Hepatic Encephalopathy

Hepatic encephalopathy is a brain disorder caused due to complication in the liver. In Hepatic encephalopathy, the term Hepatic stands for "of the liver" and encephalopathy stands for "brain disorder".

Hepatic encephalopathy is most commonly observed in the patients with 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 with Hepatic encephalopathy is at a high risk of developing cerebral edema and multiorgan failure in future.

Causes and Risk factors of Hepatic Encephalopathy

The exact cause of Hepatic encephalopathy 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 Hepatic encephalopathy. In such people, Hepatic encephalopathy may be triggered by the conditions like diarrhea, 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 Hepatic encephalopathy include alkalosis, low oxygen levels, potassium deficiency caused due to medicines like diuretics, sedatives and narcotics.

Signs and Symptoms of Hepatic Encephalopathy

In the early stages of the disease mild symptoms may be observed. They include:

• Mood changes
• Behavioral changes
• Personality changes
• Drowsiness
• Decreased attention
• Difficulty in speaking
• Deterioration of handwriting
• Changes in sleeping habits

With the progression of disease, aome other symptoms of Hepatic Encephalopathy are observed, which include:

• Sleepiness
• Forgetfulness
• Confusion
• Decreased awareness
• Decreased responsiveness
• Disorientation
• Flapping tremors
• Muscle stiffness
• Seizures
• Fetor hepaticus (a musty sweet odor)
• 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.

Treatment of Hepatic Encephalopathy

The treatment of Hepatic encepalopathy depends upon the severity of the disease. The main goal of the treatment is to eliminate the cause of the Hepatic Encephalopathy and the toxic substances from the intestine. The exact cause of the disease is identified and treated.

Toxic substances are removed from the intestine by restricting a person's diet. A person may 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 fiber 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 encepalopathy require hospitalization. For proper and better breathing, 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 transplantation may also be required.