Hepatic Encephalopathy: Symptoms, Stages, Causes, Treatment

People suffering from chronic liver diseases often face a neurological (nervous system) disorder known as hepatic encephalopathy (HE). It mostly happens when the liver is unable to efficiently carry out its functions.

Hepatic encephalopathy can be both acute (short-term) and chronic (long-term). It can further lead to severe conditions like coma. Thus, diagnosing and treating this condition from the earlier stages is important to avoid complications. Continue reading to learn more about hepatic encephalopathy meaning, gradings, symptoms, causes, risk factors, prevention, diagnosis, treatment and more.

Disease Name	Hepatic encephalopathy
Alternative Name	HE, Portosystemic encephalopathy
Symptoms	Changes in personality, Confusion, Lack of balance, Seizures, Shaky hands
Causes	Alcohol addiction and abuse, Kidney problems, Infections (like pneumonia), Hypoxia, Dehydration
Diagnosis	Blood test, Imaging test, Liver function test
Treated by	Hepatologist, Gastroenterologist
Treatment Options	Medication (Antibiotics and Laxatives)

Hepatic encephalopathy refers to a temporary disorder causing a decline in brain functioning. It occurs when individuals suffer from long and severe liver disease.

A diseased liver often struggles to fulfil its function of filtering toxins from the system, which are generated as a result of the metabolism of food, and the dissolution of drugs, alcohol and other substances inside the body.

As a result, the toxins start building up, travel to the brain and affect its function. Once toxicity affects the brain, people start having difficulty forming thoughts, personality changes, intellectual impairment, and lack of consciousness. If left untreated, it can lead to serious brain damage.

Hepatic encephalopathy is a complicated health issue, which can be of different types with differing levels of intensity for the patients. Upon understanding hepatic encephalopathy’s meaning, one might wonder about its types. Here are the main types of this condition that the patients face.  

1. Type A: Acute liver failure causes this type of hepatic encephalopathy. In most cases, it comes without an underlying chronic liver disease.
2. Type B: It occurs in people who have a shunt connecting two veins inside the liver without underlying liver disease.
3. Type C: Usually this condition ends up because of the chronic liver disease and scarring (liver cirrhosis). It affects the liver badly. 

Stages of Hepatic Encephalopathy

Medical researchers often classify different hepatic encephalopathy stages based on the severity of its symptoms in the patients. Here are the five stages of this condition following the West Haven Criteria.

1. Stage 0: This is the initial stage where the symptoms are minimal and not noticeable. 
2. Stage 1: Symptoms start getting mildly visible in this stage. They can cause changes in your ability to pay attention or sleep cycle, causing hypersomnia or insomnia.
3. Stage 2: Symptoms are more visible and moderate in this stage. They make you feel lethargic and disoriented, disturbing your brain functions.
4. Stage 3: Symptoms start getting severe and more intense from this stage. It leads to personality changes and confusion. Patients find it challenging to perform basic activities. 
5. Stage 4: This is the final and more intense stage. It usually leads to a coma.

The underlying causes of the condition often determine hepatic encephalopathy symptoms. These may vary from one patient to another. Here are the symptoms in case of moderate hepatic encephalopathy:

1. Changes in personality 
2. Difficulty thinking 
3. Lack of concentration 
4. Confusion 
5. Difficulty memorising or remembering anything 
6. Poor judgement 
7. Problem with hand movement and work 
8. Lack of balance

Apart from that, here are the symptoms you can face in case of severe hepatic encephalopathy:

1. Drowsiness and lethargy 
2. Lack of energy
3. Anxiety and panic 
4. Seizures
5. Speech problems and confusion 
6. Fatigue
7. Slow movements 
8. Shaky hands and asterixis
9. Muscle twitches
10. Cognitive impairment

Medical researchers are not sure about the exact reasons causing hepatic encephalopathy. Generally, a build-up of toxins in the bloodstream is mainly responsible for this disorder. This occurs when a person’s liver cannot complete its role of filtering the toxins.

Here are some commonly known causes of hepatic encephalopathy:

1. Alcohol addiction and abuse
2. Drugs affecting the nervous system, like antidepressants 
3. Kidney problems 
4. Infections, such as pneumonia 
5. Hypoxia 
6. Recent surgery 
7. Dehydration or electrolyte imbalance
8. Constipation 
9. Bleeding in the digestive tract 
10. Liver shunt

One of the biggest risks that puts a person at risk of developing this condition is liver cirrhosis. Nearly 50% of people suffering from liver cirrhosis end up developing hepatic encephalopathy. Alcohol abuse, viral hepatitis, fatty liver disease, autoimmune hepatitis, etc. are some of the risk factors.

Listing down the risks that lead to HE:

1. Some other serious liver condition
2. Having experienced HE before
3. The presence of portal hypertension
4. Having a TIPS process

It is not possible to guarantee the prevention of hepatic encephalopathy. However, the following activities can help you reduce the chances of its occurrence. 

