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The term hepatic encephalopathy refers to a complex of neurological abnormalities that may occur in the presence of advanced liver disease. In the dog and cat, hepatic encephalopathy most commonly results from a single congenital vascular shunt from the portal circulation, which bypasses the hepatic circulation and allows mesenteric blood to enter directly either the caudal vena cava or the azygos vein. Acquired portosystemic shunting also occurs as a consequence of diseases that induce portal hypertension, including cirrhosis, arteriovenous (AV) fistula and hepatoportal fibrosis. This chapter covers Clinical features of dogs and cats; Differential diagnosis; Diagnosis; and Treatment.