• Hepatic Encephalopathy

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


    Hepatic encephalopathy is a problem with the brain that is caused by liver disease. The problem may be temporary or permanent.
    oxygen brain lungs
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    A liver with disease cannot filter the harmful items in blood. These toxins build up in the blood, which reaches the brain and affects the brain’s ability to work properly.

    Risk Factors

    Factors that increase your chance of hepatic encephalopathy include:
    • Severe cirrhosis, especially after shunt surgery
    • Hepatitis—infectious or autoimmune
    • In people with chronic liver disease it may be triggered by:
      • Certain conditions that affect the levels of fluids and electrolytes such as hyponatremia and hyperkalemia
      • Gastrointestinal bleeding
      • Infections
      • Certain medications such as sedatives and anti-epileptics
      • Kidney failure
      • Constipation


    In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include:
    • Changes in behavior and personality
    • Shortened attention span
    • Depression or anxiety
    • Difficulty sleeping
    • Tiredness
    • Forgetfulness
    • Disorientation
    • Slurred speech
    • Uncontrolled movements, particularly a flapping tremor of the hands
    • Confusion
    • Loss of consciousness
    If you have liver problems and any of the above symptoms, call your doctor right away.


    You will be asked about your symptoms and medical history. A physical exam will be done. The condition of your nervous system will also be assessed.
    Your liver and kidney function may be assessed. This can be done with:
    • Liver function tests
    • Kidney function tests
    • Imaging tests of the liver
    Your brain and nervous system may be assessed. This can be done with:


    Hospitalization and Emergency Care

    The initial treatment will focus on treating and trying to reverse the underlying problems. If possible, toxins in your blood will be removed or neutralized.


    Medications may be used to:
    • Neutralize toxins in the intestine, such as ammonia
    • Remove blood from the intestines
    • Reduce ammonia production by intestinal bacteria
    • Treat the condition that started the encephalopathy
    • Reduce recurrence

    Dietary Restrictions

    Changes in your diet may be recommended. Tube feeding may be needed to supply nutrients, especially in the case of coma.


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


    To help reduce your chance of hepatic encephalopathy:
    • Get early treatment for liver problems.
    • If you have a disease such as cirrhosis, see your doctor regularly.
    • Follow your doctor's instructions regarding medications. Avoid overdosing.
    • Avoid being exposed to poisons or toxins.
    • Avoid excessive use of alcohol.
    • Do not use illicit drugs.


    National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov


    Canadian Liver Foundation http://www.liver.ca

    Health Canada http://www.hc-sc.gc.ca


    Bernuau J. Acute liver failure: Avoidance of deleterious co-factors and early specific medical therapy for the liver are better than late intensive care for the brain. J Hepatol. 2004;41:152-155.

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

    Hepatic encephalopathy. Canadian Liver Foundation website. Available at: http://www.liver.ca/liver-disease/types/cirrhosis/hepatic-encephalopathy.aspx. Accessed July 5, 2017.

    Hepatic encephalopathy. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/hepatic-encephalopathy/. Published June 2014. Accessed July 5, 2017.

    Hepatic encephalopathy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116905/Hepatic-encephalopathy. Updated July 8, 2016. Accessed September 29, 2016.

    Highleyman L. Hepatitis C. HCV Advocate website. Available at: http://www.hcvadvocate.org/hepatitis/hepC/hepatic%5Fencephalopathy.html. Published December 2002. Accessed February 17, 2014.

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

    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 Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116905/Hepatic-encephalopathy: FDA approves new use of Xifaxan for patients with liver disease. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm206104.htm. Updated April 24, 2013. Accessed February 17, 2014.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
    • Review Date: 03/2017
    • Update Date: 03/05/2014
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