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Hepatic Encephalopathy

Brain dysfunction caused by toxins entering the bloodstream in liver failure.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Hepatic Encephalopathy?

Hepatic encephalopathy (HE) is a neuropsychiatric disorder that develops when neurotoxic substances, primarily ammonia, reach the brain in the setting of severe liver failure or portosystemic shunting. It occurs in acute liver failure or as episodic attacks superimposed on chronic liver disease (cirrhosis).

It is graded by the West Haven criteria from Grade 1 (mild inattention) to Grade 4 (coma). Covert HE is mild cognitive impairment that cannot be detected on standard neurologic examination but is revealed by psychometric testing, and affects driving performance and daily functioning.

Triggers include gastrointestinal bleeding, infection, constipation, dehydration, electrolyte abnormalities, and excessive protein intake. Correction of the trigger and reduction of ammonia levels form the basis of treatment.

Symptoms

Inattention and difficulty concentrating (early stage)
Disturbed sleep pattern (daytime sleep, nighttime wakefulness)
Personality and behavioral changes
Hand tremor (flapping tremor / asterixis)
Speech disturbance and confusion
Confusion and loss of orientation (severe stage)
Coma (Grade 4)

Risk Factors

Liver cirrhosis
Gastrointestinal bleeding
Infection (spontaneous bacterial peritonitis, urinary infection)
High-protein diet
Constipation
Diuretic-induced dehydration and electrolyte abnormalities
Sedative and opioid drug use

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If behavioral change or confusion develops in a patient with cirrhosis
  • When hand tremor or fluctuating consciousness is present
  • When gastrointestinal bleeding or infection occurs in a cirrhotic patient
  • When sleep disturbance and inattention have begun in a liver patient

Treatment Methods

01
Identification and correction of triggers (bleeding, infection, electrolyte disturbance)
02
Lactulose: accelerates bowel transit and reduces ammonia absorption (target of 2-3 soft stools per day)
03
Rifaximin: non-absorbable antibiotic that can be added to lactulose or used for relapse prevention
04
Adequate protein intake (rich in branched-chain amino acids): protein restriction is no longer recommended
05
Zinc supplementation (if deficient)
06
TIPS evaluation in recurrent HE (reduction of shunt volume)

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.