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Hepatic Encephalopathy

(Encephalopathy, Hepatic; Portal-Systemic Encephalopathy; Encephalopathy, Portal-Systemic)

Pronounced: HEP-at-ik En-SEF-a-lo-PATH-ee

by Nathalie Smith, MSN, RN

Home | Health Information Center | Disease, Condition, & Injury Fact Sheets | Article

Definition

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

Liver

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

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
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.

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.

RESOURCES:

National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca

Health Canada
https://www.canada.ca

References:

Bernuau J. Acute liver failure: Avoidance of deleterious co-factors and early specific medical therapy for the liver are better than late intensive care for the brain. J Hepatol. 2004;41:152-155.

Butterworth RF. Role of circulating neurotoxins in the pathogenesis of hepatic encephalopathy: potential for improvement following their removal by liver assist devices. Liver Int. 2003;23(suppl 3):5-9.

Hepatic encephalopathy. Canadian Liver Foundation website. Available at: https://www.liver.ca/patients-caregivers/liver-diseases/hepatic-encephalopathy/. Accessed February 14, 2018.

Hepatic encephalopathy. Cleveland Clinic website. Available at:
...(Click grey area to select URL)
Updated August 2017. Accessed February 14, 2018.

Hepatic encephalopathy. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated November 1, 2016. Accessed February 14, 2018.

Liere V, Sandhu G, DeMorrow S. Recent advances in hepatic encephalopathy. F1000Res. 2017;6:1637.

Lizardi-Cervera J, Almeda P, Guevara L, et al. Hepatic encephalopathy: a review. Ann Hepatol. 2003;2:122-130.

Toftengi F, Larsen F. Management of patients with fulminant hepatic failure and brain edema. Metab Brain Dis. 2004;19:207-214.

4/2/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: FDA approves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Available at:
...(Click grey area to select URL)
Updated April 24, 2013. Accessed February 17, 2014.

Last reviewed March 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 3/5/2014

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