What is Hepatic Encephalopathy and How Does it Develop?


What is hepatic encephalopathy? This is a medical term that describes the reduction in the functioning of the brain that is an effect of chronic liver disease. The liver of those with this condition is unable to remove toxins and waste from the blood resulting in an accumulation of these toxins in their bloodstream. This can eventually damage the brain. Hepatic encephalopathy comes in two forms, it is either an acute case or a chronic case. It has been recorded that some hepatic encephalopathy patients became unresponsive to treatment and went into a coma.

An acute type of hepatic encephalopathy occurs in those with severe disease of the liver. And this is often seen in people suffering from any of the following conditions; acute fulminant viral hepatitis, viral hepatitis which occurs suddenly. Reye’s syndrome, a rare condition that is majorly diagnosed in children. Reye’s syndrome causes inflammation and swelling of the brain and liver. The third condition where acute hepatic encephalopathy can occur is in toxic hepatitis, which is caused by alcohol, drugs, supplements, or chemicals.

What Is Hepatic Encephalopathy

As already mentioned, hepatic encephalopathy is a condition that happens due to brain function decline. Oftentimes this signals to liver failure especially its acute type.

The chronic type of hepatic encephalopathy can be recurrent or permanent. If it’s recurrent then the patient will be subjected to multiple hepatic encephalopathy episodes as long as they live. These patients will also need continuous treatment so as to prevent the symptoms from developing. You will most likely see recurrent cases amongst individuals with scarred liver or severe cirrhosis.

It is rare to find a permanent case but it occurs only in unresponsive patients and those who already have any permanent neurological condition like an injured spinal cord or seizure disorder.

Hepatic Encephalopathy Symptoms

The symptoms of this disease differ among patients as it depends on what caused the damage to the liver. Here are some of the signs and symptoms that may be observed in a moderate case of hepatic encephalopathy;

  • Personality changes
  • Difficulty in thinking
  • Poor concentration
  • Handwriting problems or hand movements issues
  • Forgetfulness
  • Confusion
  • A sweet or musty breath odor
  • Poor judgment

For a severe case of hepatic encephalopathy these may be observed;

  • Lethargy or drowsiness
  • Fatigue
  • Anxiety
  • Seizures
  • Slow movements
  • Shaky hands
  • Serious personality changes
  • Confused speech
  • Confusion

If you have any of these severe signs please get urgent medical attention. The person may go into a coma if treatment is not quickly administered.

How Is It Developed

Nothing can be pinpointed as the cause of this condition, hepatic encephalopathy because its cause is yet to be discovered. However, the buildup or accumulation of toxins inside the blood usually triggers it and is a result of the liver’s failure in properly breaking down toxins.

The liver is made to dispose of the body of toxic chemicals like ammonia. Toxic chemicals or toxins are the leftovers of protein metabolism by different body organs. The kidneys contribute to their excretion by changing them into safer or less harmful substances that are eventually excreted via urine.

A damaged liver is unable to perform its part so the toxins remain unfiltered. These toxins continue to move freely in the blood as they increase in their number and then move into the brain. Other nerves and organs may also get damaged by these toxins.

Triggers of hepatic encephalopathy include;

  • Kidney problems
  • Infections like pneumonia
  • Dehydration
  • Medications that cause immune system suppression
  • Low amount of oxygen or hypoxia
  • Eating excess protein
  • Trauma or recent surgery
  • Tranquilizers, benzodiazepine, barbiturates and other medications that cause the central nervous system to be suppressed
  • Imbalanced electrolyte a particularly low amount of potassium which is often experienced when on diuretics or after vomiting.

Diagnosis of Hepatic Encephalopathy

There are several tests that are used in diagnosing this disease.

  • Blood tests: This test would check the white and red blood cells and also the platelets. Low oxygen and loss of blood are usually indicated through this test. It can also serve to check the amount of potassium, ammonia, and sodium in the blood. If these substances are high then that shows the liver function is impaired.
  • Imaging tests: An MRI or Ct imaging test can be conducted to check if there is bleeding In the head or for the presence of any brain abnormality.
  • Tests for liver function: High levels of enzymes will be detected through this test proving that the liver is under stress or is damaged.

If the person already has liver or kidney disease, the doctor should be informed as it will be helpful in diagnosing hepatic encephalopathy without even requiring many tests.

Are There Treatments?

The available treatment for this condition depends on the cause and its severity.

If excess consumption of protein was the cause then the patient will be told to consume less protein. Since the body needs protein in order to carry out its function properly, the person will need the help of a doctor or dietitian to plan a diet. This diet will accommodate just the amount of protein that would not worsen the symptoms.

Examples of food with high protein that should be avoided are red meat, poultry, fish, and eggs.

There are also some medications that can help to reduce the rate of toxin absorption by the blood. Doctors do prescribe lactulose and antibiotics both of which can withdraw ammonia away from the blood into the colon.

Have in mind that more research is still being carried out on this disease to find its cure and advanced treatment. While we wait for their result it is good that we know what is hepatic encephalopathy and can comfortably explain it to others.

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