Hepatic Encephalopathy

Hepatic Encephalopathy

Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma as a result of liver failure. In the advanced stages it is called hepatic coma or coma hepaticum.

It is caused by accumulation in the bloodstream of toxic substances that are normally removed by the liver. The diagnosis of hepatic encephalopathy requires the presence of impaired liver function and the exclusion of an alternative explanation for the symptoms. Blood tests may assist in the diagnosis. Attacks are often precipitated by an intercurrent problem, such as infection or constipation.

Hepatic encephalopathy is reversible with treatment. This relies on suppressing the production of the toxic substances in the intestine and is most commonly done with the laxative lactulose or with non-absorbable antibiotics. In addition, the treatment of any underlying condition may improve the symptoms. In particular settings, such as acute liver failure, the onset of encephalopathy may indicate the need for a liver transplant.

Encephalopathy is the mandatory clinical feature for diagnosis of acute liver failure. Difficulties in the recognition of the early stages of encephalopathy and distinction from drug-induced and renal induced alterations of mental state do not detract from the value of this sign as the most powerful clinical indicator of the severity of liver disease. Once encephalopathy develops, the patient is at high risk for the development of cerebral edema and multi organ failure.

Hepatic encephalopathy may be triggered by; Dehydration, Eating too much protein, Electrolyte abnormalities and a decrease in potassium from vomiting, or from treatments such as paracentesis or taking diuretics, Bleeding from the intestines, stomach, or esophagus, Infections, Kidney problems, Low oxygen levels in the body, Shunt placement or complication, and surgery.
The causes of encephalopathy are both numerous and varied. Some examples of causes of encephalopathy include; infections, anoxia- lack of oxygen to the brain, alcohol consumption, liver failure, kidney failure, metabolic diseases, brain tumors, many types of toxic chemicals, alterations in pressure in the brain, and poor nutrition.

Despite the numerous and varied causes of encephalopathy, at least one symptom present in all cases is an altered mental state. The altered mental state may be subtle and develop slowly over years. For example, in hepatitis the decreased ability to draw simple designs, termed apraxia or be profoundly obvious and develop rapidly. Often, symptoms of altered mental status can present as inattentiveness, poor judgment, or poor coordination of movements.
Other symptoms that may occur are lethargy, dementia, seizures, tremors, muscle twitching, and coma. Often the severity and type of symptoms are related to the severity and cause of the brain disease or damage. For example, alcohol-induced liver damage can result in involuntary hand tremors, while severe anoxia may result in coma with no movement.

Therefore, Hepatic Encephalopathy is very dangerous, as it might cause death.

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