(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. People with a liver disease called cirrhosis are most commonly affected.
Oxygen and Blood Flow to the Brain
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 chances of developing 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
- Slurred speech
- Tremor, 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.
These problems can develop quickly. They may resolve when the underlying condition is reversed, but immediate treatment is needed.
This condition can be serious. It can quickly become an emergency. You may need to be hospitalized. Doctors will do an exam to assess the condition of your nervous system.
To assess your liver and kidneys your doctor may order:
- Liver function tests
- Kidney function tests
- Imaging tests of the liver
Your doctor may also order tests to assess your brain and nervous system such as:
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
- Prevent intestinal bacteria from creating ammonia
- Remove blood from the intestines
- Reduce ammonia production by intestinal bacteria
- Treat the condition that started the encephalopathy
- Reduce recurrence
Your doctor may recommend changes in your diet. 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 getting this condition, take the following steps:
- Get early treatment for liver problems.
- If you have a disease such as cirrhosis, see your doctor regularly.
- Follow your doctor's instructions regarding medication. Avoid overdosing.
- Avoid being exposed to poisons or toxins.
- Avoid excessive alcohol.
- Do not use IV 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 https://dynamed.ebscohost.com/about/about-us: 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. Published March 24, 2010. Accessed April 2, 2010.
Last reviewed May 2013 by Rimas Lukas, MD; Michael Woods, 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.