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Liver  
oxygen brain lungs

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Definition  

Hepatic encephalopathy is a problem with the brain that is caused by liver disease. The problem may be temporary or permanent.

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Causes  

A liver with disease cannot filter the harmful items in blood. These toxins build up in the blood, which reaches the brain and affects the brain’s ability to work properly.

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Risk Factors  

Factors that increase your chances of developing hepatic encephalopathy include:

  • Cirrhosis
  • Certain conditions that affect the levels of fluids and electrolytes such as hyponatremia and hyperkalemia
  • Kidney failure
  • Infections
  • Gastrointestinal bleeding
  • Certain medications such as sedatives and anti-epileptics
  • Constipation
  • Hepatitis—infectious or autoimmune
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Symptoms  

In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include:

  • Changes in behavior and personality
  • Shortened attention span
  • Depression or anxiety
  • Difficulty sleeping
  • Tiredness
  • Forgetfulness
  • Disorientation
  • Slurred speech
  • Uncontrolled movements, particularly a flapping tremor of the hands
  • Confusion
  • Loss of consciousness

If you have liver problems and any of the above symptoms, call your doctor right away.

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Diagnosis  

You will be asked about your symptoms and medical history. A physical exam will be done. The condition of your nervous system will also be assessed.

Your liver and kidney function may be assessed. This can be done with:

  • Liver function tests
  • Kidney function tests
  • Imaging tests of the liver

Your brain and nervous system may be assessed. This can be done with:

  • Images of the brain with MRI scan or CT scan
  • EEG to look at brain waves for evidence of encephalopathy and/or seizures
  • Lumbar puncture to look for other causes of the encephalopathy
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Treatment  

Hospitalization and Emergency Care  

The initial treatment will focus on treating and trying to reverse the underlying problems. If possible, toxins in your blood will be removed or neutralized.

Medications  

Medications may be used to:

  • Neutralize toxins in the intestine such as ammonia
  • Remove blood from the intestines
  • Reduce ammonia production by intestinal bacteria
  • Reduce the amount of ammonia producing bacteria
  • Treat the condition that started the encephalopathy
  • Reduce recurrence

Dietary Restrictions  

Changes in your diet may be recommended. Tube feeding may be needed to supply nutrients, especially in the case of coma.

Transplantation  

If this condition is due to liver failure, you may need a liver transplant .

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Prevention  

To help reduce your chance of getting this condition, take the following steps:

  • Get early treatment for liver problems.
  • If you have a disease such as cirrhosis, see your doctor regularly.
  • Follow your doctor's instructions regarding medication. Avoid overdosing.
  • Avoid being exposed to poisons or toxins.
  • Avoid excessive use of alcohol.
  • Do not use IV drugs.