Liver Life Cafe

Hepatic Encephalopathy (HE)

Hepatic encephalopathy is a brain disorder and refers to the changes in the brain that occur in patients with advanced, acute or chronic liver disease and is one of the major complications of cirrhosis. Hepatic encephalopathy (HE), may occur suddenly in people with acute liver failure however, the condition is more often seen in people with chronic liver disease. An important job of the liver is to change harmful substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged and unable to function fully, these “toxins” may build up in the bloodstream. HE occurs when the liver cannot remove chemicals, such as ammonia. These chemicals then enter the brain and can affect both the mental and physical condition of patients. Often certain factors can be responsible for triggering an episode of HE in liver patients. The following factors may trigger an episode of HE: • Dehydration (loss of water from the body) • Low oxygen levels in the body • Eating too much protein • Constipation • Infections • Intestine, stomach, or oesophagus bleeding • Medications that affect the nervous system, such as tranquilisers or sleep medications • Kidney problems or Surgery Patients with acute liver disease, who have an episode of HE, generally find that once the trigger is removed and their liver condition is treated, the HE disappears. However, some patients with the chronic liver disease find they will have recurring episodes of HE. Episodes of HE usually result in hospitalisation, as without treatment, patients remain at high risk for recurrence. Other complications of untreated HE can be brain swelling, permanent nervous system damage, increased risk of heart failure, kidney failure, respiratory failure and sepsis (blood poisoning) and in severe cases coma. HE symptoms can present at a range of stages from mild to overt (severe). Mild Symptoms of HE can be observed in nearly 70% of patients with cirrhosis. Overt HE occurs in about 30-45% of patients with cirrhosis. HE symptoms can vary from person to person; they can develop rapidly or slowly over time. Patients with HE can have both physical symptoms and reduced mental function. I believe, that it is so important for family members and friends to understand that when a person suffers from an HE episode. It isn’t the individual being mean or nasty. It is a chemical reaction within the brain that is causing this uncommon behaviour. It isn’t the fault of the patient, and although the words that are spoken are often confusing, there is no meaning behind them as they are being chemically driven.