Hepatic Encephalopathy (HE)
What is hepatic encephalopathy?
Hepatic encephalopathy (HE) is a brain disorder that can develop in those with liver disease. If an individual has cirrhosis of the liver, they have a 70% chance of developing HE. It can also affect those who have a portosystemic shunt; 24-53% of those with one develop HE.
It can be divided into three subtypes, A, B, and C, depending on the underlying cause.
What are the symptoms of hepatic encephalopathy?
HE is a spectrum, so the symptoms can vary throughout affected individuals. Some may barely even notice symptoms, while others can experience life-threatening effects. They include:
- Swelling in the brain
- Intracranial hypertension
- Changes in memory and/or concentration
- Issues with intellectual function
- Problems with coordination
- Shortened attention span
- Decreased alertness
- Changes in mood and personality
- Changes in sleep patterns
- Regression of skills
- Slurred speech
- Inappropriate behavior
- Lack of restraint
There are complications that can arise from HE, including nervous system damage, kidney abnormalities, respiratory abnormalities, sepsis, and heart failure.
What causes hepatic encephalopathy?
Liver disease is the major cause of HE. The liver can no longer clear toxins, and they travel to the brain. Essentially, the blood bypasses the liver. For the same reasoning, those with a portosystemic shunt can develop HE.
Episodes of HE can also be triggered. Causes include low oxygen levels, gastrointestinal bleeding, dehydration, infections, certain drugs, kidney abnormalities, an alcohol binge, and surgery.
How is hepatic encephalopathy diagnosed?
Doctors will look for patient history and the characteristic symptoms, as well as perform a clinical evaluation and tests. Tests include a complete blood count, MRI, CT scan, tests to evaluate serum ammonia levels, liver function tests, and electroencephalogram.
What are the treatments for hepatic encephalopathy?
Treatments can vary depending on the cause and symptoms. If a certain trigger is found, doctors will treat it. Other treatment is meant to lower the amount of toxins in the blood. Doctors may use synthetic sugars, which are often used with antibiotics and lactulose. Rifaximin has also been improved to lower the risk of HE episodes.