Health Talk on Hepatic

Encephalopathy

Submitted by : Aditya

Asha Tigga

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HEPATIC ENCEPHALOPATHY

Hepatic encephalopathy (HE) is a nervous system disorder brought on by severe liver disease.
When the liver doesn’t work properly, toxins such as ammonia are built up in the blood.
These toxins can travel to the brain and affect brain function. People with hepatic
encephalopathy may seem confused. This can cause physical and psychological symptoms.
Treatments can rid the body of toxins and reverse this temporary condition.

Normal values were defined as follows: ammonia 12-55 µmol/L. HE was assumed when
ammonia-levels were above (≥) the normal limit of 55 µmol/L

TYPES OF HEPATIC ENCEPHALOPATHY

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HOW HEPATIC ENCEPHALOPATHY OCCURS IN LIVER DISEASE

Healthy liver Liver disease

Ammonia
Ammonia

I can’t do
anything

Urea
Ammonia

OUT OF THE BODY

CAUSE OF HEPATIC ENCEPHALOPATHY

Patients with chronic liver disease are at risk for hepatic encephalopathy. Something usually
triggers the condition, such as:

 Alcohol use.
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  Certain drugs that affect the nervous system, such as sleeping
pills and antidepressants.
 Constipation (being unable to pass stool, or poop, normally).
 Dehydration or electrolyte imbalance.
 Digestive tract bleeding.
 Infection.
 Kidney disease.
 Liver shunt (TIPS)

SYMPTOMS OF HEPATIC ENCEPHALOPATHY

Symptoms of hepatic encephalopathy differ depending on the underlying cause of the liver
damage.

Symptoms and signs of moderate hepatic encephalopathy may include:

 Difficulty thinking
 poor concentration
 problems with handwriting or loss of other small hand movements
 confusion
 forgetfulness
 poor judgment
 a musty or sweet breath odor

Symptoms of severe hepatic encephalopathy are:

 confusion
 drowsiness or lethargy
 anxiety
 seizures
 severe personality changes
 fatigue
 confused speech
 shaky hands
 slow movements

STAGES OF HEPATIC ENCEPHALOPATHY

Hepatic encephalopathy is divided into stages based on the severity of the symptoms.

The five stages of hepatic encephalopathy, according to the West Haven Criteria, are:

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  Stage 0. At this stage, symptoms are minimal.
 Stage 1. Symptoms are mild. They may include a shortened attention span and
changes to your sleep habits, such as hypersomnia or insomnia.
 Stage 2. Symptoms are moderate. At this stage, you may feel disoriented or lethargic.
 Stage 3. Symptoms are severe. You’ll be unable to perform basic tasks. You’ll also
feel confused and experience personality changes.
 Stage 4. This stage is characterized by coma.

DIAGNOSIS OF HEPATIC ENCEPHALOPATHY

Clinical examination: Demonstrating decreased attention, altered personality and reversal of
day/night (sleep) cycle and on physical examination (asterixis)

Another type of test used to diagnose HE are brain scans.

 An electroencephalography (EEG) can detect changes in brain activity.

 Computed tomography (CT) or Magnetic resonance imaging (MRI) scans of the head
can detect bleeding or other unusual changes in the brain.

For more advanced HE

This diagnosis is based on further physical examination by a specialist. Part of the process is
to rule out symptoms that may be caused by something other than HE. Some symptoms can
be difficult to detect in a physical examination, but disorientation, dyspraxia (poor
coordination) and asterixis (involuntary flapping movements of the hands) are very often
present and usually signs of more advanced HE.

TREATMENT OF HEPATIC ENCEPHALOPATHY

Your doctor may suggest two types of drugs that reduce the toxins in your body:
Lactulose. This is a type of sugar that can make you have more bowel movements. This
helps get rid of some toxins from your body, like ammonia, which can trigger HE. Your
doctor or nurse will explain how to figure out the right amount.
For example, you will need to adjust your dose until you are having 2 to 3 bowel movements
a day.
Antibiotics. Drugs like neomycin (Neo-Fradin) and rifaximin (Rifagut, Xifaxan) may help.
They curb bacteria that create toxins when they digest your food.
Your doctor may also ask you to take some other steps that can improve your symptoms:
Change diet. If you eat a lot of meat, your body may make too much ammonia. Your doctor may
ask you to cut back, but you still need to get enough protein from other sources. Try dairy and
veggies. Also eat frequent small meals rather than three big ones a day.

