of cirrhosis/portosystemic shunting. West Haven: grade 1 (reduced attention/calculation, mild asterixis); grade 2 (lethargy/apathy, disorientation, obvious asterixis, slurred speech); grade 3 (somnolent to semi-stuporous but rousable, severe disorientation, abnormal behavior); grade 4 (coma). Overt HE = grade 2–4. Ammonia is not used to guide treatment; a normal ammonia should prompt considering another diagnosis. Use GCS in grade 3–4, watch for aspiration.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.