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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.
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.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Current as of: March 22, 2023
Author: Healthwise Staff
Medical Review:Elizabeth T. Russo MD - Internal Medicine & Peter J. Kahrilas MD - Gastroenterology
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