Hepatic Encephalopathy

(Encephalopathy, Hepatic; Portal-Systemic Encephalopathy; Encephalopathy,

Portal-Systemic)
Pronounced: MET-a-bol-ik En-SEF-a-lo-PATH-ee
by Nathalie Smith, MSN, RN
En Espaol (Spanish Version)

Definition
Hepatic encephalopathy refers to brain dysfunction due to liver disease. The brain dysfunction may be temporary
or permanent. People with cirrhosis, a liver disease, are most commonly affected.
Oxygen and Blood Flow to the Brain

If the liver is not working properly, toxins can build up in the blood. The toxic blood travels to the brain, affecting
the brain's ability to function.
2011 Nucleus Medical Media, Inc.

Causes
This condition happens because the diseased liver can no longer filter toxins from the body. In some cases, the
liver has too much scar tissue, and blood has to be re-routed around the liver. Toxins, like ammonia, build up,
affecting the brains ability to function.
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Risk Factors
These factors increase your chance of developing metabolic encephalopathy:
Certain conditions that affect the levels of fluids and electrolytes (eg, hyponatremia, hyperkalemia)
Kidney failure
Infections
Gastrointestinal bleeding
Certain medicines (eg, sedatives, anti-epileptics)
Constipation
Cirrhosis
Hepatitis (infectious or autoimmune)
Tell your doctor if you have any of these risk factors.

Symptoms
In the early stages, there may not be any symptoms. As the condition progresses, symptoms may include:
Changes in behavior and personality
Shortened attention span
Depression and anxiety
Insomnia
Fatigue
Forgetfulness
Disorientation
Slurred speech
Tremor (particularly a flapping tremor of the hands)
Asterixis (rapid momentary loss of tone in the muscles)
Confusion
Stupor orcoma
These problems can develop quickly. They may resolve when the condition is reversed. But, prompt treatment is
needed before a coma occurs.

Diagnosis
This condition is potentially very serious. It can quickly become an emergency. You may need to be hospitalized.
Doctors will do an exam to assess your neurological condition. The following tests may be done:
Liver function tests
Kidney function tests
MRI scan a test that uses magnetic waves to make pictures of structures inside the brain
CT scan a type of x-ray that uses a computer to make pictures of structures inside the brain
Imaging tests of the liver (may be done)

Treatment
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Hospitalization and Emergency Care

In the hospital, the staff will treat and try to reverse the underlying problem. They will try to remove or neutralize
toxins that have built up in the blood.

Medications
Medications may be used to:
Neutralize toxins
Treat the condition
Reduce recurrence
A common medicine used is called lactulose. This is a type of sugar that the body cannot digest. It may help to
reduce how much ammonia your body produces.

Dietary Restrictions
You may need to eat a low-protein diet to help lower blood ammonia levels. (The body creates ammonia when it
metabolizes and uses protein.) You may have other changes in your diet.
Tube feeding and life support may be needed, especially in the case of coma.

Transplantation
If this condition is due to liver failure, you may need a transplant.

Prevention
To help reduce your chance of getting this condition, take the following steps:
Get early treatment for liver problems. If you have liver problems and any of the above symptoms, call your
doctor right away.
If you have a disease (such as cirrhosis), see your doctor regularly.
Avoid overdosing. Avoid being exposed to poisons or toxins.
RESOURCES:

National Digestive Diseases Information Clearinghouse

http://digestive.niddk.nih.gov/index.htm/
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/
CANADIAN RESOURCES:

Canadian Liver Foundation

http://www.liver.ca/Home.aspx/
Health Canada
http://www.hc-sc.gc.ca/index_e.html/
REFERENCES:

Bernuau J. Acute liver failure: avoidance of deleterious co-factors and early specific medical therapy for the liver
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are better than late intensive care for the brain (review). J Hepatol . 2004;41:152-155.
Butterworth RF. Role of circulating neurotoxins in the pathogenesis of hepatic encephalopathy: potential for
improvement following their removal by liver assist devices. Liver Int . 2003;23(suppl 3):5-9. Review.
DynaMed Editorial Team. Hepatic encephalopathy. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php . Updated July 22, 2010. Accessed August 3, 2010.
Highleyman L. Hepatitis C. HCV Advocate website. Available at: http://www.hcvadvo... . Published December
2002. Accessed August 3, 2010.
Juretschke L. Kernicterus: still a concern. Neonatal Netw . 2005;24:7-9.
Lizardi-Cervera J, Almeda P, Guevara L, et al. Hepatic encephalopathy: a review. Ann Hepatol . 2003;2:122-130.
Review.
Siegal GJ, Agranoff BW, Albers RW, Uhler MD. Metabolic encephalopathies. In: Basic Neurochemistry:
Molecular, Cellular, and Medical Aspects. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Toftengi F, Larsen F. Management of patients with fulminant hepatic failure and brain edema. Metab Brain Dis .
2004;19:207-214.
4/2/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : FDA
approves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Available
at: http://www.fda.gov... . Published March 24, 2010. Accessed April 2, 2010.

Last reviewed September 2011 by Marjorie Bunch, MD

Last Updated: 9/1/2011

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