Hepatic Encephalopathy: What Causes It + Symptoms to Watch Out For

Hepatic encephalopathy is a medical condition that results from the accumulation of toxins within the brain. This usually comes as a manifestation of abnormal liver functions. This article explains more about this disease, its causes, symptoms, and methods of treatment.

Woman confused

If you have been diagnosed with liver disease, you may begin noticing a difference in your action and feeling. Maybe, you easily get confused or forget things, people around you may begin drawing your attention to your slurred speech or that you are saying inappropriate things. You might also notice that your behavior is changing, at times, you find it difficult to move either or both hands at other times it’s your body that is sluggish. Why is all this happening to you? Have you heard about hepatic encephalopathy?

Hepatic encephalopathy is a disorder that is caused by toxin build-up inside the brain, and this can be linked to advanced stages of liver disease. This condition affects things like speech, mood, behavior, movement, or sleep. It is easy to miss these symptoms because they can be so mild, but whether the signs are obvious or subtle changes, you should see a doctor as soon as you can. Getting proper treatment can help to control the condition and prevent it from worsening. As you read on, you will understand more about this condition, why it occurs, and a detailed explanation of the symptoms.

Causes of Hepatic Encephalopathy

The liver is responsible for carrying out so many jobs within the body, one of its vital jobs is to clean up the blood by removing the harmful chemicals produced by the body.

Hepatic encephalopathy will begin when the liver gets damaged due to a disease that has been existing for a long period, like Reye’s syndrome, chronic hepatitis, or cirrhosis. The liver does not work as it should anymore and these means that toxins easily escape into the blood and can travel to the brain. At the brain, they keep on accumulating, and this is what results in the physical and mental symptoms of hepatic encephalopathy.

Several things may trigger the symptoms or worsen the condition. For instance, there is an increased risk of a shunt tube is inserted into the liver. This procedure might be performed to redirect the flow of blood as a form of treatment of a long term health issue or cirrhosis. There is the chance that this shunt tube might permit the toxins to escape the liver and get into the brain.

Other things can trigger hepatic encephalopathy and this might be as a result of;

  • Infection
  • Getting constipated
  • Insufficient water to drink
  • Bleeding from the stomach, esophagus, or intestines
  • Taking medications like pain relievers, water pills, or sleeping pain
  • Kidney problems
  • Consumption of alcohol

The Symptoms

Hepatic encephalopathy affects the body In different ways, some people do not even manifest symptoms while some only manifest mild symptoms. The effects of this condition might begin slowly then gradually worsen little by little. Sometimes the effect might hit hard at once.

These are some of the mental signs you have to look out for;

  • Getting confused
  • Forgetting things
  • Feeling excited or nervous
  • Experiencing sudden behavioral or personality changes
  • Acting or speaking inappropriately
  • Lack of interest in things
  • Getting cranky

In terms of behavioral changes, you will be the last person to realize something is not right. So if you are sick with liver disease do ask your friends and family to alert you if they notice any changes in your behavior. Let them know that they can be honest with you and feel free to tell you when you are not acting like you used to.

Sleep patterns may also be noticed. You may find it difficult to sleep at night but get sleepy in the course of your daytime.

Physical changes may also creep in, an example of this are;  

  • Your breath begins to smell musty or sweet
  • Difficulty in using or moving your hands
  • Hands or arms begin to flap or shake when they are held out
  • Slurred speech
  • Sluggishness during movement of the body


It might be initially difficult to pick off the signs of HE. The people around you may notice your movement or behavior changes before you. If you were previously treated for any liver disease or is currently battling one, the doctor in charge of you may ask if anyone has informed you about any personality changes. The doctor will examine you to check for physical symptoms or signs that come with a brain disorder.

A blood test may be done to check your quantity of ammonia, if the values are high then that is a signal of the weak liver. It is not filtering substances as they should. Excess of this toxin can accumulate in the brain leading to the symptoms of HE.

Here are some questions that you can ask your doctor if you get an HE diagnosis:

  • What is the stage of the brain disease?
  • What are the recommended treatments?
  • Will the symptoms go away or get better?
  • Is there a need for diet change?
  • Will you be able to do the things you normally do like working, driving?


Before treatment can be administered there are many things that will be taken into consideration like:

  • What triggers the episodes
  • The severity of your case
  • What are your symptoms?
  • The seriousness of the liver disease
  • Your age and overall health

Lactulose and antibiotics are two drugs that might be recommended to help reduce the number of toxins.

Other measures can be taken to help relieve your symptoms. For instance, a diet change may be required. The amount of meat you eat needs to be reduced as it is supplying excess ammonia to your body. You can get your protein from sources like veggies and diaries. Also, you should eat small meals more frequently rather than eating three big meals daily.

  • Skipping alcohol – This can also help to relieve the symptoms of HE as these are known to damage the liver.
  • Treating infections – Antibiotics will be given to help you fight infections as your body may not be able to do it.
  • Treat constipation Reduce your meat intake and focus more on vegetables, it will help to regulate movements in your bowels.

Some medications can also help to relieve symptoms and depending on your case the doctor would carry out some medical procedures to relieve your hepatic encephalopathy symptoms. 

Causes of Hepatic Encephalopathy

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