Conditions in which blood circulation does not enter the liver
An important job of the liver is to make toxic substances in the body harmless. These can include substances made by the body as well things that you take in (such as medicines). However, when the liver is damaged, these "poisons" can build up in the bloodstream. Ammonia, which is produced by the body when proteins are digested, is one of the substances normally made harmless by the liver. Other toxins may also build up. These things can cause damage to the nervous system.
When liver damage occurs, hepatic encephalopathy may occur suddenly, even in people who have not had liver problems in the past. More often, the problem develops in people with chronic liver disease.
Hepatic encephalopathy can be a medical emergency that requires a hospital stay.
The first step is to identify and treat any factors that may have caused hepatic encephalopathy.
Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Infections, kidney failure, and electrolyte abnormalities (especially potassium) need to be treated.
Life support may be necessary to help with breathing or blood circulation, particularly if the person is in a coma. The brain may swell, which can be life-threatening.
If the problem is very bad, you may need to cut down the protein in your diet. However, too little protein can cause malnutrition, so you should talk to a dietitian about how to change your diet. People who are very ill may need intravenous or tube feedings.
You may be given lactulose to prevent intestinal bacteria from creating ammonia and to remove blood from the intestines. You may also get neomycin to reduce ammonia production by intestinal bacteria. Rifaximin, a new antibiotic, is also effective in hepatic encephalopathy.
You may need to avoid sedatives, tranquilizers, and any other medicines that are broken down by the liver. Medicines containing ammonium (including certain antacids) should also be avoided. Your doctor may suggest other medicines and treatments. These may have varying results.
Acute hepatic encephalopathy may be treatable. Chronic forms of the disorder often continue to get worse and come back.
Both forms of the condition may result in irreversible coma and death. The majority of people who go into a coma will die. The chances of getting better vary from person to person.
Increased risk of heart, kidney, and breathing problems
Increased risk of body-wide infection
Permanent nervous system damage
Coma that continues to get worse
Side effects of medicines
When to Contact a Medical Professional
Call your health care provider if you or people around you notice any problems with your mental state or nervous system function. This is very important for people who already have a liver disorder. Hepatic encephalopathy can get worse quickly and become an emergency condition.
Treating liver problems may prevent hepatic encephalopathy. Avoiding heavy drinking and intravenous drug use can prevent many liver disorders.
Nevah MI, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopumonary syndrome, and systemic complications of liver disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 92.
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.
George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.