Hepatic encephalopathy is a brain disorder caused by liver impairment that results in toxic substances not being removed from the blood. This causes disturbances in mental functioning. It is commonly seen in people with cirrhosis when substances like ammonia accumulate abnormally in the blood and reach the brain. Symptoms range from mood changes to confusion and coma depending on severity. Treatment focuses on restricting diet to reduce toxic substances in the intestines and administering medications to promote bowel movements and removal of toxins from the blood. For severe cases, hospitalization, ventilator support, artificial liver support, or even liver transplantation may be needed.

2. Hepatic encephalopathy is a brain disorder caused due
to a complication in the liver. The term hepatic stands
for "of the liver" and encephalopathy stands for "brain
disorder."
Hepatic encephalopathy is most commonly observed in
patients of cirrhosis. It occurs when the toxic
substances, which are normally removed by the liver,
accumulate in the blood and reach the brain. This is
caused due to liver impairment and is marked by a
disturbance in mental functioning. A person affected by
this condition is at a high risk of developing cerebral
edema and multi-organ failure.

3. The exact cause this condition is not known, but it is
considered to be caused by the disorders affecting the
liver. It can also be caused due to an increased amount of
ammonia and other harmful substances in the blood.
People with liver disorders like cirrhosis or hepatitis are
most likely to develop this disorder. In such people, it
might be triggered by the conditions like diarrhoea,
constipation, gastrointestinal bleeding, vomiting, bacterial
or viral infection and high protein intake.
It may also be triggered due to excessive alcohol
consumption. Other conditions that may cause this
condition include alkalosis, low oxygen
levels, potassiumdeficiency caused due to medicines like
diuretics, sedatives and narcotics.

4. Mild symptoms might be observed in the early stages of
Hepatic encephalopathy. These include:
 Mood changes
 Behavioural changes
 Personality changes
 Drowsiness
 Decreased attention
 Difficulty in speaking
 Deterioration of handwriting
 Changes in sleeping habits

5. With the progression of disease, some other
symptoms might be observed. These include:
 Sleepiness
 Forgetfulness
 Confusion
 Decreased awareness
 Decreased responsiveness
 Disorientation
 Flapping tremors
 Muscle stiffness
 Seizures
 Fetor hepaticus (a musty sweet odour)
 Coma
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6. The diagnosis of hepatic encephalopathy is done on the
basis of physical examination, mental status
examination, electroencephalography, medical history
and blood tests.

7. The treatment depends upon the severity of the disease. The
main goal of the treatment is to address the underlying
cause, and eliminate the toxic substances from the intestine.
Toxic substances are removed from the intestine by
restricting a person's diet. The affected person might be
asked to reduce protein intake in order to lower ammonia
production. Instead, he may be asked to increase the amount
of vegetable protein so that he gets adequate protein, but
without worsening the condition.
Carbohydrates that are given either orally or intravenously
serve as the main source of calories. A person may also be
asked to eat the vegetables high in fibre content.

8. This helps in speeding up the passage of food through
intestine, altering the intestinal acidity and thereby reducing
the absorption of ammonia.
Lactulose may be given orally to acidify the ammonia in the
colon and form the ammonium that can be easily excreted. It
is used as a laxative for evacuating blood from intestines and
for reducing ammonia production by intestinal bacteria.
Gastrointestinal bleeding should also be controlled.
Medications may also be provided to increase bowel
movements to reduce the absorption of toxins and ammonia
from the blood.
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9. Severe cases of hepatic encephalopathy usually require
hospitalisation. For proper and better intake of oxygen,
ventilator may be used. Artificial liver support may also be
used to clean the blood. Your blood is passed through a
special filter and this filtered blood is returned to you.
Sometimes, a surgery or liver transplantation may also be
required.
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