Patient discussions
Patients with cirrhosis should be advised to avoid factors that precipitate the development of HE, such as sedative use, constipation, and hypoglycaemic or hypoxic states. They should also be advised to seek medical attention if they have any gastrointestinal bleeding, develop an infection, or feel unwell. Research has shown that patients with a history of HE and their carers tend to have limited disease awareness. One pilot study demonstrated that a single, quick (15-minute) educational intervention was effective in reducing re-admission rates and increasing awareness of the basic pathophysiology of HE, common treatments, and how to ensure/maintain regular bowel emptying.[62]
Patients should be instructed to avoid opioids, alcohol, and benzodiazepines.
Patients should be advised regarding their country's national driving regulations for those with previous episodes of HE. Expert consensus recommends avoidance of driving after an episode of overt HE, and patients and carers should be given verbal and written advice regarding this.[2][63]
Long-term protein restriction is not recommended in patients with HE.
Carer discussions
Carers should be counselled about early signs and symptoms of HE and what to do if these occur. HE places a considerable burden on carers, who report a significant impact on their own health and schedule and a sense of entrapment.[57] Carers may benefit from discussions about financial support, respite care availability, and local support groups.
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