(Encephalopathy, Hepatic; Portal-Systemic Encephalopathy; Encephalopathy, Portal-Systemic)
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:
Severe cirrhosis, especially after shunt surgery
- Hepatitis—infectious or autoimmune
- In people with chronic liver disease it may be triggered by:
- Certain conditions that affect the levels of fluids and electrolytes such as hyponatremia and hyperkalemia
- Gastrointestinal bleeding
- Certain medications such as sedatives and anti-epileptics
- Kidney failure
In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include:
- Changes in behavior and personality
- Shortened attention span
- Slurred speech
Uncontrolled movements, particularly a flapping tremor of the hands
- Loss 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 tests
- Kidney function tests
- Imaging tests of the liver
Your brain and nervous system may be assessed. This can be done with:
Hospitalization and Emergency Care
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 ammonia
- Remove blood from the intestines
- Reduce ammonia production by intestinal bacteria
- Treat the condition that started the encephalopathy
- Reduce 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.
National Digestive Diseases Information Clearinghouse
National Institute of Neurological Disorders and Stroke
Canadian Liver Foundation
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EBSCO Medical Review Board Rimas Lukas, MD
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