Hepatic encephalopathy

What is Hepatic encephalopathy?

This disease describes the changes in the brain that happen after liver disease. A healthy liver filters toxins from the blood, but when it is damaged harmful toxins and chemicals can get to the brain causing an array of symptoms.


Hepatic encephalopathy

Hepatic encephalopathy is a syndrome usually experience by patients with cirrhosis. Hepatic encephalopathy is a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction.

Symptoms of hepactic encephalopathy

Symptoms of hepatic encephalopathy can vary depending on the underlying cause of the liver damage, they can be debilitating in some patients.

Signs and symptoms of moderate hepatic encephalopathy may include:

  • personality changes
  • difficulty thinking
  • poor concentration
  • problems with handwriting or loss of other small hand movements
  • forgetfulness
  • confusion
  • poor judgment
  • a musty or sweet breath odor

Symptoms of severe hepatic encephalopathy are:

  • confusion
  • drowsiness or lethargy
  • seizures
  • anxiety
  • severe personality changes
  • fatigue
  • confused speech
  • shaky hands
  • slow movements

Hepatic encephalopathy is also described in patients without cirrhosis who experience either spontaneous or surgically created portosystemic shunts. The development of hepatic encephalopathy is caused mostly by the effect of neurotoxic substances, which occurs in the setting of portal hypertension in cirrhosis.

Nearly 70% of patients with cirrhosis will experience subtle signs of hepatic encephalopathy.

How is it diagnosed?

There's no specific test used to diagnose Hepatic Encephalopathy. Their diagnosis is based on a combination of three things:

  • A patients medical history
  • Symptoms
  • A clinical exam by a doctor

Blood tests can identify abnormalities associated with kidney and liver dysfunction, infections, bleeding and other conditions that may contribute the syndrome, Hepatic Encephalopathy.

These tests are not specific to Hepatic Encephalopathy and simply aid in making the HE diagnosis to be based on the patients history and symptoms.

Many symptoms of Hepatic Encephalopathy also occur in people with other types of brain disease or damage (for example, stroke, brain tumor, or bleeding inside the skull) the doctor may order specialised imaging tests to rule out some of them.

Imaging tests are obtained by using various types of equipment and are likely to include:

In addition, the doctor may order electroencephalogram, a test that measures the electrical activity of your brain, it look for brain wave changes associated with HE.

There is no specific “HE test”, the diagnosis of HE is often referred to as a diagnosis of exclusion. This means the doctor should exclude – or rule out – other possible causes of symptoms in order to correctly diagnose the HE.

How is it treated?

Once the doctor has determined the patient has hepatic encephalopathy , the first step they take is to then identify and treat any factors that caused it.

Depending on the cause, treatment may include:

  • Medication to treat infections
  • Procedures to stop bleeding
  • Therapy for kidney issues.
  • Stopping the use of certain medications that depress central nervous system function and can trigger HE.


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