What is hepatic encephalopathy?

Hepatic encephalopathy (say "hip-PAT-ik in-sef-uh-LAW-puh-thee") is a problem in the brain. It happens when the liver has been damaged and can't filter toxins from the blood. These toxins build up in your bloodstream and affect your brain. This can lead to personality changes. It can also make it hard to think clearly and remember things.

It may be caused by long-term (chronic) liver disease. These diseases include cirrhosis, liver failure, and a type of high blood pressure in the veins that filter blood into the liver (portal hypertension).

In some cases, symptoms are mild. In other cases, they can be very serious. It depends on the cause and how much the condition has progressed.

Your doctor may do a few tests to diagnose this problem. These may include blood tests and memory tests. You may have MRI or CT scans, which show a picture of your brain. You also may have an EEG. This is a test that shows the electrical activity of your brain.

What can you expect when you have it?

Some cases of hepatic encephalopathy last just a short time. They may be cured with treatment. If the condition lasts a long time (is chronic), it usually gets worse over time. But if you work closely with your doctor and follow your treatment plan, you may make some symptoms less severe.

Flare-ups of symptoms can happen. Following your treatment plan may help reduce flare-ups.

If your symptoms are severe, you may need help with daily activities. You may need support at home. Severe cases may require a stay in the hospital.

What are the symptoms?

Symptoms may include feeling cranky, grouchy, or depressed. You may have problems finding words, thinking, concentrating, or remembering things. Your sleep pattern may change, such as being sleepy during the day and awake at night. Symptoms such as twitching of muscles or jerking movements of hands may also occur.

How is it treated?

Treatment may include medicine to treat any other problems, such as bleeding in the digestive tract. Your doctor will also likely prescribe a medicine called lactulose. It increases bowel movements. This helps prevent the buildup of toxins in the blood that may lead to encephalopathy. Make sure to keep taking your medicine as directed, because it can keep the condition from quickly getting worse. Your doctor also may prescribe antibiotics, such as rifaximin.

Your doctor also may talk to you about changes in diet. Certain foods may make symptoms worse.

If treatment doesn't help, then a liver transplant may be needed.

How can you prevent flare-ups?

• Your doctor may talk to you about changing your diet. Certain foods may make symptoms worse.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Check with your doctor nurse advice line before you use any new medicines. Some medicines can cause symptoms to flare up.