Hepatic Encephalopathy

Introduction of Hepatic Encephalopathy

Hepatic encephalopathy is a brain disorder caused due to a complication in the

liver. The term hepatic stands for "of the liver" and encephalopathy stands for
"brain disorder."
Hepatic encephalopathy is most commonly observed in patients of cirrhosis. It
occurs when the toxic substances, which are normally removed by the liver,
accumulate in the blood and reach the brain. This is caused due to liver
impairment and is marked by a disturbance in mental functioning. A person
affected by this condition is at a high risk of developing cerebral edema and multiorgan failure.

Causes of Hepatic Encephalopathy

The exact cause this condition is not known, but it is considered to be caused by
the disorders affecting the liver. It can also be caused due to an increased
amount of ammonia and other harmful substances in the blood. People with liver
disorders like cirrhosis or hepatitis are most likely to develop this disorder. In
such people, it might be triggered by the conditions like diarrhoea, constipation,
gastrointestinal bleeding, vomiting, bacterial or viral infection and high protein
intake.
It may also be triggered due to excessive alcohol consumption. Other conditions
that may cause this condition include alkalosis, low oxygen levels, potassium
deficiency caused due to medicines like diuretics, sedatives and narcotics.

Symptoms of Hepatic Encephalopathy

Mild symptoms might be observed in the early stages of Hepatic
encephalopathy. These include:
Mood changes
Behavioural changes
Personality changes
Drowsiness
Decreased attention
Difficulty in speaking
Deterioration of handwriting
Changes in sleeping habits

With the progression of disease, some other symptoms might be observed. These
include:
Sleepiness
Forgetfulness
Confusion
Decreased awareness
Decreased responsiveness
Disorientation
Flapping tremors
Muscle stiffness
Seizures
Fetor hepaticus (a musty sweet odour)
Coma

Diagnosis of Hepatic Encephalopathy

The diagnosis of hepatic encephalopathy is done on the basis of physical

examination, mental status examination, electroencephalography, medical
history and blood tests

The treatment depends

upon the
of Encephalopathy
the disease. The main goal of the
Treatments
of severity
Hepatic
treatment is to address the underlying cause, and eliminate the toxic substances
from the intestine. Toxic substances are removed from the intestine by restricting
a person's diet. The affected person might be asked to reduce protein intake in
order to lower ammonia production. Instead, he may be asked to increase the
amount of vegetable protein so that he gets adequate protein, but without
worsening the condition.
Carbohydrates that are given either orally or intravenously serve as the main
source of calories. A person may also be asked to eat the vegetables high in fibre
content. This helps in speeding up the passage of food through intestine, altering
the intestinal acidity and thereby reducing the absorption of ammonia.
Lactulose may be given orally to acidify the ammonia in the colon and form the
ammonium that can be easily excreted. It is used as a laxative for evacuating
blood from intestines and for reducing ammonia production by intestinal bacteria.
Gastrointestinal bleeding should also be controlled.
Medications may also be provided to increase bowel movements to reduce the
absorption of toxins and ammonia from the blood.
Severe cases of hepatic encephalopathy usually require hospitalisation. For
proper and better intake of oxygen, ventilator may be used. Artificial liver support
may also be used to clean the blood. Your blood is passed through a special filter
and this filtered blood is returned to you. Sometimes, a surgery or liver