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Treat infections. They can affect the way your liver works. You may need antibiotics to get rid
of them.
Treat urinary blockages. If you can't pee normally, it can trigger your HE. Treatment for the
infection or disease that's causing it can help.
Stop some medications. Certain medicines, such as sedatives or narcotics, may cause problems
with your liver. (don’t take medication without doctor’s prescription
Treat constipation. You may need to eat less meat and more vegetables. This can help you have
more regular bowel movements so you can flush toxins from your body.
Keep yourself hydrated
Look for the signs of GI bleeding.

PREVENTION OF HEPATIC ENCEPHALOPATHY

Proper management and treatment of liver disease is key to lowering the chances of
developing hepatic encephalopathy. These steps can lower the risk:

 Avoid alcohol, which damages liver cells.

 Avoid medications that affect the nervous system, such as sleeping pills and
antidepressants.
 Eat a nutritious diet, exercise and maintain a healthy weight (especially important if
you have fatty liver disease).
 Take your prescribed medications to treat liver disease.
 Undergo regular liver function tests.
 Take precaution for Viral hepatitis.

COMPLICATION OF HEPATIC ENCEPHALOPATHY

Complications that may be irreversible include:

 brain herniation
 brain swelling
 organ failure

DIET
 Protein consideration – When proteins break down, they release toxins such as
ammonia. A diseased liver is unable to do a complete breakdown which leads to
confusion and disorientation. Therefore a low-protein diet is strongly recommended.
Lean protein sources such as chicken (without skin) and fish are suggested.
 Reducing salt levels – A diseased liver can lead to fluid accumulation in which case
salt intake needs to be reduced. This can be done by consuming fresh whole foods
instead of packaged and processed foods as they contain a lot of salt.
 Limit carbohydrates – Excess of carbohydrates is known to deposit fatty layers on
the liver which interfere with its functioning. It is advised to avoid white-flour foods
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 and sugary drinks and increase the consumption of whole grains, fruits and
vegetables.

DIET RESTRICTIONS: FOOD ITEMS TO LIMIT IN HEPATIC

ENCEPHALOPATHY

1. Saturated fats found in butter, sour cream, and other high-fat dairy foods, fatty cuts
of meat, and fried foods
2. Sugary treats like cookies, cake, soda, and packaged baked goods
3. Foods heavily laced with salt
4. Alcohol

DO'S AND DONT'S WHILE FOLLOWING DIET PLAN FOR

HEPATIC ENCEPHALOPATHY

To control hepatic encephalopathy, you can start making some simple changes in your
lifestyles and food habits which are mentioned below, along with the diet plan for hepatic
encephalopathy mentioned above:

Do's & Dont's

1. Avoid drinking alcohol. It damages liver cells and even a small amount can be
harmful. The best thing to do is avoid alcohol completely.
2. Get your protein from vegetables and dairy products, rather than meat.
3. Eat small, frequent meals to avoid long periods of fasting.
4. Maintain a healthy caloric intake.
5. Generally, between 1800 and 2400 calories for women and between 2000 and 3200
for men
6. Eat whole grain breads and cereals.
7. Eat at least 5 servings of fruits and vegetables a day; eating things of varying colors
can provide a range of nutrients.
8. Limit your intake of salty, sugary and fatty foods.
9. Drink enough fluids (generally 6-8 glasses day). In addition to water, you can
include juice, tea, milk, soup, and frozen fruit bars.

FOOD ITEMS YOU CAN EASILY CONSUME IN HEPATIC

ENCEPHALOPATHY
1. Coffee : Drinking coffee may also reduce the risk of developing a common type of
liver cancer, and it has positive effects on liver disease and inflammation
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2. Tea : Drinking 5–10 cups of green tea per day was associated with improved blood
markers of liver health.

3. Grapefruit :The protective effects of grapefruit are known to occur in two ways —
by reducing inflammation and protecting cells. Blueberries and Cranberries :
Consuming these fruits for 3–4 weeks protected the liver from damage. Grapes :
They lower inflammation, prevent damage and increase antioxidant levels. Beetroot
Juice : It reduces oxidative damage and inflammation in the liver, as well as
increases natural detoxification enzymes. Cruciferous Vegetables : Cruciferous
vegetables like Brussels sprouts, broccoli and mustard greens are known for their
high fiber content and distinctive taste. Nuts are high in fats, nutrients including the
antioxidant vitamin E which is beneficial for liver health. Fatty Fish : The fats
found in fatty fish are beneficial for the liver, as well.