Cirrhosis and portal hypertension

Portosystemic shunting

Brain edema
Astrocyte swelling (↑ Glu and Gln)
Neurotransmitter and receptor alterations (↑ GABA)
Altered brain glucose metabolism

↑ Blood NH₃ levels

Inflammation, bacterial translocation, and vasoactive mediators

Increased permeability of blood-brain barrier

Splanchnic and peripheral vasodilatation

Hepatocyte dysfunction

Hepatic encephalopathy

End