Hepatic Encephalopathy

What is hepatic encephalopathy?

Hepatic (he-PAT-ik) encephalopathy (en-sef-ah-LOP-ah-the) is a condition affecting your brain due to liver disease. One of the functions of the liver is to clean blood coming from the gastrointestinal system. The gastrointestinal system includes your stomach and the intestines. Blood from the gastrointestinal system often contains ammonia and toxins made by intestinal bacteria (germs). Normally, the blood is cleaned in the liver by turning these harmful substances into less harmful products. The clean blood then goes to the lungs to get oxygen before going to the heart. The heart then pumps the blood to all parts of the body, including the brain.

With this condition, there may be a problem in the blood flow into the liver. This happens when blood does not easily go into the liver because of liver disease. When blood cannot flow into the liver, it uses other blood vessels to return to the heart. This then leaves the blood uncleaned of harmful substances, including ammonia. The function of the liver to convert ammonia in blood may also be decreased in liver disease. Ammonia and other harmful substances may go into the brain and damage brain cells. This may affect many of the brain's important functions that could cause even more problems to your body. Early treatment is needed to reverse the damaging effects of this condition and restore proper brain function.

What causes hepatic encephalopathy?

Hepatic encephalopathy is caused by an increased amount of ammonia and other harmful substances in the blood. These substances are often found in high amounts when you have cirrhosis of the liver. Cirrhosis is a condition where damaged liver cells lead to scarring of liver tissue. Many things that occur in people with cirrhosis may increase the risk for hepatic encephalopathy. These may include any of the following:

• Diarrhea (loose bowel movements), constipation (dry hard bowel movements), and vomiting (throwing up).
  
  
• Gastrointestinal bleeding.
  
  
• High protein diet.
  
  
• Infections by germs called bacteria or viruses.
  
  
• Medicines, such as sedatives and diuretics (water pills).

What are the signs and symptoms of hepatic encephalopathy?

There may only be mild symptoms early in the disease. These may include mood changes, a short attention span, and drowsiness. Changes in sleeping habits and difficulty in speaking or writing may occur. As this condition worsens, there may be confusion and amnesia (inability to recall past events). The breath may have a musty sweet odor. Flapping motion of the hands when the arms are outstretched and muscle stiffness may also occur. Sleepiness, decreased awareness, and coma may occur with severe hepatic encephalopathy.

How is hepatic encephalopathy diagnosed?

You may need any of the following tests:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• EEG: This test is also called an electroencephalogram. Many small pads or metal discs are put on your head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of your brain. Caregivers look at the tracing to see how your brain is working.
  
  
• Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  
  
• Urine sample: For this test you need to urinate into a small container. You will be given instructions on how to clean your genital area before you urinate. Do not touch the inside of the cup. Follow instructions on where to place the cup of urine when you are done.

How is hepatic encephalopathy treated?

Treatment depends on how bad your condition is. For mild hepatic encephalopathy, a change to a low protein diet may be all that is needed. A high protein diet increases the ammonia in blood and may worsen the disease. You may also be given medicine to increase bowel movements to reduce the amount of ammonia and other toxins being absorbed into your blood.

You may need to be in the hospital if you have a severe disease. A machine called a ventilator may be used to help you breathe better. Artificial liver support to clean the blood may also be used. This is done by passing your blood through a special filter, then returning the blood back to you. Surgery to correct blood flow to the liver or a liver transplant may be other treatment options. Ask your caregiver for more information on the different treatments for your condition.

Where can I find support and more information?

Hepatic encephalopathy may be a life-changing disease for you and your family. Accepting that you have hepatic encephalopathy may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group with other people who have hepatic encephalopathy. Contact any of the following for more information:

• American Liver Foundation
  39 Broadway Suite 2700
  New York , New York 10006
  Phone: 1- 212 - 668-1000
  Phone: 1- 800 - 465-4837
  Web Address: http://www.liverfoundation.org
  

• Brain Injury Association
  1608 Spring Hill Road
  Vienna , VA 22182
  Phone: 1- 703 - 761-0750
  Phone: 1- 800 - 444-6443
  Web Address: http://www.biausa.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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