Hepatic Encephalopathy: Prognosis and Management


Well, for people not into the medical field some words sound like they are from another planet. But the truth is that it’s quite easy to guess what some of these big words mean. For instance, anytime you see the word “derma” you know it has something to do with the skin. And anytime you see the word “hepatic” you automatically know it has something to do with the liver. You might not be sure of the exact nature of the condition. But at least you have an idea of what organ is affected. Talking about big names we have one and it’s hepatic encephalopathy. We will take a look at what this condition is all about. And also hepatic encephalopathy prognosis.

The truth is that for every disease condition the prognosis differs. For conditions that are very severe, it’s a given that the prognosis wouldn’t be so good. And for conditions that are quite mild, you can expect a good prognosis. Given that the management method works the prognosis is expected to be good. But then again this is affected by so many factors. So we can’t make a general rule that is definite as to prognosis of different conditions. But for today we have the prognosis of hepatic encephalopathy. If you want to find out a lot more then keep scrolling.

What is Hepatic Encephalopathy?

What is Hepatic Encephalopathy?

So hepatic encephalopathy is actually a condition that affects the brain. This condition develops in people that have a liver problem. Hepatic encephalopathy is one complex condition. And it encompasses a lot from no sign of sign a symptom to the severe type that is life-threatening.

This condition can happen in people that have acute or chronic liver diseases. It can also happen in people that don’t have liver disease. Like people that had their liver bypassed by a portosystemic shunt. This shunt is a shunt that allows the passage of blood from the GI tract bypassing the liver.

Also, this condition can be present at birth or can be acquired later on in life. Hepatic encephalopathy happens when toxins that are normally removed from the body accumulate in the liver. In the end, they end up going into the brain. The good thing is that if it’s detected early it can be reversible and treated.

We actually have different types of hepatic encephalopathy. We have the chronic and the acute type. Let’s take a look at both of them.

Acute hepatic encephalopathy is actually as a result of severe liver disease. And it could occur in people with the following conditions.

  • Toxic hepatitis: This is actually caused by exposure of the liver to too much alcohol, drugs, chemicals and even supplements.
  • Acute fulminant viral hepatitis: This is actually a severe type of hepatitis, viral hepatitis to be precise. And it doesn’t develop over time, it comes suddenly.
  • Reye’s syndrome: A rare and serious condition that is mostly seen in children. It causes inflammation and swelling of the liver as well as the brain.

Chronic hepatic encephalopathy comes in two forms. It can either be permanent or recurrent.

Recurrent type is associated with different episodes. This type requires continuous treatment to prevent the development of the symptoms. They are often seen in patients with cirrhosis or scarring of the liver.

Permanent cases are quite rare and in people that don’t respond to the treatment given. And also in patients that have neurological conditions like spinal cord injury and seizure disorder.

Some of the symptoms of this condition are:

  • Shortened attention span
  • Reduced alertness
  • Disruption in sleep pattern
  • Personality changes
  • Slow in performing mental tasks
  • Mild confusion.
  • Changes in memory
  • Confusion
  • Slurred speech
  • Lethargy
  • Lack of restraint


When trying to manage a patient with hepatic encephalopathy, the approach is based on the mental status changes of the patient. And also the presence of comorbidities. All these would guide you as to the management. For instance, a patient that has cirrhosis and has mild complaints of lack of concentration would need an empiric trial. The patient can be given lactulose or rifaximin. And then you would ask the patient to come back for follow-up. But this is not the approach you will use for a patient in a hepatic coma due to GI bleeding.

But then again there are general management recommendations that you can try out. And they are:

  • You have to first remove non-hepatic causes of altered mental function
  • Then you have to correct the precipitants of hepatic encephalopathy such as metabolic disturbances, infection, gastrointestinal bleeding and constipation
  • Avoid medications that would cause further damage to the central nervous system most especially narcotics and benzodiazepines
  • Give patients that have severe agitation together with hepatic encephalopathy haloperidol, this would serve as a sedative
  • For patients that have alcohol withdrawal and hepatic encephalopathy treating may not be so easy, so you might have to give benzodiazepines together with lactulose as well as other medications for the condition
  • For patients with the risk of aspiration you have to consider prophylactic endotracheal intubation


As mentioned earlier, hepatic encephalopathy is a complex condition. And when a patient develops this condition it has a negative impact on the survival of the patient. With this condition, it’s quite severe so it would most likely lead to the hospitalization of the patient.

The survival probability of the patient is around 42% at 1 year and 23% after 3 years. According to statistics, about 30% of patients with end-stage liver disease have severe encephalopathy. And this could lead to a coma.

That’s why it’s important that you go see a doctor as soon as you experience any of the signs and symptoms. If detected early, you can be sure of a better prognosis. So what are you still waiting for, book an appointment with your doctor.

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