Hepatic Encephalopathy : Symptoms and Treatment

July 7, 2023

Hepatic Encephalopathy : Symptoms and Treatment
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What Is Hepatic Encephalopathy?

Hepatic encephalopathy is a transient neurological disorder often arising from chronic, severe liver disease. This condition occurs due to the liver’s struggle to effectively filter toxins – substances generated from food breakdown, alcohol, medications, and muscle metabolism – from the bloodstream. As these toxins accumulate and travel to the brain, their toxic effects impair cognitive function.

People affected by hepatic encephalopathy commonly exhibit confusion and difficulties in cognitive processing. Taking appropriate treatments can lead to the removal of toxins and a potential reversal of the condition. However, as liver disease advances, the condition’s responsiveness to treatment can diminish. Also known as portosystemic encephalopathy (PSE), hepatic encephalopathy is notably linked to cirrhosis – a condition characterised by the accumulation of scar tissue in the liver that obstructs blood flow and toxin filtration.

What Are The Risk Factors For Hepatic Encephalopathy?

The prevalence of hepatic encephalopathy is notably connected to cirrhosis, a condition where liver scar tissue buildup hampers blood flow and toxin filtration. This underscores the liver’s role in effectively filtering natural toxins out of the body. Individuals with cirrhosis face an elevated risk of developing hepatic encephalopathy, with up to 50% of such cases eventually exhibiting symptoms.

What Are The Types Of Hepatic Encephalopathy?

Hepatic encephalopathy presents in three distinct types:

  • Type A: This variant emerges from acute liver failure in the absence of underlying chronic liver disease.
  • Type B: Occurring in individuals with a liver shunt connecting two veins; type B arises without underlying liver disease.
  • Type C: This variant is common, stemming from chronic liver disease and cirrhotic scarring.

What Are The Root Causes Of Hepatic Encephalopathy?

Liver disease impairs the liver’s ability to filter natural toxins effectively. Consequently, toxins like ammonia accumulate in the bloodstream, potentially leading to brain function impairment temporarily or permanently. Chronic liver disease poses a risk for hepatic encephalopathy. The condition is typically triggered by factors such as alcohol use, medications affecting the nervous system, constipation, dehydration, digestive tract bleeding, infection, kidney disease, and liver shunts.

What Are The Symptoms Of Hepatic Encephalopathy?

People with hepatic encephalopathy experience impaired brain function. Symptoms include:

  • Anxiety or irritability.
  • Cognitive impairment 
  • Coordination or balance problems
  • Difficulty concentrating or short attention span
  • Flapping hand motion 
  • Mood or personality changes
  • Muscle twitches 
  • Reduced alertness
  • Sleep problems
  • Slurred speech

What Are The Diagnostic Processes And Evaluation For Hepatic Encephalopathy?

While no standard test exists for hepatic encephalopathy, 

  • blood tests are pivotal in identifying infections and bleeding associated with liver disease. 
  • Additional tests are employed to differentiate from conditions presenting similar symptoms. 
  • These tests encompass MRI, CT scans, and EEG. Diagnosis predominantly relies on medical history, symptomatology, and clinical examination.

What Are The Preventive Measures?

Proper management of liver disease is crucial to decrease the chances of hepatic encephalopathy. This can be achieved through various preventive measures, such as

  • refraining from alcohol consumption to prevent liver cell damage
  • avoiding medications that may affect the nervous system, following a balanced diet
  • engaging in regular exercise to maintain a healthy weight
  •  taking prescribed liver disease medications as directed by doctors
  • undergoing routine liver function tests.

When To Seek Medical Attention?

It is crucial to reach out to your doctor under specific circumstances promptly:

If you are living with liver disease and observe manifestations indicative of hepatic encephalopathy, such as compromised cognitive function, alterations in mood, sleep disturbances, and hand flapping.

Furthermore, if you are grappling with liver disease and encounter constipation, it is vital to inform your doctor/ general physician/hepatologist. Regular bowel movements play a pivotal role in expelling toxins from the body, and reduced bowel movements can lead to toxin accumulation.

What Are The Key Questions To Ask Your Doctor?

If you or a loved one is dealing with hepatic encephalopathy, addressing pertinent queries with your doctor can offer clarity and guidance. Some essential questions to consider include:

Impact Of Liver Disease

  • How is liver disease affecting my overall health and bodily functions?
  • What are the specific ways in which liver disease is impacting my body?

Enhancing Liver Function

  • Can I implement lifestyle changes or interventions to enhance liver function or slow the progression of liver disease?
  • What strategies can I adopt to support optimal liver health?

Liver Disease Treatment

  • What treatment options are available to manage my liver disease at this stage effectively?
  • Which treatment approach is best suited to my current condition and needs?

Managing Hepatic Encephalopathy

  • What is the recommended course of action for managing hepatic encephalopathy?
  • How long is the anticipated duration of hepatic encephalopathy treatment?
  • Are there any specific medications I should be cautious about in relation to hepatic encephalopathy?

Dietary Considerations

  • Are there dietary modifications I should consider to support liver function and overall health?
  • What dietary choices can contribute positively to my liver’s well-being?

People also ask

1. What are the different stages of hepatic encephalopathy?

The stages of hepatic encephalopathy are as follows:

  • Stage 0 – Minimal HE: This stage involves slight alterations in memory and concentration.
  • Stage 1 – Mild HE: Mood shifts and sleep disturbances characterize this stage.
  • Stage 2 – Moderate HE: Individuals may exhibit inappropriate behavior, slurred speech, and difficulties with basic math.
  • Stage 3 – Severe HE: Symptoms escalate to disorientation, extreme drowsiness, and anxiety.
  • Stage 4 – Coma: The condition progresses to a state of coma.

2. What are some of the early signs of hepatic encephalopathy?

Early signs of hepatic encephalopathy include:

  • Anxiety or irritability.
  • Cognitive impairment, including confused thinking and judgment.
  • Coordination and balance issues.
  • Difficulty concentrating or maintaining attention.
  • Flapping hand motion, known as asterixis.
  • Mood or personality alterations.
  • Muscle twitches, referred to as myoclonus.
  • Reduced alertness.

3. How long does encephalopathy last, and is it reversible?

The duration of encephalopathy varies depending on the cause and severity. While some forms are reversible, others may result in permanent brain damage. Reversibility depends on addressing the underlying cause and implementing appropriate treatments.

4. What is meant by “end-stage encephalopathy”?

End-stage hepatic encephalopathy occurs when toxins in the bloodstream, stemming from liver disease, disrupt brain function. Those affected usually survive for approximately 12 months after the onset of hepatic encephalopathy. This stage indicates severe deterioration and requires specialized medical attention.

Disclaimer: We recommend consulting a Doctor before taking any action based on the above shared information.


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