Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a complication of advanced liver disease or acute liver failure. It can come on suddently and it can be very serious.

 

What is hepatic encephalopathy?

Forgetfulness and other brain issues like problems with concentration, changes in sleeping habits, drowsiness, or falling a lot can be a sign you have hepatic encephalopathy.

It means the brain brain function gets worse. It can be short term and get better, or it can last a long time.

Sometimes people with hepatic encephalopathy can slip into a coma or even die.

What causes hepatic encephalopathy?

The liver’s job is to filter out harmful substances from the body. If the liver can’t work properly, these toxins build up in the bloodstream and can enter the brain.

Hepatic encephalopathy is quite common in people who have cirrhosis. It can also be triggered by:

• Dehydration
• Constipation
• An infection, like pneumonia
• Kidney problems
• Low oxygen levels
• An accident or surgery
• Some medications
• An electrolyte imbalance, e.g. if you’ve been vomiting or taking water pills
• Too much protein in the body.

What are the symptoms of hepatic encephalopathy?

HE can cause a range of symptoms:

• Being very disorientated
• Being very confused or drowsy
• Strange behaviour
• Personality changes
• Slurred speech
• Moving slowly
• Being unconscious and unresponsive

Symptoms can come on quickly or develop slowly over time.

At first you or someone close to you might notice your attention span is shorter. You might have trouble sleeping, or be sleeping too much.

As the condition gets worse, you might feel disorientated or lethargic. You might be vague and have difficulty following a conversation or reading a book.

In the severe stage, people with HD get very confused and can’t do simple tasks.

How is hepatic encephalopathy treated?

HE needs to be treated by a doctor as soon as possible.

If it’s caused by too much protein, you might be put on a low protein diet. This means you will need to avoid meat, poultry, eggs and fish.

Some people will have medications such as:

• Lactulose (lowers amonia in the gut and treats constipation)
• Antibiotics
• Probiotics
• Thiamine (vitamin B1) supplements

People with very serious HE may need to be treated in hospital. Some people with HE will need a liver transplant.

Tips for managing hepatic encephalopathy

The best way to prevent and manage HE is to stop your liver disease from getting worse.

• Eat a healthy, balanced diet
• Try to be a healthy weight
• Get enough exercise
• Avoid alcohol

Living Well

Reviewed September 2024