What is hepatic encephalopathy?

Some cases of hepatic encephalopathy last just a short time. They may be cured with treatment. If the condition lasts a long time (is chronic), it usually gets worse over time. But if you work closely with your doctor and follow your treatment plan, you may make some symptoms less severe.

Flare-ups of symptoms can happen. Following your treatment plan may help reduce flare-ups.

If your symptoms are severe, you may need help with daily activities. You may need support at home. Severe cases may require a stay in the hospital.

Symptoms may include feeling cranky, grouchy, or depressed. You may have problems finding words, thinking, concentrating, or remembering things. Your sleep pattern may change, such as being sleepy during the day and awake at night. Symptoms such as twitching of muscles or jerking movements of hands may also occur.

Treatment may include medicine to treat any other problems, such as bleeding in the digestive tract. Your doctor will also likely prescribe a medicine called lactulose. It increases bowel movements. This helps prevent the buildup of toxins in the blood that may lead to encephalopathy. Make sure to keep taking your medicine as directed, because it can keep the condition from quickly getting worse. Your doctor also may prescribe antibiotics, such as rifaximin.

Your doctor also may talk to you about changes in diet. Certain foods may make symptoms worse.

If treatment doesn't help, then a liver transplant may be needed.

Your doctor will ask about your symptoms and do a physical exam. You may also have a blood test and take a memory test. Other tests may include an MRI, a CT scan, or an electroencephalogram (EEG).

There are things you can try to relieve your symptoms. If your doctor prescribed medicine, take it as instructed. Follow your treatment plan, including any recommended changes in your diet. Avoid alcohol, which damages the liver. And don't drive until your doctor says it's okay.

Encephalopathy is most likely to occur in people who have high blood pressure in the portal vein system (portal hypertension). But it may also occur in people who have severe acute liver damage but do not have portal hypertension.

Certain procedures (such as shunting, which redirects the flow of blood or fluid through other areas of the body) that help lower portal hypertension and prevent variceal bleeding may actually increase your risk for encephalopathy.

Many things can contribute to encephalopathy. These may include the use of sedatives, opioids, or alcohol. Other things that may increase your risk include gastrointestinal bleeding, abnormal levels of electrolytes in the blood (especially low potassium levels), the amount of protein in the diet, infection such as peritonitis, dehydration, or constipation.

Hepatic encephalopathy (say "hip-PAT-ik in-sef-uh-LAW-puh-thee") is a problem in the brain. It happens when the liver has been damaged and can't filter toxins from the blood. These toxins build up in your bloodstream and affect your brain. This can lead to personality changes. It can also make it hard to think clearly and remember things.

It may be caused by long-term (chronic) liver disease. These diseases include cirrhosis, liver failure, and a type of high blood pressure in the veins that filter blood into the liver (portal hypertension).

In some cases, symptoms are mild. In other cases, they can be very serious. It depends on the cause and how much the condition has progressed.

Your doctor may do a few tests to diagnose this problem. These may include blood tests and memory tests. You may have MRI or CT scans, which show a picture of your brain. You also may have an EEG. This is a test that shows the electrical activity of your brain.

• Your doctor may talk to you about changing your diet. Certain foods may make symptoms worse.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Check with your doctor before you use any new medicines. Some medicines can cause symptoms to flare up.