Hepatic Encephalopathy

Overview

What is hepatic encephalopathy?

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).

Who might get hepatic encephalopathy?

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.

What are the types of hepatic encephalopathy?

There are three types of hepatic encephalopathy:

  • Type A is brought on by acute liver failure (without underlying chronic liver disease).
  • Type B occurs in some people who have a shunt that connects two veins inside the liver without underlying liver disease.
  • Type C results from chronic liver disease and scarring (cirrhosis).

Symptoms and Causes

What causes 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:

What are the symptoms of hepatic encephalopathy?

People with hepatic encephalopathy experience impaired brain function. Symptoms include:

  • Anxiety or irritability.
  • Cognitive impairment (confused thinking or judgment).
  • Coordination or balance problems.
  • Difficulty concentrating or short attention span.
  • Flapping hand motion (asterixis).
  • Mood or personality changes.
  • Muscle twitches (myoclonus).
  • Reduced alertness.
  • Sleep problems.
  • Slurred speech,

Diagnosis and Tests

How is hepatic encephalopathy diagnosed?

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:

  • Medical history.
  • Symptoms.
  • Office exam.

Management and Treatment

How is hepatic encephalopathy managed or treated?

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:

  • Antibiotics: Bacteria in your body make natural toxins from digested foods. Antibiotics, such as rifaximin (Xifaxan®), stop bacterial growth. As a result, the body produces fewer toxins.
  • Laxatives: Lactulose oral solution, a laxative made from lactose sugar, draws toxins into the colon. The laxative stimulates frequent bowel movements that help remove toxins from the body.

What are the complications of hepatic encephalopathy?

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.

Prevention

How can I prevent hepatic encephalopathy?

Proper management and treatment of liver disease is key to lowering the chances of developing hepatic encephalopathy. These steps can lower your risk:

  • Avoid alcohol, which damages liver cells.
  • Avoid medications that affect the nervous system, such as sleeping pills and antidepressants.
  • Eat a nutritious diet, exercise and maintain a healthy weight (especially important if you have fatty liver disease).
  • Take your prescribed medications to treat liver disease.
  • Undergo regular liver function tests.

Outlook / Prognosis

What is the prognosis (outlook) for people with hepatic encephalopathy?

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.

Living With

When should I call the doctor?

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.

What questions should I ask my doctor?

If you or someone you love has hepatic encephalopathy, you may want to ask your doctor:

  • How is liver disease affecting my body?
  • What can I do to improve liver function or slow liver disease?
  • What liver disease treatment will work best for me now?
  • What is the best treatment for hepatic encephalopathy?
  • How long do I need to take medication for hepatic encephalopathy?
  • Are there any medications I should avoid?
  • Should I make any dietary changes to support liver function?
  • Could I benefit from a liver transplant?
  • Should I look out for signs of complications?

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.

References

  • Liver Foundation. Accessed 5/7/2020.Hepatic Encephalopathy Information Center. (https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/hepatic-encephalopathy/)
  • Merck Manual Consumer Version. Accessed 5/7/2020.Hepatic Encephalopathy. (https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/hepatic-encephalopathy)
  • National Organization for Rare Disorders (NORD). Accessed 5/7/2020.Hepatic Encephalopathy. (https://rarediseases.org/rare-diseases/hepatic-encephalopathy/)

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