Hepatic encephalopathy

Hepatic encephalopathy is a set of reversible neuropsychiatric symptoms. It occurs in acute liver failure, in which the liver cells die and thus the liver detoxification function is impaired. Hepatic encephalopathy also occurs in chronic liver disease, most often in liver cirrhosis. The cause of hepatic encephalopathy is an increased concentration of substances normally metabolized by the liver, which inhibit nerve transmission in the CNS. It is primarily a change in transmission on GABA receptors. These substances are, for example, ammonia, neurosteroids, glutamine, phenols, mercaptans.

Clinical signs
There are 4 stages


 * 1) In the first stage, the patient is slightly confused, sleep and behavior disorders appear.
 * 2) In the second stage, personality and thinking disorders are present.
 * 3) In the third stage, the patient experiences somnolence and disorientation.
 * 4) The fourth and final stage is defined by coma.

Specific symptoms are flapping tremor and foetor hepaticus.

Diagnostics
It includes a laboratory examination, during which we look for increased ammonia, which is a high level of ammonia in the blood.

We also carry out auxiliary examinations:
 * number connection test (latency when connecting scattered numbers according to sequence),
 * constructional apraxia (e.g. cannot draw a star),
 * EEG, evoked potentials (ocular, auditory, cognitive),
 * CT or MRI of the brain are important in the differential diagnosis.

Differential diagnosis

 * Alcoholism (withdrawal syndrome, delirium tremens),
 * Wilson's disease.

Treatment
The ideal treatment is a liver transplant, because after its implementation, the changes in the body are usually fully reversible. It is also possible to limit protein intake and administer lactulose or lactitol, which are used to cause osmotic diarrhea. ATBs are also administered against intestinal microflora, which will reduce the amount of ammonia produced by intestinal bacteria. For example, rifaximin is used, which acts only on the intestinal microflora and does not have a systemic effect and associated systemic side effects.

Related Articles

 * Liver failure
 * Liver cirrhosis