Hepatic encephalopathy

When the liver has been damaged, it may not be able to filter poisons from the bloodstream, especially substances in the blood produced by bacteria in the large intestine. As a result, these substances (which include ammonia) may build up in the bloodstream and cause problems in your brain called encephalopathy. High ammonia levels are a sign of encephalopathy.

Symptoms of encephalopathy may include:

• Irritability.
• Depression.
• Changes in sleep patterns.
• Twitching of muscles or jerking movements of hands.
• Difficulty with word-finding.
• Poor short-term memory.
• Poor concentration.
• Confusion and disorientation.
• Coma.

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).

Most cases of encephalopathy are treated using a medicine called lactulose. This drug helps prevent the buildup of substances in the large intestine that may lead to encephalopathy. Lactulose is effective at decreasing ammonia levels in the blood and improving encephalopathy.

If you have had many cases of encephalopathy, your doctor may give you another medicine called rifaximin. This medicine may be used with lactulose to help prevent encephalopathy.

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.