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Hepatic Encephalopathy

About Hepatic Encephalopathy (HE, Hepatic Coma)

Hepatic encephalopathy is a disorder that develops in the brain of some individuals as a result of liver disease. Reduced liver function can create disturbances in the central nervous system.

Why it is Problematic

Hepatic encephalopathy is a serious condition that has effects that may range from subtle to life threatening. Patients with hepatic encephalopathy are often unable to care for themselves. In prominent cases of hepatic encephalopathy, an individual can become unconscious, unresponsive, comatose, or may even die. The majority of individuals who go into a coma as a result of hepatic encephalopathy will die.

Causes and Risk Factors

The exact cause of hepatic encephalopathy is unknown. It may appear suddenly when liver damage occurs in individuals who had no previously known liver damage. More often, hepatic encephalopathy occurs in individuals with chronic liver disease and may be triggered by:

Bleeding from intestines, stomach, or esophagus
Dehydration
Eating too much protein
Electrolyte abnormalities
Immunosuppressant medication
Infection
Kidney problems
Low oxygen levels in the body
Surgery

Some other conditions that resemble or hide hepatic encephalopathy are:

Alcohol intoxication
Complicated alcohol withdrawal
Meningitis
Metabolic abnormalities such as low blood glucose
Sedative overdose
Subdural hematoma (bleeding under the skull)
Wernicke-Korsakoff syndrome

Symptoms

Symptoms of hepatic encephalopathy may be mild at first. They may begin slowly and gradually worsen, or they may stay the same.

Common symptoms include:

Change in sleep patterns
Change in thinking
Forgetfulness
Mental fog
Mild confusion
Musty or sweet breath
Personality or mood changes
Poor concentration
Poor judgment
Worsening of handwriting or other small movements

Severe symptoms include:

Abnormal movements (shaking hands)
Agitation, excitement, or seizures
Disorientation
Drowsiness, confusion
Inappropriate behavior
Severe personality changes
Slurred speech
Slowed or sluggish movements

Diagnosis

Doctors have many tests available to diagnose hepatic encephalopathy.

The presence of particular physical signs used in diagnosis may include:

Examining the individual for "flapping,"the flapping-like shaking of hands when the individual is trying to hold arms out and in front of the body.
Checking for signs of liver disease such as jaundice, ascites, dark urine, and musty breath.
Checking for signs of an abnormal mental state, with a focus on cognitive tasks.

Diagnostic tests may include complete blood count, liver function tests, ammonia level testing, manganese level testing, a complete metabolic panel test ( specifically sodium, potassium, BUN and creatinine) and imagining tests.

Treatment and Prevention

Hepatic encephalopathy may be considered a medical emergency, depending on the severity of the symptoms. Seek immediate medical attention if you or someone you know experiences any of the symptoms of hepatic encephalopathy. Hospitalization may be required.

Treatment will focus on the root cause of hepatic encephalopathy such as:

Treat electrolyte imbalances
Stop gastrointestinal bleeding
Support breathing and/or blood circulation
Discuss the need to take medications as prescribed such as lactulose and rifaximim
Avoid medications such as sedatives, tranquilizers, and other medications that broken down by the liver

Acute hepatic encephalopathy may be treatable. Recovery and risks will vary from patient to patient. The best course of treatment is prevention. Some ways to help prevent liver disease and damage are to:

Avoid alcohol
Avoid drugs and IV drug use
Have only protected sex
Vaccinate against hepatitis A and B
Take only medication and herbal supplements only as recommended
Avoid inhalation and skin absorption of toxins

Incidence

Hepatic encephalopathy is most often seen in people with chronic liver disease with the accumulation of toxins built up in the body if the liver is not working well. It can occur suddenly in individuals with no previous liver problems if damage to the liver occurs.

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