Pronounced: MET-a-bol-ik En-SEF-a-lo-PATH-ee
Hepatic encephalopathy is a problem with the brain that is caused by liver disease. The problem may be temporary or permanent. People with a liver disease called cirrhosis are most commonly affected.
Oxygen and Blood Flow to the Brain
If the liver is not working properly, toxins can build up in the blood. The toxic blood travels to the brain, affecting the brain's ability to function.
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A liver with disease cannot filter the harmful items in blood. These toxins build up in the blood, which reaches the brain and affects the brain’s ability to work properly.
Factors that increase your chances of developing hepatic encephalopathy include:
In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include:
If you have liver problems and any of the above symptoms, call your doctor right away.
These problems can develop quickly. They may resolve when the underlying condition is reversed, but immediate treatment is needed.
This condition can be serious. It can quickly become an emergency. You may need to be hospitalized. Doctors will do an exam to assess the condition of your nervous system.
To assess your liver and kidneys your doctor may order:
Your doctor may also order tests to assess your brain and nervous system such as:
The initial treatment will focus on treating and trying to reverse the underlying problems. If possible, toxins in your blood will be removed or neutralized.
Medications may be used to:
Your doctor may recommend changes in your diet. Tube feeding may be needed to supply nutrients, especially in the case of coma.
If this condition is due to liver failure, you may need a liver transplant.
To help reduce your chance of getting this condition, take the following steps:
RESOURCES:
National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov
References:
Bernuau J. Acute liver failure: avoidance of deleterious co-factors and early specific medical therapy for the liver are better than late intensive care for the brain (review). J Hepatol. 2004;41:152-155.
Butterworth RF. Role of circulating neurotoxins in the pathogenesis of hepatic encephalopathy: potential for improvement following their removal by liver assist devices. Liver Int. 2003;23(suppl 3):5-9. Review.
Hepatic encephalopathy. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 7, 2012. Accessed May 20, 2013.
Highleyman L. Hepatitis C. HCV Advocate website. Available at: http://www.hcvadvocate.org/hepatitis/hepC/hepatic_encephalopathy.html. Published 2002. Accessed May 20, 2013.
Juretschke L. Kernicterus: still a concern. Neonatal Netw. 2005;24:7-9.
Lizardi-Cervera J, Almeda P, Guevara L, et al. Hepatic encephalopathy: a review. Ann Hepatol. 2003;2:122-130. Review.
Metabolic encephalopathy. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 11, 2009. Accessed May 20, 2013.
Siegal GJ, Agranoff BW, Albers RW, Uhler MD. Metabolic encephalopathies. In: Basic Neurochemistry: Molecular, Cellular, and Medical Aspects. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Toftengi F, Larsen F. Management of patients with fulminant hepatic failure and brain edema. Metab Brain Dis. 2004;19:207-214.
4/2/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: FDA approves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm206104.htm. Published March 24, 2010. Accessed April 2, 2010.
Last reviewed May 2013 by Rimas Lukas, MD; Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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