Hepatic encephalopathy

[Tanya Shivari]

Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach the brain.

Hepatic encephalopathy occurs in people who have a long-standing (chronic) liver disorder.
Hepatic encephalopathy may be triggered by bleeding in the digestive tract, an infection, failure to take drugs as prescribed, or another stress.
People become confused, disoriented, and drowsy, with changes in personality, behavior, and mood.
Doctors base the diagnosis on symptoms, results of the examination, and response to treatment.
Eliminating the trigger and taking lactulose (a laxative) and rifaximin (an antibiotic) may help symptoms resolve.

(See also Overview of Liver Disease.)
Substances absorbed into the bloodstream from the intestine pass through the liver, where toxins are normally removed. Many of these toxins (such as ammonia) are normal breakdown products of the digestion of protein. In hepatic encephalopathy, toxins are not removed because liver function is impaired. Also, some toxins may completely bypass the liver through abnormal connections (called collateral vessels) that form between the portal venous system (which supplies blood to the liver) and the general circulation. These vessels form as a result of liver disease and portal hypertension (high blood pressure in the portal vein, which is the large vein that brings blood from the intestine to the liver).
A procedure used to treat portal hypertension (called portosystemic shunting) may also enable toxins to bypass the liver. Whatever the cause, the outcome is the same: Toxins can reach the brain and affect its function. Doctors aren