(Encephalopathy, Hepatic; Portal-Systemic Encephalopathy; Encephalopathy, Portal-Systemic)
How to Say It: HEP-at-ik En-SEF-a-lo-PATH-ee
by Cynthia M. Johnson, MA
Hepatic encephalopathy is a problem with the brain in people who have liver disease. The problem may be temporary or permanent.
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.
This problem is more common in people with:
In these people, it may be triggered by:
There may not be symptoms in the early stages. As the disease gets worse, problems may be:
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:
The goal of treatment is to lower the amount of toxins in the blood. Options are:
Initial care will be needed to find and correct any underlying health problems that are causing symptoms. This may mean removing or neutralizing toxins in the blood.
Medications may be used to:
Dietary changes may be needed. For example, tube feeding may be used to improve nutrition.
If this problem is due to liver failure, a liver transplant may be needed.
To lower the risk of this health problem:
National Digestive Diseases Information Clearinghouse
National Institute of Neurological Disorders and Stroke
Hepatic encephalopathy. Canadian Liver Foundation website. Available at: https://www.liver.ca/patients-caregivers/liver-diseases/hepatic-encephalopathy. Accessed July 21, 2021.
Hepatic encephalopathy. Cleveland Clinic website. Available at:
...(Click grey area to select URL)
Accessed July 21, 2021
Hepatic encephalopathy. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hepatic-encephalopathy. Accessed July 21, 2021.
Liere V, Sandhu G, et al. Recent advances in hepatic encephalopathy. F1000Res. 2017;6:1637.
Liotta EM, Kimberly WT. Cerebral edema and liver disease: classic perspectives and contemporary hypotheses on mechanism. Neurosci Lett. 2020;721:134818.
Last reviewed July 2021 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 7/21/2021
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
To send comments or feedback to our Editorial Team regarding the content please email us at email@example.com. Our Health Library Support team will respond to your email request within 2 business days.