What is Hepatic Encephalopathy

Hepatic encephalopathy is a loss of brain function due to advanced liver disease. When the liver is damaged, harmful substances (toxins) can build up in the body. Some of these toxins, such as ammonia, can harm the brain.

The effects of the condition depend on the type of liver damage and how severe it is. In some cases, hepatic encephalopathy can be reversed.

What are the causes?

Certain things can trigger or worsen hepatic encephalopathy, such as:

• Infection.
• Constipation.
• Taking certain medicines, such as benzodiazepines.
• Alcohol use.
• Bleeding into the intestinal tract.
• Imbalances in minerals (electrolytes) in the body.
• Dehydration.

Hepatic encephalopathy can sometimes be reversed if these triggers are resolved.

What increases the risk?

You are at risk of developing this condition if you have advanced liver disease (cirrhosis). Conditions that can cause liver disease include:

• Infections in the liver, such as hepatitis C.
• Infections in the blood.
• Drinking a lot of alcohol over a long period of time.
• Taking certain medicines, including tranquilizers, diuretics, antidepressants, sleeping pills, or acetaminophen.
• Genetic diseases, such as Wilson’s disease.

What are the signs or symptoms?

Symptoms may develop suddenly. Or, they may develop slowly and get worse gradually. Symptoms can range from mild to severe.

Mild symptoms include:

• Mild confusion.
• Shortened attention span.
• Personality and mood changes.
• Anxiety and agitation.
• Drowsiness.

Symptoms of worsening or severe hepatic encephalopathy include:

• Extreme confusion (disorientation).
• Slowed movement.
• Slurred speech.
• Extreme personality changes.
• Abnormal shaking or flapping of the hands.
• Coma.

How is this diagnosed?

This condition may be diagnosed based on:

• A physical exam.
• Your symptoms and medical history.
• Blood tests. These may be done to check levels of ammonia in your blood, measure how long it takes your blood to clot, or check for infection.
• Liver function tests. These may be done to check how well your liver is working.
• MRI and CT scans. These may be done to check for a brain disorder and to check for problems with your liver.
• Electroencephalogram (EEG). This test measures the electrical activity in your brain.

How is this treated?

The first step in treatment is to identify and treat the cause of your liver damage or triggering illness, if possible. The next step is taking medicine to lower the level of toxins in your body and prevent ammonia from building up. Treatment will depend on how severe your encephalopathy is, and may include:

• Medicine to lower your ammonia level (lactulose).
• Antibiotic medicine to reduce the amount of ammonia-producing bacteria in your gut.
• Close monitoring of your blood pressure, heart rate, breathing, and oxygen levels.
• Removal of fluid from your abdomen.
• Close monitoring of how you think, feel, and act (mental status).
• Dietary changes.
• Liver transplant, in severe cases.

Follow these instructions at home:

Eating and drinking

• Work with a dietitian or with your health care provider to make sure you are getting the right balance of protein and minerals.
• Drink enough fluids to keep your urine pale yellow.
• Do not drink alcohol or use drugs.

General instructions

• If you were prescribed an antibiotic, take it as told by your health care provider. Do not stop taking the antibiotic even if your condition improves.
• Take other over-the-counter and prescription medicines only as told by your health care provider.
• Do not start taking any new medicines, including over-the-counter medicines, without first checking with your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You develop new symptoms.
• Your symptoms change or get worse.
• You have a fever.
• You are constipated. Signs of constipation include having:
  • Fewer bowel movements in a week than normal.
  • Trouble having a bowel movement.
  • Stools that are dry, hard, or larger than normal.
• You have persistent nausea, vomiting, or diarrhea.

Get help right away if:

• You become very confused or drowsy.
• You vomit blood or material that looks like coffee grounds.
• Your stool is bloody, black, or looks like tar.

Summary

• Hepatic encephalopathy is a loss of brain function due to advanced liver disease. When the liver is damaged, harmful substances (toxins) can build up in your body. Some of these toxins, such as ammonia, can harm your brain.
• Certain things can trigger or worsen hepatic encephalopathy. Hepatic encephalopathy can sometimes be reversed if these triggers are resolved.
• The first step in treatment is to identify and treat the cause of your liver damage or triggering illness, if possible. The next step is taking medicine to lower the level of toxins in your body and prevent ammonia from building up.
• Your treatment will depend on how severe your hepatic encephalopathy is.