Hepatic encephalopathy is a nervous system disorder brought on by severe liver disease. When the liver doesn’t work properly, toxins build up in the blood. These toxins can travel to the brain and affect brain function. People with hepatic encephalopathy may seem confused. Treatments can rid the body of toxins and reverse this temporary condition.
Hepatic encephalopathy is an often-temporary neurological (nervous system) disorder due to chronic, severe liver disease. A diseased liver struggles to filter toxins (substances created from the breakdown of food, alcohol, medications and even muscle) from the bloodstream. These toxins build up in the body and travel to the brain. Toxicity affects brain function and causes cognitive impairment.
People with hepatic encephalopathy may seem confused or have difficulty processing their thoughts. Treatments can remove the toxins and reverse the problem. As liver disease progresses, the condition may worsen and become less treatable. Hepatic encephalopathy is also known as portosystemic encephalopathy (PSE).
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Up to 50% of people with cirrhosis of the liver eventually develop symptoms of hepatic encephalopathy.
Cirrhosis is a buildup of scar tissue in the liver. This scar tissue blocks blood flow and affects the liver’s ability to filter toxins, hormones and nutrients.
There are three types of hepatic encephalopathy:
When you have liver disease, the liver struggles to filter natural toxins out of the body. Toxins, such as ammonia, accumulate in the blood. Toxins in the bloodstream can travel to the brain and temporarily (or sometimes permanently) affect brain function.
People with chronic liver disease are at risk for hepatic encephalopathy. Something usually triggers the condition, such as:
People with hepatic encephalopathy experience impaired brain function. Symptoms include:
There isn’t a standard test to check for hepatic encephalopathy. However, blood tests can identify problems such as infections and bleeding associated with liver disease. Your doctor may order other tests to rule out conditions that cause similar symptoms, such as strokes and brain tumors. These tests include magnetic resonance imaging (MRI), computed tomography (CT) scans and electroencephalogram (EEG).
Generally, your doctor makes a diagnosis based on your:
Treatment varies depending on your symptoms and overall health and how severe the condition is. It’s important to take medications for hepatic encephalopathy exactly as prescribed. With treatment, it’s possible to slow, and sometimes stop, the disease from getting worse. Your doctor may recommend one or both of these treatments:
Liver disease needs treatment, such as medications and lifestyle changes, including not drinking alcohol. If the underlying cause of liver disease isn’t treated, liver function deteriorates, and toxins continue to build. Some people with advanced hepatic encephalopathy lose consciousness and go into a hepatic coma.
Proper management and treatment of liver disease is key to lowering the chances of developing hepatic encephalopathy. These steps can lower your risk:
People with hepatic encephalopathy can slow, stop or reverse the disease by sticking to their prescribed treatment plan. People who have chronic liver disease may need to keep treating hepatic encephalopathy to stop symptoms from getting worse or coming back.
It’s important to see a doctor right away when you first notice signs of hepatic encephalopathy. Untreated hepatic encephalopathy can get worse and increase your risk of serious complications, such as coma.
People who develop end-stage liver disease (also called liver failure) may need to consider a liver transplant. You’ll undergo testing to see if you can withstand such a major procedure. A new liver often gets rid of hepatic encephalopathy.
You should call your doctor if you have liver disease and you notice signs of hepatic encephalopathy. Symptoms include impaired thinking, mood changes, sleep problems and hand flapping.
You should also notify your doctor if you have liver disease and become constipated. Bowel movements help rid the body of toxins. Having fewer bowel movements can cause toxins to build up in your body.
If you or someone you love has hepatic encephalopathy, you may want to ask your doctor:
Remember, hepatic encephalopathy is a serious but treatable condition. Symptoms often resolve with early detection and proper treatment. If you have liver disease, ask your doctor about warning signs of hepatic encephalopathy so you can start treatment promptly. You should also discuss how to best manage liver disease to keep hepatic encephalopathy from occurring or worsening.
Last reviewed by a Cleveland Clinic medical professional on 04/16/2020.
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