Liver Diseases / Hepatic Encephalopathy

Hepatic Encephalopathy

Hepatic encephalopathy is the deterioration in brain function observed in people with acute liver failure or chronic liver disease. It’s a condition, not a form of liver disease.

your quick guide to this page

what is hepatic encephalopathy?: Learn what defines hepatic encephalopathy and what its general consequences are.
fast facts: Get a quick overview of hepatic encephalopathy through statistics and bite-sized facts.
symptoms: Learn about the symptoms of hepatic encephalopathy, how to recognize them, and what to do if you experience them.
lifestyle impacts: Find out how hepatic encephalopathy impacts your lifestyle.
what can I do?: Discover management and treatment strategies for hepatic encephalopathy.
additional resources: Find useful links, education, articles, recipes and more that can help with hepatic encephalopathy.

what is hepatic encephalopathy?

Hepatic encephalopathy (HE) is a complication resulting from liver disease or failure, that affects brain function. The brain is a very sensitive organ and relies on a healthy liver to properly function.

HE can be grouped into three categories, types A, B, and C:

Type A is associated with acute liver failure. Acute liver failure is a rapid deterioration (within days and weeks) of liver function in a person who had no pre-existing liver disease. Acute liver failure, also known as fulminant hepatic failure, can cause serious complications including excessive bleeding and elevated pressure in the brain which require emergency hospitalization.
Type B is associated with portal-systemic bypass without liver disease. This occurs when blood flows around the liver and therefore the liver cannot control/remove substances in the blood. Type B usually occurs as a result of congenital abnormalities and/or as a result of an invasive procedure or trauma.
Type C is associated with chronic liver disease, like cirrhosis.

In these conditions, there is an accumulation of ammonia and inflammatory compounds in circulation which enter the brain. This leads to brain dysfunction.

It is important to note that children can also develop HE, but their symptoms are different compared to adults and therefore this information is not helpful for children with HE. Parents and guardians are advised to seek medical advice if you think your child may have HE.

symptoms

HE often starts slowly, and at first, you may not be aware you have it. The stages of HE spans from mild to severe and involve numerous symptoms. If you have been diagnosed with a chronic liver disease, you could have HE if you are experiencing the following:

Memory loss
Poor concentration
Confusion
Sleep insomnia
Anxiety
Forgetfulness
A slow reaction time
Shortened attention span
Poor judgement
Mental fogginess
Worsening of handwriting or fine motor skills

Oftentimes, these symptoms are identified by a family member or a caregiver.

more severe symptoms include:

Flapping tremor (tremor of the hand when the wrist is extended called asterixis) or abnormal movements
Gross disorientation
Drowsiness or severe confusion
Strange behaviour or severe personality changes
Slurred speech
Slowed or sluggish movement
Coma: unconscious and unresponsive

lifestyle impacts

Being confronted with a diagnosis of HE can be overwhelming. HE will affect your quality of life and will impact your whole family. Because HE can affect your memory, concentration and thinking ability, it’s best to discuss your illness with your family and whenever possible bring a family member with you to your appointments. Keep in mind that sometimes the changes or symptoms of HE are so minimal that your family or friends might notice them before you do. So, it’s good to have someone with you who can help fill in the gaps about your symptoms and medical history.

care for your brain

Taking care of your brain during your illness is extremely important. Some of the symptoms of HE, like anxiety, confusion and forgetfulness may interfere with your ability to keep up and follow your treatment regimen, and you may need to ask a family member to help you. You may also need help communicating with your healthcare providers, keeping your medical appointments, getting the necessary lab tests and eating an appropriate diet.

diet and exercise

One thing you can do to stay as healthy as possible is to eat a nutritious diet and exercise regularly. Talk to your healthcare provider about specific diet recommendations based on your needs and response to treatment.

don’t drive

It is strongly recommended that individuals with cirrhosis who have had episodes of OHE do not drive or operate a motor vehicle, even if they may have “recovered” between episodes. Please discuss this further with your healthcare provider.

what can I do?

diagnosis

There are no specific tests to diagnose hepatic encephalopathy as it is primarily diagnosed through symptoms. Symptoms can vary based on severity of the condition.

treatment

There are several treatment options that are currently available in Canada that you can discuss with your healthcare provider:

Lactulose is an artificial form of sugar that is not absorbed into your body (meaning, it does not enter the bloodstream). Lactulose creates a hostile environment for the “bad” bacteria in the intestine, therefore lowering ammonia production in the intestine. It may also be used to treat constipation. Like any medication, lactulose can have side effects, including nausea, gas, abdominal cramps and diarrhea and some people may not be able to tolerate lactulose over a long period of time.
Antibiotics are also prescribed to control growth of bacteria, including those that produce harmful toxins.
Probiotics or friendly bacteria can change the balance of bacteria in the intestines, increasing the proportion of friendly bacteria. This can result in decreased levels of ammonia production and other toxic substances.
Branched-chain amino acids can help maintain muscle mass and increase ammonia clearance (primarily through the muscle).
Individuals with alcoholic-related cirrhosis and HE may be given thiamine (Vitamin B1 supplements).