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Hepatic Encephalopathy
Posted on Oct 15, 2015
Hepatic encephalopathy is a brain disorder caused due to a complication in the liver. The term hepatic stands for "of the liver" and encephalopathy stands for "brain disorder."

Hepatic encephalopathy is most commonly observed in patients of cirrhosis. It occurs when the toxic substances, which are normally removed by the liver, accumulate in the blood and reach the brain. This is caused due to liver impairment and is marked by a disturbance in mental functioning. A person affected by this condition is at a high risk of developing cerebral edema and multi-organ failure.

Causes and risk factors of hepatic encephalopathy
The exact cause this condition is not known, but it is considered to be caused by the disorders affecting the liver. It can also be caused due to an increased amount of ammonia and other harmful substances in the blood. People with liver disorders like cirrhosis or hepatitis are most likely to develop this disorder. In such people, it might be triggered by the conditions like diarrhoea, constipation, gastrointestinal bleeding, vomiting, bacterial or viral infection and high protein intake.

It may also be triggered due to excessive alcohol consumption. Other conditions that may cause this condition include alkalosis, low oxygen levels, potassium deficiency caused due to medicines like diuretics, sedatives and narcotics.
Mild symptoms might be observed in the early stages of Hepatic encephalopathy. These include:
  • Mood changes
  • Behavioural changes
  • Personality changes
  • Drowsiness
  • Decreased attention
  • Difficulty in speaking
  • Deterioration of handwriting
  • Changes in sleeping habits

With the progression of disease, some other symptoms might be observed. These include:
  • Sleepiness
  • Forgetfulness
  • Confusion
  • Decreased awareness
  • Decreased responsiveness
  • Disorientation
  • Flapping tremors
  • Muscle stiffness
  • Seizures
  • Fetor hepaticus (a musty sweet odour)
  • Coma

Diagnosis and treatment of hepatic encephalopathy
The diagnosis of hepatic encephalopathy is done on the basis of physical examination, mental status examination, electroencephalography, medical history and blood tests.
The treatment depends upon the severity of the disease. The main goal of the treatment is to address the underlying cause, and eliminate the toxic substances from the intestine. Toxic substances are removed from the intestine by restricting a person's diet. The affected person might be asked to reduce protein intake in order to lower ammonia production. Instead, he may be asked to increase the amount of vegetable protein so that he gets adequate protein, but without worsening the condition.

Carbohydrates that are given either orally or intravenously serve as the main source of calories. A person may also be asked to eat the vegetables high in fibre content. This helps in speeding up the passage of food through intestine, altering the intestinal acidity and thereby reducing the absorption of ammonia.

Lactulose may be given orally to acidify the ammonia in the colon and form the ammonium that can be easily excreted. It is used as a laxative for evacuating blood from intestines and for reducing ammonia production by intestinal bacteria. Gastrointestinal bleeding should also be controlled.

Medications may also be provided to increase bowel movements to reduce the absorption of toxins and ammonia from the blood.

Severe cases of hepatic encephalopathy usually require hospitalisation. For proper and better intake of oxygen, ventilator may be used. Artificial liver support may also be used to clean the blood. Your blood is passed through a special filter and this filtered blood is returned to you. Sometimes, a surgery or liver transplantation may also be required.
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