What is your approach to the management of post-TIPS hepatic encephalopathy?

In general, this will depend on if HE is provoked or unprovoked. Provoking factors such as infection, dehydration, medications (sedatives) or GI bleeding are reversible and often do not require aggressive HE treatment when the underlying trigger is removed. It may be reasonable to consider lactulose 10-30g once daily to prevent further episodes. If HE is unprovoked, then I will utilize lactulose titrated to a goal of 3-5 soft bowel movements (Bristol stool Type 5-6) along with rifaximin. It shou...