hepatic encephalopthy

Hepatic Encephalopathy is serious condition of the brain, that includes neurological changes that are seen in some patients with severe Liver Disease (Most common). There are other causes or these changes.

The diagnosis can be a Chronic or an Acute finding. Chronic usually indicates that problems are more long term, acute is a recent problem.

The Condition or Symptoms are often reversible if treated appropriately, however if there is liver failure, that may not be the case.

Hepatic Encephalopathy can also be seen in Portal Hypertension and shunting of blood away from the Liver. A build up of Ammonia inside the body, is primarily responsible for the symptoms but other toxins can be involved as well.

The liver becomes unable to properly decontaminate the blood. Ammonia is able to cross the blood brain barrier. This toxin then causes Inflammation to occur in the Brain.

Causes Other Than Liver Disease:

–  Medications:  (Narcotics, Diuretics, Diazepam, Lorazepam)
–  Alcohol
–  Infection
–  Renal Failure
–  Hypokalemia –  *Low potassium in blood
–  Hyponatremia – *Low sodium in blood
–  Hypoglycemia  – *Low sugar in blood
–  Dehydration

Symptoms:

–  Changes in memory and personality
–  Difficulty to concentrate and slowed reaction time
–  Tremor  (Asterixis)
–  Seizures
–  Agitation
–  Coma
–  Swelling in the brain
–  Changes in speech
–  Death can occur

Typical Stages Seen with Hepatic Encephalopathy:

Subclinical – Subtle changes
Stage 1 –  Tremor, incoordination, apraxia
Stage 2 –  Asterisix slowed or slurred speech, Ataxia
Stage 3 –   Hypoactive reflexes, nystagmus, clonus, muscular rigidity
Stage 4 –   Coma, dilated pupils, absence of response to stumuli

Treatment:

–  Decrease protein intake  [This will decrease amount of ammonia]
–  Correct Hypokalemia, Hyponatremia, and Hypoglycemia
  –  Lactulose – helps decrease ammonia amounts
  –  Rifaximin  [Antibiotics]
–  Treat liver disease

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