Definition
Hepatic encephalopathy is brain and nervous system damage that occurs as a complication of liver disorders. It causes different nervous system symptoms including changes in reflexes, changes in consciousness , and behavior changes that can range from mild to severe.
Symptoms
- Changes in mental state, consciousness, behavior, personality
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Definition
Hepatic encephalopathy is brain and nervous system damage that occurs as a complication of liver disorders. It causes different nervous system symptoms including changes in reflexes, changes in consciousness , and behavior changes that can range from mild to severe.
Causes
Hepatic encephalopathy is caused by disorders affecting the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis ) and conditions where blood circulation does not enter the liver. The exact cause of hepatic encephalopathy is unknown.
However, when the liver cannot properly metabolize and and turn poisons into harmless substances in the body, these poisons build up in the bloodstream. One substance believed to be particularly harmful to the central nervous system is ammonia , which is produced by the body when proteins are digested. Ammonia is normally made harmless by the liver. Many other substances may also accumulate in the body if the liver is not working well. They add to the damage done to the nervous system.
In people with otherwise stable liver disorders, hepatic encephalopathy may be triggered by gastrointestinal bleeding, eating too much protein, infections, renal disease, procedures that bypass blood past the liver, and electrolyte abnormalities (especially a decrease in potassium). A potassium decrease may result from vomiting, or treatments such as paracentesis or taking diuretics ("water pills").
Hepatic encephalopathy may also be triggered by any condition that ...
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Treatment
Hepatic encephalopathy is an acute medical condition that may become a medical emergency. Hospitalization is required.
The goals of treatment include life support, elimination or treatment of the causes, and removal or neutralization of ammonia and other toxins. Life support may include support of breathing or blood circulation, particularly if coma develops. The brain may swell, which can be life-threatening.
Causes must be identified and treated. Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Blood breaks down into protein parts that are converted to ammonia. Treatment of infections, kidney failure, and electrolyte abnormalities (especially potassium) is important.
In patients with severe, repeated cases of encephalopathy, the patient may be told to reduce protein in the diet to lower ammonia production. However, dietary counseling is important, as too little protein in the diet can contribute to malnutrition. Specially formulated intravenous or tube feedings may be necessary for critically ill patients.
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Other Names
Hepatic coma; Encephalopathy - hepatic
Possible Complications
- Brain swelling
- Brain herniation
- Progressive, irreversible coma
- Permanent nervous system damage (to movement, sensation, or mental state)
- Increased risk of:
- Side effects of medications (see the specific medication)
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Outlook (Prognosis)
Acute hepatic encephalopathy may be correctable, while chronic forms of the disorder often keep getting worse. Both forms may result in irreversible coma and death. Approximately 80% ( 8 out of 10 patients) die if coma develops. Recovery and the risk of repeated cases are variable.
Prevention
Treating liver disorders may prevent some cases of hepatic encephalopathy. Avoiding heavy drinking and intravenous drug use can prevent many liver disorders.
If there are any neurological symptoms in a person with known or suspected liver disease, call for immediate medical attention.
Exams and Tests
Neurological symptoms may change. Coarse, "flapping" muscle tremor may be observed during voluntary movement, such as when the person attempts to hold the arms out in front of the body .
Mental status examination will be abnormal, particularly cognitive (thinking) tasks such as connecting numbers with lines.
Liver disease may be known or may be suspected, and signs of liver disease such as jaundice ( yellow skin and eyes) and ascites (fluid collection in the abdomen) may be noted. Occasionally, there is a characteristic musty odor to the breath and the urine.
Blood tests may be nonspecific, or may show liver failure.
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