Hepatic Encephalopathy

Liver disease that involves loss of cells (hepatocytes) and irreversible scaring of the liver,cirrhosis as in itself is not infectious


Hepatic failure (liver cells failure) due to

  • Acute viral hepatitis
  • Cirrhosis
  • Prolonged use of drugs with high side effects
  • Hepatic encephalopathy may be triggered by:

    • Infections such as pneumonia
    • Kidney problems
    • Dehydration
    • Hypoxia, or low oxygen levels
    • Recent surgery or trauma
    • Medications that suppress your immune system
    • Eating too much protein
    • Medications that suppress your central nervous system, such as barbiturates or benzodiazepine tranquilizers
    • Electrolyte imbalance, especially a decrease in potassium after vomiting or taking diuretics


    A. Disturbance in consciousness

    • Disturbances in sleep rythm
    • Impaired memory
    • Mental confusion
    • Apathy
    • Coma

    B. Changes behaviour

    • Childish behaviour
    • May be aggressive outburst
    • Euphoric


    Symptoms and signs of moderate hepatic encephalopathy may include:

    • Difficulty thinking;
    • Personality changes;
    • Poor concentration;
    • Problems with handwriting or loss of other small hand movements
    • Confusion
    • Forgetfulness
    • Poor judgment
    • A musty or sweet breath odor

    Symptoms of severe hepatic encephalopathy are:

    • Confusion
    • Drowsiness or lethargy
    • Anxiety
    • Seizures
    • Severe personality changes
    • Fatigue
    • Confused speech
    • Shaky hands
    • Slow movements


    • Diagnosis is usually made clinically
    • Routine investigations include: l fts, electrolytes, urea, creatinine
    • Elevation of blood ammonia
    • CSF & CT scan


    • Supportive treatment
    • Specific treatment aims at: decreasing ammonia production in colon