Hepatic Encephalopathy: Causes, Symptoms, Treatment, Prognosis, Prevention, Diagnosis

Hepatic Encephalopathy is a pathological condition in which there is a significant decline in the functioning of the brain as a result of a disease of the liver. Hepatic Encephalopathy occurs as a result of the liver’s inability to eliminate toxins from the blood which ultimately results in accumulation of toxins in the blood causing significant damage to the brain. Hepatic Encephalopathy can be acute or chronic. By acute Hepatic Encephalopathy, we mean that the condition is for a shorter period of time where as by chronic Hepatic Encephalopathy we mean that the condition stays for a longer period of time. In chronic cases of Hepatic Encephalopathy, some patients may go into a coma due to lack of functioning of the brain.

Acute Hepatic Encephalopathy may occur in people who have the following conditions:

• Acute Fulminant Viral Hepatitis: It is a type of viral hepatitis which is of sudden onset
• Toxic Hepatitis: This is found mostly in people who abuse alcohol, recreational drugs, and other chemicals or supplements.
• Reye Syndrome: This is a rare condition found mostly in children in which there is sudden swelling of the liver and brain

Chronic Hepatic Encephalopathy may be a permanent condition or may go into remission for some time only to recur again. Patients with recurrent form of this condition will have episodes of Hepatic Encephalopathy time and again throughout their entire life and will be in need of continuous treatments in order to avoid recurrence of the condition. This is mostly seen in people with severe form of cirrhosis of the liver.

Permanent Hepatic Encephalopathy occurs in people who have preexisting conditions like seizure disorder or a severe injury to the spinal cord but this is quite rare and is not seen often.

There is no known cause of Hepatic Encephalopathy, although it is normally caused due to excessive buildup of toxins in the blood stream. The function of the liver is to eliminate toxins like ammonia from the body. These toxins are accumulated due to breakdown of various proteins and other metabolites that are used by other organs of the body. When there is an injury or damage to the liver, it is not able to filter the bloodstream and remove the toxins from the body thus resulting in gradual buildup of toxins in the bloodstream which may then infiltrate the brain causing Hepatic Encephalopathy. Some of the medical conditions which may result in Hepatic Encephalopathy are:

• Pneumonia
• Kidney dysfunction
• Severe dehydration
• Hypoxia
• Recent surgery
• Excessive use of immunosuppressants
• Excessive proteins in the body
• Electrolyte imbalance.

The presenting symptoms of Hepatic Encephalopathy depend on the underlying cause of the condition. Some of the symptoms of Hepatic Encephalopathy are:

• Problems with thinking
• Changes in personality
• Concentration problems
• Difficulty writing and other dexterity issues
• Confusion
• Excessive forgetfulness
• Inadequate judgment
• Lethargy
• Anxiety
• Seizures
• Speech difficulties.

In order to diagnose Hepatic Encephalopathy, the following tests are done:

• Blood Tests: A CBC will be done to check on the status of the RBCs, WBCs, and platelets. A low RBC count may indicate lack of oxygen and reduced amount of blood in the body. Blood tests will also be done to check on the status of sodium, potassium, and ammonia levels. If they are increased then it indicates a problem with the functioning of the liver.
• Imaging: Radiological studies in the form of CT or MRI can check for any abnormalities in the brain.
• Liver Function Tests: These tests are done to check whether the liver is functioning normally or not.

Treating Hepatic Encephalopathy depends on the underlying cause of the condition and the severity of the disease process. The physician may recommend you to decrease the amount of protein in the diet for which a dietician will formulate a clear diet chart for you in which foods to avoid will be eggs, meat, and fish. Apart from this, medications which will help in eliminating toxins from the body will be given. In extremely severe cases, the patient may have to be put into a ventilator.

Prognosis for Chronic Hepatic Encephalopathy is better then that for Acute Hepatic Encephalopathy. This even gets better if the underlying condition responsible is treated adequately and on time. Some of the complications of Hepatic Encephalopathy are brain herniation, brain swelling, multiple organ failure.

The following steps will help in avoiding Hepatic Encephalopathy:

• Avoid alcohol
• Avoid fatty foods
• Maintain an ideal weight
• Abstain from recreational drug use.