(Encephalopathy, Hepatic; Portal-Systemic Encephalopathy; Encephalopathy, Portal-Systemic)
Hepatic encephalopathy is a problem with the brain that is caused by liver disease. The problem may be temporary or permanent.
A liver with disease cannot filter the harmful items in blood. These toxins build up in the blood, which reaches the brain and affects the brain’s ability to work properly.
Factors that increase your chance of hepatic encephalopathy include:
In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include:
- Changes in behavior and personality
- Shortened attention span
- Depression or anxiety
- Difficulty sleeping
- Slurred speech
- Uncontrolled movements, particularly a flapping tremor of the hands
- Loss of consciousness
If you have liver problems and any of the above symptoms, call your doctor right away.
You will be asked about your symptoms and medical history. A physical exam will be done. The condition of your nervous system will also be assessed.
Your liver and kidney function may be assessed. This can be done with:
- Liver function tests
- Kidney function tests
- Imaging tests of the liver
Your brain and nervous system may be assessed. This can be done with:
Hospitalization and Emergency Care
The initial treatment will focus on treating and trying to reverse the underlying problems. If possible, toxins in your blood will be removed or neutralized.
Medications may be used to:
- Neutralize toxins in the intestine, such as ammonia
- Remove blood from the intestines
- Reduce ammonia production by intestinal bacteria
- Reduce the amount of ammonia producing bacteria
- Treat the condition that started the encephalopathy
- Reduce recurrence
Changes in your diet may be recommended. Tube feeding may be needed to supply nutrients, especially in the case of coma.
If this condition is due to liver failure, you may need a liver transplant.
To help reduce your chance of hepatic encephalopathy:
- Get early treatment for liver problems.
- If you have a disease such as cirrhosis, see your doctor regularly.
- Follow your doctor's instructions regarding medications. Avoid overdosing.
- Avoid being exposed to poisons or toxins.
- Avoid excessive use of alcohol.
- Do not use illicit drugs.
National Digestive Diseases Information Clearinghouse
National Institute of Neurological Disorders and Stroke
Canadian Liver Foundation
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4/2/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm206104.htm. Updated April 24, 2013. Accessed February 17, 2014.
Last reviewed January 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.