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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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.
Factors that increase your chance of hepatic encephalopathy include: CirrhosisCertain conditions that affect the levels of fluids and electrolytes such as hyponatremia and hyperkalemiaKidney failureInfectionsGastrointestinal bleedingCertain medications such as sedatives and anti-epilepticsConstipationHepatitis—infectious or autoimmune
In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include: Changes in behavior and personalityShortened attention spanDepression
Uncontrolled movements, particularly a flapping tremor of the hands
ConfusionLoss of consciousness
If you have liver problems and any of the above symptoms, call your doctor right away.
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 testsKidney function testsImaging tests of the liver
Your brain and nervous system may be assessed. This can be done with:
Images of the brain with
CT scanElectroencephalogram (EEG) to look at brain waves for evidence of encephalopathy and/or seizuresLumbar puncture to look for other causes of the encephalopathy
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 may be used to: Neutralize toxins in the intestine, such as ammoniaRemove blood from the intestinesReduce ammonia production by intestinal bacteriaReduce the amount of ammonia producing bacteriaTreat the condition that started the encephalopathyReduce recurrence
Changes in your diet may be recommended.
Tube feeding may be needed to supply nutrients, especially in the case of coma.
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.
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. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated February 18, 2014. Accessed March 5, 2014.
Highleyman L. Hepatitis C. HCV Advocate website. Available at:
http://www.hcvadvocate.org/hepatitis/hepC/hepatic_encephalopathy.html. Published December 2002. Accessed February 17, 2014.
Juretschke L. Kernicterus: Still a concern.
Neonatal Netw. 2005;24:7-9.
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's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: FDA approves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm206104.htm. Updated April 24, 2013. Accessed February 17, 2014.
Last reviewed January 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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