From the Guidelines
Hepatic Encephalopathy Classification The main difference between covert and overt hepatic encephalopathy is the severity of the symptoms, with covert HE being characterized by minor or no signs/symptoms but abnormalities on neuropsychological and/or neurophysiological tests, whereas overt HE is defined as the occurrence of disorientation, flapping tremor, or asterixis, corresponding to West Haven criteria grades II-IV 1.
Key Characteristics of Covert and Overt HE
- Covert HE:
- Minimal or no clinical signs of HE
- Abnormalities detected only by neuropsychological and/or neurophysiological tests
- Includes minimal and grade 1 HE, according to the West Haven criteria
- Overt HE:
- Presence of disorientation, flapping tremor, or asterixis
- Corresponds to West Haven criteria grades II-IV
- Can be further classified as episodic, recurrent, or persistent
Diagnosis and Classification
The diagnosis of HE should be based on the severity of the underlying liver disease, the severity and time course of mental alterations, and any identified precipitating events 1. The West Haven criteria are commonly used to classify the severity of HE, with covert HE corresponding to grades 0-1 and overt HE corresponding to grades II-IV 1.
Importance of Accurate Diagnosis
Accurate diagnosis and classification of HE are crucial for determining the appropriate treatment and management strategy, as well as for predicting patient outcomes 1. The presence of covert HE is an independent risk factor for the development of overt HE, and early detection and treatment can help prevent progression and improve patient outcomes 1.
Challenges in Diagnosis
The diagnosis of covert HE can be challenging due to the lack of specific clinical signs and the need for specialized testing, such as neuropsychological and neurophysiological tests 1. Additionally, the differential diagnosis of covert HE includes other conditions, such as mild cognitive impairment, which can present with similar symptoms 1.
Clinical Implications
In clinical practice, it is essential to be aware of the differences between covert and overt HE and to use a combination of clinical evaluation, laboratory tests, and specialized testing to diagnose and classify HE accurately 1. Early detection and treatment of covert HE can help prevent progression to overt HE and improve patient outcomes, highlighting the importance of regular screening and monitoring of patients with liver disease 1.
From the Research
Difference between Covert and Overt Hepatic Encephalopathy
There are no research papers provided to directly answer the question about the difference between covert and overt hepatic encephalopathy. The studies provided focus on the ethical considerations of covert administration of medication, particularly in patients with dementia or severe mental illness 2, 3, 4, 5, 6.
Covert Administration of Medication
- The practice of covert administration of medication is a complex and contentious issue, with some scholars arguing that it is never acceptable due to the inherent wrongness of deception 2, 3.
- Others believe that deception may be necessary in certain situations, such as when a patient lacks the competence to give informed consent 3, 4.
- The administration of medication in food and drink, including covert medication, is a relatively common practice in institutional and homecare contexts 4, 5, 6.
- However, this practice raises significant ethical concerns, including the risk of losing trust in caregivers and food, and the potential for therapeutic relationships to be jeopardized 5.
Documentation and Policy
- The documentation of covert medication administration is often poor, with many institutions lacking a formal policy on the matter 4, 6.
- It is essential to discuss the matter with the multidisciplinary team and, where appropriate, with the patient's relatives before administering medication covertly 4.
- Supporting documentation should be completed to avoid medico-legal difficulties 4.