Definition

Hepatic encephalopathy is a problem with the brain in people who have liver disease. The problem may be temporary or permanent.

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Causes

A diseased liver 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 as it should.

Risk Factors

This problem is more common in people with:

• Severe cirrhosis, especially after shunt surgery
• Hepatitis—infectious or autoimmune

In these people, it may be triggered by:

• Problems that affect the body's levels of fluids and electrolytes, such as hyponatremia and hyperkalemia
• Bleeding in the stomach and intestines
• Infection
• Certain medicines, such as sedatives and anti-epileptics
• Kidney failure
• Constipation

Symptoms

There may not be symptoms in the early stages. As the disease gets worse, problems may be:

• Problems sleeping
• Tiredness
• Lack of focus
• Memory problems
• Confusion
• Movements that cannot be controlled, such as a flapping tremor of the hands
• Slurred speech
• Changes in behavior and personality
• Depression or anxiety
• Loss of alertness

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. Your blood will be tested to find out how well your liver and kidneys are working.

There are no specific tests to diagnose this health problem. Tests will be done to look for other health problems that may be causing your symptoms.

Images of the brain will be taken. This can be done with:

• CT scan
• MRI scan

Treatment

The goal of treatment is to lower the amount of toxins in the blood. Options are:

Prevention

To lower the risk of this health problem:

• Manage chronic liver problems.
• Limit or avoid alcohol to improve liver health.
• Take medicines as advised.
• Avoid being exposed to poisons or toxins.
• Do not use illegal drugs.