What Is Hepatic Encephalopathy?

Overview

Hepatic encephalopathy can occur when your liver stops filtering toxins from your blood.
Hepatic encephalopathy can occur when your liver stops filtering toxins from your blood.

Hepatic encephalopathy (HE) is a condition that can happen when your liver stops filtering toxins (poisons) out of your blood like it should. When your liver can’t do its job, those poisons build up in your body and hurt your brain. This can cause problems with your movement, thinking, and mood. Here is information that can help you understand what HE is and what you need to do if you have it.

Hepatic Encephalopathy Causes

The most common cause of HE is advanced liver disease (cirrhosis). You may have cirrhosis because of another disease, a genetic condition, an infection like hepatitis, or chronic alcoholism. Nearly 70% of people with cirrhosis show signs of HE.

It’s also possible to get HE because of a problem with blood vessels around your liver. If they don’t send blood through your liver but around it, toxins go to your brain. This might happen because of high blood pressure in these vessels. You may also have a shunt (a new pathway for blood) near your liver. You could have been born with an abnormal pathway in the blood vessels to your liver. Or your doctor may have needed to create one to relieve high blood pressure in that area.

Doctors don’t know all the ways that HE harms your brain. But the buildup of ammonia plays a big part. Ammonia is very toxic to brain cells.

Hepatic Encephalopathy Symptoms

HE can come on slowly. You may not have any symptoms at first, even though your liver isn’t filtering toxins. Once symptoms occur, they can be mild or severe.

Symptoms of early-stage HE can be hard to spot but may include:

  • Small changes in personality
  • Trouble with multi-step thinking
  • Slightly shorter attention span
  • Delayed reaction time
  • Sleeping a lot or trouble sleeping
  • Depression
  • Irritability

Once HE gets worse, the symptoms become more obvious. They include:

  • Drowsiness
  • Trouble caring about people or things
  • Slurred speech
  • Not being able to hold your hands steady when you stretch out your arms (asterixis)
  • Very different personality
  • Strange behavior
  • Difficulty with time
  • Problems with many mental tasks
  • Jerking motions in response to sudden noise, light, or movements (myoclonus)
  • Sweet-smelling breath

Once HE is severe, symptoms include:

Even with treatment, coma from HE often leads to death.

Diagnosing Hepatic Encephalopathy

To find out if you have HE, your doctor will look at your symptoms and ask about your medical history. If you have liver disease, the most common cause of HE, the doctor will also ask about habits or illnesses that might trigger HE, such as:

  • Infection
  • Not taking a prescription correctly
  • Bleeding in your digestive tract
  • Eating too much red meat
  • Not getting enough water (dehydration)
  • An imbalance in your body’s electrolytes
  • Drug or alcohol abuse

Your doctor will give you a blood test to check for infection or other disorders that could be causing HE. The lab results can also tell your doctor how much ammonia is in your blood. A mental status test can help your doctor see if you have any changes to your brain. You may also have a test called an electroencephalogram (EEG) to look at your brain activity. This could tell your doctor there’s a problem with your brain function, but you’ll need other tests to know whether HE caused the problem. In severe cases, the doctor might order a scan to look for swelling in the brain.

Hepatic Encephalopathy Treatments

Your treatment will depend on what caused your liver to stop working. You may need:

  • Medicine to get rid of infection
  • Surgery to stop bleeding
  • Treatment for your kidneys
  • A medication switch

Once your doctor has dealt with the underlying cause, you’ll also need treatment for the extra ammonia and other toxins in your blood. Your doctor will give you a lab-made sugar (lactulose) to help flush toxins out in your stool. You’ll also take antibiotics to stop the growth of certain toxin-making bacteria.

If your liver has stopped working and treatments are not helping, you may need a liver transplant. You can get a liver from someone who has died. You can also get part of a liver from a living donor.

You may only need treatment for a while before your HE gets better. However, once symptoms are severe, you’re at risk of more serious problems that can lead to coma and death. If you have a chronic liver problem, you’ll likely have HE several times and need to treat it in the future. With the right treatment, and if you catch your HE early, you can reverse it completely, especially if you can take away the cause completely.

References
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American Liver Foundation: “Hepatic Encephalopathy Information Center.”

Merck Manual: “Hepatic Encephalopathy.”

Mayo Clinic: “Cirrhosis.”

Medscape: “Hepatic Encephalopathy.”

National Organization for Rare Disorders: “Hepatic Encephalopathy.”
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