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.

Risk Factors

Factors that increase your chance of hepatic encephalopathy include:

• Severe cirrhosis, especially after shunt surgery
• Hepatitis—infectious or autoimmune
• In people with chronic liver disease it may be triggered by:
  • Certain conditions that affect the levels of fluids and electrolytes such as hyponatremia and hyperkalemia
  • Gastrointestinal bleeding
  • Infections
  • Certain medications such as sedatives and anti-epileptics
  • Kidney failure
  • Constipation

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.

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
• Electroencephalogram (EEG) to look at brain waves for evidence of encephalopathy and/or seizures
• Lumbar puncture to look for other causes of the encephalopathy

Treatment

Prevention

To help reduce your chance of hepatic encephalopathy:

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