Have you ever heard of the term hepatic encephalopathy? Maybe now that you are reading this article, one of your friends and relatives in the hospital is in the phase of hepatic encephalopathy. In this article, we intend to provide information about the concept of hepatic encephalopathy and talk about the symptoms and clinical manifestations in people with encephalopathy.
Doctors use the term hepatic encephalopathy when brain function is reduced and impaired due to liver dysfunction.
In fact, hepatic encephalopathy is not a disease in itself, but a secondary disorder that will follow a liver disorder.
The liver plays a key role in clearing toxins from the bloodstream. In some disorders and liver failure, the liver cannot complete detoxification, so we will have the accumulation of toxins in the bloodstream. These toxins reach the brain through the bloodstream and cause brain dysfunction or encephalopathy.
Because the liver disorder has caused this encephalopathy, it is called hepatic encephalopathy.
In the phase of hepatic encephalopathy, the patient first becomes confused, then loses consciousness and eventually goes into a coma.
Types of hepatic encephalopathy or HE
In one form of classification, HE can be divided into the following two general categories:
- Acute hepatic encephalopathy:
Acute hepatic disease occurs in a person with severe liver disease. Doctors say the occurrence of acute hepatic encephalopathy in a person with severe liver disease can be a sign of liver failure.
The following people may develop acute hepatic encephalopathy:
- People with toxic hepatitis:
Toxins can cause severe inflammation and liver disorders called toxic hepatitis.
- Chemical toxins
They are the causative agents of toxic hepatitis
- Acute viral hepatitis
- Ray Syndrome:
It is a very serious condition that often occurs in children and quickly causes cerebral edema and inflammation of the brain and liver.
- Chronic hepatic encephalopathy:
This complication occurs in people who have previously had cirrhosis and liver failure. These people should be treated promptly. Chronic hepatic encephalopathy can occur frequently or cause permanent complications such as seizures or spinal cord injuries.
In the following, we will deal with another type of HE classification.
- Type A hepatic encephalopathy:
This type of hepatic encephalopathy develops following an acute ALF liver failure.
These people have no previous history of liver disease and suddenly experience a decrease in liver function. This decrease in function progresses over days and weeks. The most common cause of type A encephalopathy is acetaminophen overdose.
And other causes are:
- Acute viral hepatitis
- Wilson’s disease
- Excessive alcohol consumption
- Type B hepatic encephalopathy:
This type causes disorders of blood flow around the liver that interfere with the liver’s detoxification function.
The most common causes of type B HE
- Congenital disorders
- Hepatic encephalopathy type c:
Cirrhosis is the last phase of liver dysfunction.
Seventy percent of people with cirrhosis will have HE
Many people with cirrhosis may only experience mild symptoms of hepatic encephalopathy that recur frequently throughout their lives. The most common causes of cirrhosis are:
- Chronic hepatitis B
- Chronic hepatitis C.
- Alcohol-dependent liver disorders
- Non-alcoholic fatty liver
Stages and symptoms of liver encephalopathy
There are five standard stages for hepatic encephalopathy. At each stage, the symptoms vary in type and severity. There is an increase in the severity of the symptoms in advanced stages. Physicians describe these five stages according to criteria known as West Haven as follows:
Clinical signs will be minimal, for example, to the extent of impaired concentration
- The person’s symptoms are mild
- Concentration disorder
- Changes in sleep habits
- Sleeping a lot
Moderate clinical signs appear
- Memory impairment
- Memory loss
- changes in speech and expression(Speech disorders)
In this phase, the symptoms have intensified.
- The patient cannot do his daily routines on his own
- He has severe lethargy
- He has confusion
- Even at this stage, personality changes occur
At this stage, the person has a decreased level of consciousness and will eventually fall into a coma
Why does hepatic encephalopathy occur?
Disorders of liver function will lead to an increase in toxins in the bloodstream. A healthy liver will remove toxins such as nitrogenous toxins and ammonia compounds from the blood.
In the presence of a defective liver, the accumulation of toxins in the blood increases and as the toxins reach the brain, the brain cells become impaired and their function decreases. In the early stages, the manifestations of this decrease and dysfunction of brain cells are low and mild. With gradual progression, both the symptoms become more severe and the symptoms become more severe.
The following factors may provide the conditions for the onset and progression of hepatic encephalopathy, or they may themselves cause symptoms such as hepatic encephalopathy:
- Dehydration of body cells
- New surgery
- Trauma and accidents
- Excessive consumption of proteins that leads to an increase in nitrogenous toxins
- Kidney problems
- Decreased blood potassium, for example, following chronic vomiting or diuretics
- Decreased blood oxygen
- Drugs such as:
- Antidepressant drugs
- Immunosuppressive drugs
We emphasize that hepatic encephalopathy will be severely exacerbated despite any of the following conditions:
- Excessive consumption of oral protein
- Dehydration of the body
Certainly, the clinical signs and manifestations of hepatic encephalopathy are related to the underlying cause, ie the type of liver disorder, but in general
Symptoms in moderate hepatic encephalopathy:
- Memory impairment
- Impaired concentration, decreased concentration and lack of concentration
- Impaired judgment
- Impaired ability to think
- Personality changes
Symptoms in severe HE:
- Severe confusion
- Excessive fatigue
- Slow movements
- Speech changes
- Shaking hands
- Very severe and obvious personality changes
- Excessive drowsiness
- Decreased level of consciousness
Failure to seek immediate medical attention will result in coma.
Hepatic encephalopathy is considered as a neurological abnormalities that can be controlled and eliminated with timely treatment. With the improvement of liver function, all symptoms will disappear.
Sometimes hepatic encephalopathy presents only with psychological problems and personality changes.
Complications of hepatic encephalopathy
- Protrusion of the brain from the sub cranial hole and entry of the brain into the brainstem (cerebral hernia)
- Inflammation of brain tissue
- Movement disorders in the arms or legs