1. Avoid or reduce alcohol consumption. 
2. Plan a diet with limited high-protein and high-fat food items. 
3. Avoid medicines that affect the nervous system. 
4. Try to keep your weight in a healthy range. 
5. Go for regular liver tests to keep track of the liver condition. 
6. Wash your hands properly after using the bathroom to avoid viral hepatitis.
7. Avoid close contact with people who are suffering from the condition. 
8. Do not share contaminated needles.

There is no standard test for diagnosing hepatic encephalopathy. However, blood tests and other physical examinations can help this process. When individuals visit the hospital, the doctor asks questions about their medical history and symptoms.

Here are some of the common procedures used to diagnose this condition:

1. Blood Tests: Blood tests are usually conducted to determine the total count of RBC, WBC and platelets. Moreover, they also help check your body's sodium, potassium and ammonia levels.
   The presence of excessive amounts of these substances might be a sign of impaired liver function.
2. Imaging Tests: These tests are also essential for diagnosing any damage in the brain or checking if it is unable to function properly. CT scans and MRIs are done to check for any abnormalities in your brain or possibilities of internal bleeding in your head.
3. Liver Function Tests: As the name suggests, such tests are done to check the condition of your liver. It helps the doctors check for growth in enzyme levels, which indicates stress on the liver and associated damage.

How to Prepare for a Doctor’s Consultation?

When considering a doctor’s consultation, it can be helpful to have an idea of the kind of questions to ask the doctor to get a better understanding of the condition. Here are some of them:

1. Which stage of hepatic encephalopathy am I suffering from?
2. Will I recover through proper treatment?
3. When will my symptoms start reducing?
4. Do I need to change my diet?
5. Will I be able to continue working?

One must also know that doctors usually consider the following factors when planning the treatment process for patients. 

1. Factors triggering the symptoms 
2. The severity of the condition 
3. Types and intensity of the symptoms
4. Age and overall health condition 

Thus, patients should be prepared to undergo a long-term and severe healthcare plan based on these factors.

Hepatic encephalopathy treatment depends on the severity and stage of the disease. Hence there is no standard regimen. Proper medication and diet usually help to reduce the intensity of the symptoms.

Medication

Usually, the following medicines are prescribed for this condition. 

1. Antibiotics: Doctors often prescribe antibiotics to prevent bacterial growth. Bacteria are responsible for creating toxins from digested food. These medicines, thus, help in curbing toxins from the body.
2. Laxatives: Doctors might suggest laxatives like Lactulose oral solution to draw toxins towards the colon. The laxatives speed up/initiate frequent bowel movements to make the process happen.

The liver disease requires treatment, such as medications and lifestyle changes, such as abstaining from alcohol. If the underlying cause of the liver disease is not addressed, liver function deteriorates and toxins accumulate.

Hepatic Encephalopathy is already a complicated health issue. So, when it affects the health of an individual, he/she is likely to face various other related complications and problems. Here are some of these:

1. Brain herniation
2. Brain swelling
3. Coma (in advanced HE stage)
4. Organ failure

When to Consult a Doctor?

It is essential to consult the doctor when one starts seeing symptoms of hepatic encephalopathy. It is easier to predict these for people already suffering from liver disease.

Even if a patient is unable to determine, people in his/her surroundings will clearly see differences in terms of personality changes, mood swings, impaired thinking, etc.

Moreover, when the liver disease starts developing issues of bowel movement, such as constipation, it is an indication of hepatic encephalopathy. One should therefore consult a doctor if he/she notices such symptoms.

As hepatic encephalopathy is an intricate health issue, it is important to follow a meticulous diet to avoid any further complications or side effects. Protein intake must be managed effectively while integrating more carbohydrates, which will be the primary source of calories.

Here is a list of food items that can be added to the diet chart when one suffers from this condition. 

1. Rice
2. Milk 
3. Vegetables like beetroots, potatoes, onions, green peas, tomatoes, carrots, etc.
4. Fruits like grapes, blueberries, cranberries, melons, etc. 
5. Tea or coffee
6. Nuts 
7. Fatty fish 

However, there are certain food items one needs to avoid while suffering from hepatic encephalopathy, as these can lead to health complications. Here are some of these:

1. Fatty cuts of meat
2. Fried food
3. High-fat dairy food
4. Butter or sour cream
5. Sugary food items like cake, soda, cookies, packaged food, etc.
6. Food items with high salt content 
7. Alcohol

Hopefully, that gives you a complete understanding of hepatic encephalopathy. It is a serious health issue, which should not be neglected. As this article pointed out, this condition can lead to disruptions in brain functions, even causing multiple organ failure and coma. Thus, you should not waste time seeking medical attention if you notice its symptoms. 

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