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Hepatic Encephalopathy

(Encephalopathy, Hepatic; Portal-Systemic Encephalopathy; Encephalopathy,Portal-Systemic)

Pronounced: MET-a-bol-ik En-SEF-a-lo-PATH-ee

by Nathalie Smith, MSN, RN

En Espaol (Spanish Version)

Definition

Hepatic encephalopathy refers to brain dysfunction due to liver disease. The brain dysfunction may be temporaryor permanent. People with cirrhosis, a liver disease, are most commonly affected.

Oxygen and Blood Flow to the Brain

If the liver is not working properly, toxins can build up in the blood. The toxic blood travels to the brain, affectingthe brain's ability to function.

2011 Nucleus Medical Media, Inc.

Causes

This condition happens because the diseased liver can no longer filter toxins from the body. In some cases, theliver has too much scar tissue, and blood has to be re-routed around the liver. Toxins, like ammonia, build up,affecting the brains ability to function.

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Hospitalization and Emergency Care

In the hospital, the staff will treat and try to reverse the underlying problem. They will try to remove or neutralizetoxins that have built up in the blood.

Medications

Medications may be used to:

Neutralize toxinsTreat the conditionReduce recurrence

A common medicine used is called lactulose. This is a type of sugar that the body cannot digest. It may help toreduce how much ammonia your body produces.

Dietary Restrictions

You may need to eat a low-protein diet to help lower blood ammonia levels. (The body creates ammonia when itmetabolizes and uses protein.) You may have other changes in your diet.

Tube feeding and life support may be needed, especially in the case of coma.

Transplantation

If this condition is due to liver failure, you may need a transplant.

Prevention

To help reduce your chance of getting this condition, take the following steps:

Get early treatment for liver problems. If you have liver problems and any of the above symptoms, call yourdoctor right away.If you have a disease (such as cirrhosis), see your doctor regularly.Avoid overdosing. Avoid being exposed to poisons or toxins.

RESOURCES:

National Digestive Diseases Information Clearinghousehttp://digestive.niddk.nih.gov/index.htm/

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Canadian Liver Foundationhttp://www.liver.ca/Home.aspx/

Health Canadahttp://www.hc-sc.gc.ca/index_e.html/

REFERENCES:

Bernuau J. Acute liver failure: avoidance of deleterious co-factors and early specific medical therapy for the liver

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are better than late intensive care for the brain (review). J Hepatol. 2004;41:152-155.

Butterworth RF. Role of circulating neurotoxins in the pathogenesis of hepatic encephalopathy: potential forimprovement following their removal by liver assist devices. Liver Int. 2003;23(suppl 3):5-9. Review.

DynaMed Editorial Team. Hepatic encephalopathy. EBSCO DynaMed website. Available at:http://www.ebscohost.com/dynamed/what.php . Updated July 22, 2010. Accessed August 3, 2010.

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Lizardi-Cervera J, Almeda P, Guevara L, et al. Hepatic encephalopathy: a review. Ann Hepatol. 2003;2:122-130.Review.

Siegal GJ, Agranoff BW, Albers RW, Uhler MD. Metabolic encephalopathies. In: Basic Neurochemistry:Molecular, Cellular, and Medical Aspects. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.

Toftengi F, Larsen F. Management of patients with fulminant hepatic failure and brain edema. Metab Brain Dis.2004;19:207-214.

4/2/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : FDAapproves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Availableat: http://www.fda.gov... . Published March 24, 2010. Accessed April 2, 2010.

Last reviewed September 2011 by Marjorie Bunch, MDLast Updated: 9/1/2011

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