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Hepatic Encephalopathy


Hepatic encephalopathy (HE) is a brain condition that is caused by liver disease. Liver diseases such as cirrhosis prevent the liver from removing ammonia and other harmful substances from the blood. The harmful substances build up in the blood and prevent the brain from working correctly. Early treatment is needed to reverse the damaging effects of this condition and restore proper brain function.


Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.


You may need to limit protein and sodium (salt). A dietitian will talk to you about the changes you need to make.


  • Antibiotics may be given to treat a bacterial infection. Antibiotics also decrease the amount of ammonia produced by normal bacteria in the intestines.
  • Laxatives may help to reduce the amount of ammonia in your blood by drawing it into your colon. It then leaves your body in your bowel movements.


  • Blood and urine tests may be done to look for infection or to test liver function. Healthcare providers may also use the tests to get information about your overall health.
  • An EEG is also called an electroencephalogram. 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. Healthcare providers look at the tracing to see how your brain is working.
  • A neurologic exam can show healthcare providers how well your brain works after an injury or illness. Healthcare providers will check how your pupils react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  • A sample of your bowel movement is sent to a lab for tests. The test may show if a germ is causing your illness.


  • Artificial liver support may be needed. A machine is used to clean your blood when your liver cannot. Chemicals and waste products are removed from your blood by a filtering machine. Your blood is passed through a filter and then returned to your body.
  • Surgery to correct blood flow to the liver, or a liver transplant may be needed.
  • A ventilator is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your mouth or nose and attached to the ventilator. You may need a trach if an ET tube cannot be placed. A trach is a tube put through an incision and into your windpipe.


Without treatment, HE may damage your brain cells for the rest of your life. This may cause problems in your mood, behavior, and the way you think. Severe brain damage could lead to a coma and may be life-threatening.


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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.