Hepatic Encephalopathy

Hepatic encephalopathy is diagnosed as a reduction in brain functioning that is caused by chronic liver disease. Patients with hepatic encephalopathy have poorly functioning livers that are not equipped to remove toxins from the blood. With a build-up of toxins in the bloodstream, brain damage results. It is seen in patients who suffer from cirrhosis of the liver. Hepatic encephalopathy is also known as Portosystemic encephalopathy. 

Mental impairment, personality changes, and poor concentration are the key symptoms of hepatic encephalopathy.

Hepatic encephalopathy can take the form of being acute or short-term, or chronic or long-term. It is not uncommon for patients in this condition to stop responding and become comatose.

Symptoms by Grade 

Grade 0 

Mild impairments in short-term memory, focus, and reaction speed. This is recognized only by the patient or those closest to them. These can be detected through standard neuropsychological assessments.

Grade 1 

• Mild confusion or forgetfulness
• Difficulties adding and subtracting
• Mood swings, like euphoria or anxiety
• Sleeping during the day and waking at night
• Difficulties with fine motor skills, like writing

Grade 2 

• Clear personality changes
• Inappropriate or out-of-character behaviours
• Lethargy and apathy
• Disorientation in time
• Slurred speech

Grade 3 

• Slow thinking and sluggish movements
• Disorientation in space (Where am I?)
• Drowsiness and loss of general awareness
• Severe confusion, delirium or amnesia
• Involuntary twitching, tremors, or asterixis

Grade 4 

• Total loss of consciousness (coma)

Causes

Though the exact cause of this condition is yet unknown, it is set off due to a build-up of toxins in the bloodstream. This happens when the liver can no longer break down toxins. It is also set off by:

• Pneumonia
• Renal issues
• Dehydration
• Surgery or trauma
• Low oxygen levels
• Medications that quash the immune system
• Overeating protein
• Use of barbiturates or benzodiazepine tranquilizers
• Imbalance of electrolytes

Risk Factors

While undergoing treatment for hepatic encephalopathy, the mental status of some patients may not be affected. However, others may show extreme damage to the memory, despite being under treatment. Both these types of patients will experience an extreme form of this condition.

Types

Healthcare providers define different types of hepatic encephalopathy based on the original cause. 

Type A 

Type A is caused by acute liver failure. There is a sudden loss of liver function due to a sudden, severe liver injury. Viral infections, autoimmune liver disease, and acetaminophen poisoning are common causes. Cerebral edema, swelling in your brain, is a frequent side effect that may contribute to the effects of hepatic encephalopathy. Acute liver failure is an emergency, and in some cases, it may require a liver transplant. 

Type B 

Type B is caused by a portosystemic shunt. A shunt is when blood flow bypasses its normal route through a new, abnormal passageway. A portosystemic shunt is when your portal circulation bypasses your liver on its way to your systemic circulation. Your body may create a shunt if there’s a blockage in the normal pathway. 

Type C

Type C is caused by chronic liver failure. Chronic liver failure is the gradual decline of liver function from chronic liver disease. It is not reversible. Chronic hepatitis C, chronic alcohol use disorder, and metabolic dysfunction-associated steatotic liver disease (MASLD) are common causes. At this stage, extensive scarring in your liver (cirrhosis) may prevent it from working properly. Scarring may also compress your portal vein, triggering a portosystemic shunt. 

Diagnosis

The tests to diagnose hepatic encephalopathy are:

Blood Tests

Your doctor will ask for a complete report of blood count, which checks your red and white blood cells and platelets. If your red blood cell count is low, it means that there’s been some blood loss and insufficient oxygen.

With the help of the blood tests, your doctor will also check blood levels of ammonia, sodium, and potassium. If an individual consumes too much of these three substances, it could impair their regular liver functioning.

Imaging Tests

A CT scan or an MRI will check for any bleeding or abnormalities in the head and brain.

Liver Function Tests

With the results of these tests, your doctor will check for raised enzyme levels. A high level of enzymes denotes a stressed liver or already pre-existing liver damage.

If you have pre-existing liver disease, inform your doctor at this stage.

EEG 

An electroencephalogram (EEG) can detect abnormal brain activity, but it’s not specific to hepatic encephalopathy and can be used to assess the severity of the condition.  

Doppler Ultrasound 

A Doppler ultrasound uses sound waves to visualize how blood flows through your blood vessels. It can be used to look at the blood flow through your liver. 

Treatment Options

Depending on the severity of the patient’s condition and its underlying cause, your doctor will suggest treatment options.

Diet. If your doctor detects that you’ve been eating excess protein, he will ask you to cut down on your protein intake so that your symptoms don’t worsen.

You should avoid these protein foods:

• Poultry
• Fish
• Red Meat
• Eggs

Medication. With medication, the rate at which the blood absorbs toxins will slow down, so your doctor will prescribe certain antibiotics, lactulose, and a synthetic sugar. With these medicines, your body will be able to draw out ammonia and send it to your colon. Your blood will now be removed from the colon. In case you have difficulty breathing, you might be asked to wear an oxygen mask, or you might be put on a ventilator.

Preparing for Your Appointment

It can be very overwhelming and frightening to be told that you suffer from hepatic encephalopathy. Since this is a medical condition that has a direct impact on your cognitive abilities, memory, and concentration, it is advisable to bring a family member or a friend with you to the doctor’s appointment.

In a condition like Hepatic encephalopathy, it’s common for symptoms to be so small that no one really notices it. So, it’s good to have someone close to you who can help you fill in any gaps relating to your symptoms and overall medical history.

To be well-prepared for your appointment, you should come with information relating to this checklist:

• Any symptoms that you experience in recent times, and those that close friends or relatives have noticed about you
• Issues pertaining to your driving skills and job performance
• Have a ready list of all the medications you’re currently on
• Any questions you may want to ask or things you want the doctor to know

Prevention

Management of the liver is the best way of preventing liver disease. Further, hepatic encephalopathy can be prevented by following these pointers:

• Avoid alcohol completely or use it in moderation
• If you are obese, lose weight.
• Avoid fatty foods.
• Don’t accept contaminated needles.

WHY Rela Hospital

Advantages/Expertise

Dr.Rela Hospital has been set up under the leadership of a world-renowned Liver Surgery and Transplantation surgeon, Prof. Mohamed Rela.

To cater to all kinds of liver ailments and surgeries, this liver hospital in Chennai is home to one of the world’s largest dedicated liver intensive care units. It also provides primary and secondary medical care to the local people of Chennai.

The impressive Dr. Rela Hospital has been established on a 36-acre estate in Chromepet, Chennai, Tamil Nadu, India. This 450-bedded hospital comprises 130 critical-care beds, 14 operating rooms, and state-of-the-art reference laboratories and radiology services.

Top liver specialists in Chennai are empanelled here for immediate service to patients. This is an extremely beneficial service for patients of a variety of liver ailments to get state-of-the-art treatment from top-notch medical professionals. In fact, past patients recommend this hospital as the best liver transplantation hospital in Chennai, India.

Frequently Asked Questions