• No categories

Dr Ravindra Nidoni

Hepatic Encephalopathy

Hepatic Encephalopathy (HE), sometimes referred to as portosystemic encephalopathy or PSE, is a condition that causes temporary worsening of brain function in people with advanced liver disease. When your liver is damaged it can no longer remove toxic substances from your blood. These toxins build up and can travel through your body until they reach your brain, causing mental and physical symptoms of HE.

Diagnosing Hepatic Encephalopathy

There is no specific test used to diagnose HE. A Hepatic Encephalopathy diagnosis is based on a combination of three things:

  • Your medical history
  • Your symptoms
  • A thorough clinical exam by your healthcare provider

Learn if you or someone you love is at risk of getting HE, what triggers this complication and how it’s exhibited

Treating Hepatic Encephalopathy
Being confronted with a diagnosis of HE can be overwhelming and because HE is a complicated condition, a multidisciplinary approach is often required to manage it. Learn more about treating Hepatic Encephalopathy.
Support for Patients with Hepatic Encephalopathy
If you’re living with HE or caring for a loved one with HE you’ll likely need emotional, physical, or financial support at certain points in your journey. Learn how and where you can get that support – from finding resources to help pay for the cost of medications to learning how to talk about your diagnosis with friends and family.
Caregivers of Patients with Hepatic Encephalopathy
If you are the caregiver for someone with HE, it’s likely you’re not completely new to this role as your loved one has probably been living with some form of chronic liver disease and cirrhosis for some time now. Learn more about caring for patients with Hepatic Encephalopathy.

Facts at-a-Glance

01
Hepatic Encephalopathy is a brain disorder that develops in some individuals with liver disease.
02
Approximately 70% of individuals with cirrhosis may develop symptoms of Hepatic Encephalopathy.
03
In some cases, Hepatic Encephalopathy is a short-term problem that can be corrected. It may also occur as part of a chronic problem from liver disease that gets worse over time.

What is hepatic encephalopathy?

A poorly working liver may lead to the build-up of toxins. These toxins can cause problems such as:

  • Falls
  • Poor sleep
  • Mood changes (crankiness)
  • Poor concentration
  • Inability to calculate (do bills, manage money)
  • Less alertness

If it gets bad, these toxins can even cause a coma. See Figure 1, below. These changes are all symptoms of hepatic encephalopathy. Sometimes we call this “HE”.

HE is when toxins from the gut bypass the liver and hurt brain function. There are different grades (levels) of HE. Grades 2-4 are serious and require immediate medical attention

  • Grade 4: Coma
  • Grade 3: Sleepy, hard to get attention
  • Grade 2: Confused, goofy, stumbling
  • Grade 1: Poor attention, mood changes

Minimal: Poor concentration, bad sleep Key point: This is not dementia. This is mostly reversible with treatment such as lactulose.

How is Hepatic Encephalopathy diagnosed?

This diagnosis is made by a clinician such as a doctor, physician assistant, or nurse practitioner. We examine you, listen to you or your caregivers and use the information about what is happening in your life to make the diagnosis. There is no blood test for hepatic encephalopathy. It often occurs in people with high ammonia levels, but not always. People with low ammonia can have hepatic encephalopathy and people with high ammonia may not have hepatic encephalopathy.

  1. Your doctor may stop medications that can make you confused. Some of the main medications we worry about are called benzodiazepines which include Ativan, Xanax, and valium. Some pain medications can also make hepatic encephalopathy worse. 2. Lactulose is the primary medication we use to treat hepatic encephalopathy. Lactulose is a syrup. It helps flush toxins from your gut by trapping them in your stool and making you poop more frequently. Other laxatives or medications that make you poop more will not do the same thing. People usually start with 2 or more tablespoons of lactulose syrup once or twice a day. The dose is gradually increased until you are having about 2-4 soft stools a day. Lactulose is one of the only medicines where it is up to you and your family to adjust the dose. • Increase the dose if: o Your stools are firm o You are having fewer than 2 stools per day o You are developing symptoms like worsening sleep, falls/stumbling, mood changes, or confusion. • Decrease the dose if you are having more than 4 loose stools per day. 3. Some people will need a medication called rifaximin (Xifaxan®). This is an antibiotic (used to treat infections caused by bacteria) that only works in the intestine. This medicine lowers your risk of developing an episode of severe hepatic encephalopathy.
  2. Your doctor will likely recommend a high protein diet. Your body’s muscle plays a big role in cleaning your blood. We need to support it by making sure you eat enough protein. The general amount of protein we recommend is 1 gram protein for every kilogram (about 2 pounds) of your body weight). You may hear from other doctors or websites that high protein is bad. That advice is outdated. Without high protein you may lose muscle, experience more hepatic encephalopathy, and become weaker. For more information see “Cirrhosis Nutrition Therapy” here:
  1. Some people with this condition develop active and severe hepatic encephalopathy. Get urgent medical attention if you are: • Disoriented • Confused • Falling asleep inappropriately We want you to be seen in the emergency department if you have these symptoms because hepatic encephalopathy can be a sign of infection, dehydration, or kidney damage, and those issues need to be treated urgently.
Open chat
1
Scan the code
Powered by Joinchat
Hello 👋
Can we help you?