Patients with cirrhosis are at risk of hepatic encephalopathy (HE). While its pathogenesis is not fully understood, the circulation of increased levels of ammonia through the bloodstream to the brain is thought to be a key causative factor. The ammonia penetrates the blood-brain barrier, ultimately leading to cerebral oedema. This can result in cognitive impairments, which can exhibit in multiple ways, adversely affecting quality of life for both patients and their families. The need for hospitalisation and longer hospital stays associated with HE has cost implications for the health service. Treatment revolves around the reduction of ammonia levels in the bloodstream

Michelle Clayton, Lecturer in Liver Care, School of Healthcare, University of Leeds and Liver Nurse Educator, Leeds Liver Unit, St James’s University Hospital, Leeds -