Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood.
Symptoms
Symptoms many begin slowly and gradually worsen, or they may begin suddenly and be severe from the start.
Symptoms may be mild at first. Family members or caregivers may notice that the patient has:
More severe symptoms may include:
Exams and Tests
Tests may include:
Causes
Type | Causes |
Excessive nitrogen load | Consumption of large amounts of protein, gastrointestinal bleeding e.g. from esophageal varices (blood is high in protein, which is reabsorbed from the bowel), renal failure (inability to excrete nitrogen-containing waste products such as urea), constipation |
Electrolyte or metabolic disturbance | Hyponatraemia (low sodium level in the blood) and hypokalaemia (low potassium levels)—these are both common in those taking diuretics, often used for the treatment of ascites; furthermore alkalosis (decreased acid level), hypoxia (insufficient oxygen levels), dehydration |
Drugs and medications | Sedatives such as benzodiazepines (often used to suppress alcohol withdrawal or anxiety disorder), narcotics (used as painkillers or drugs of abuse) and sedative antipsychotics, alcohol intoxication |
Infection | Pneumonia, urinary tract infection, spontaneous bacterial peritonitis, other infections |
Others | Surgery, progression of the liver disease, additional cause for liver damage (e.g. alcoholic hepatitis, hepatitis A) |
Unknown | In 20–30% of cases, no clear cause for an attack can be found |
Treatment
Lactulose may be given to prevent intestinal bacteria from creating ammonia, and as a laxative to remove blood from the intestines. Neomycin may also be used to reduce ammonia production by intestinal bacteria. Rifaximin, a new antibiotic, is also effective in hepatic encephalopathy.