Hepatic encephalopathy is one of the most common and clinically important complications of advanced liver disease and cirrhosis. It is a frequent cause of altered mental status encountered by emergency physicians, intensivists, hospitalists, gastroenterologists, hepatologists, and other healthcare professionals caring for critically ill patients. In this episode, we review the pathophysiology of hepatic encephalopathy, including ammonia metabolism, neuroinflammation, and the gut-liver-brain axis. We also discuss clinical presentation, the West Haven grading system, common precipitating factors, diagnostic evaluation, differential diagnosis, and evidence-based treatment strategies including lactulose and rifaximin. Additional topics include recurrent hepatic encephalopathy and TIPS-associated encephalopathy. Whether you are learning hepatic encephalopathy for the first time or looking to strengthen your understanding of this common complication of cirrhosis, this episode provides a practical and physiology-based review designed for healthcare professionals. ▶️ Watch the full video version: https://www.youtube.com/watch?v=UU9QGH-YCwI 🌐 Explore WhiteBoard Medicine: https://www.whiteboardmedicine.com 📚 Looking for more emergency medicine and critical care education? The WhiteBoard Medicine Patreon includes: • Comprehensive Study Guides • Bedside One-Pagers • Clinical Reviews • Mini-Courses • Practice Questions • Ad-Free Videos • Structured Learning Collections Join here: https://www.patreon.com/WhiteBoardMedicine Educational Disclaimer: This podcast is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.

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