Hepatic encephalopathy and liver cirrhosis

Hepatic Encephalopathy

Hepatic encephalopathy is potentially reversible abnormal brain function that occurs in liver failure. It can occur as a complication of cirrhosis or if the liver fails or in acute (sudden onset) liver failure. Hepatic encephalopathy occurs as the liver fails to remove certain toxic substances generated in the gut from the bloodstream. A normally functioning liver removes these toxins from the blood before they reach the brain. In cirrhosis, some blood leaving the gut bypasses the liver as blood flow through the liver is decreased. Metabolism of the substances is also decreased as liver cell function deteriorates. Ammonia, which is one of the potentially substances toxic to the brain, accumulates in the blood as the liver fails and can be measured by routine blood testing.
The signs of hepatic encephalopathy can range from subtle to dramatic. In its early stages, hepatic encephalopathy is characterized by subtle mental changes such as poor concentration, confusion and difficulty sleeping can occur. Some patients sleep during the day and stay awake at night. The inability to do simple constructive tasks, such as make a six-point star or do a child’s “connect the dots” picture is also an early subtle sign. In some cases, a flapping tremor known as asterixis, usually best observed in the hands, occurs. In severe cases, hepatic encephalopathy can lead to stupor, coma, brain swelling and death.
Signs and symptoms of hepatic encephalopathy can be aggravated by concurrent metabolic problems that occur with liver failure. Infection and bleeding into the gastrointestinal tract are common aggravating factors. Drugs such as narcotics, benzodiazepines, diuretics and alcohol also make signs and symptoms worse. High dietary protein intake can also worsen hepatic encephalopathy.
Several interventions can reverse hepatic encephalopathy. Improvement of even subtle signs and symptoms, such as sleep problems or mild concentration problem, will greatly benefit a patient. Commonly used treatments include reduced protein intake, lactulose and the antibiotic neomycin. However, there are major drawbacks with these treatments, including protein malnutrition and significant diarrhea.