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Hepatic encephalopathy is a complication of liver disease that occurs when blood flow bypasses the liver and enters into the rest of the circulation. This unfiltered blood carries high levels of ammonia which enters the brain and affects normal function. This effect on the brain is seen as an altered level of consciousness, altered intellectual function or changes in personality/behavior. Muscle and reflex abnormalities are also present. These changes can range from mild to severe and can lead to coma and death.
Symptoms may begin slowly and slowly get worse. They may also begin suddenly and be severe from the start.
Early symptoms may be mild and include:
More severe symptoms may include:
Patients are often not able to care for themselves because of these symptoms.
Hepatic encephalopathy can be a medical emergency that requires a hospital stay.
The first step is to identify and treat any factors that may have caused hepatic encephalopathy.
Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Infections, kidney failure, and electrolyte abnormalities (especially potassium) need to be treated.
Life support may be necessary to help with breathing or blood circulation, particularly if the person is in a coma. The brain may swell, which can be life-threatening.
If the problem is very bad, you may need to cut down the protein in your diet. However, too little protein can cause malnutrition, so you should talk to a dietitian about how to change your diet. People who are very ill may need intravenous or tube feedings.
You may be given lactulose to prevent intestinal bacteria from creating ammonia and to remove blood from the intestines. You may also get neomycin to reduce ammonia production by intestinal bacteria. Rifaximin, a new antibiotic, is also effective in hepatic encephalopathy.
You may need to avoid sedatives, tranquilizers, and any other medicines that are broken down by the liver. Medicines containing ammonium (including certain antacids) should also be avoided. Your doctor may suggest other medicines and treatments. These may have varying results.
