Gastroenterology - Hepatic Encephalopathy

What is Hepatic encephalopathy?

Hepatic encephalopathy, also known as Portosystemic encephalopathy, is the occurrence of confusion, altered levels of consciousness and coma as a result of liver failure. It may ultimately lead to death.

It is caused by the accumulation in the blood stream of toxic substances normally removed by the liver and deposited in the brain. Many patients with cirrhosis experience episodes of hepatic encephalopathy, mostly at a level where it is not very noticeable.

Who is at risk?

Hepatic encephalopathy can affect people of all ages, regardless of whether they are male or female and who have liver disease/ cirrhosis.

Signs and symptoms

When it is noticed, it can show as sleep disturbance in particularly sleeping by day and being awake at night.

There may be mild confusion, slurring of words, tremors and a particular symptom of flapping hands once you extend your arms known as asterixis. There may be some subtle personality changes too.

In some people, the sleepiness can progress to a loss of consciousness and even a coma which can be life threatening.

What are the different stages of Hepatic Encephalopathy?

Stage 1 - Mild drowsiness and impaired cognition.

Stage 2 - Increased confusion more drowsy probably sleeping by day and being awake at night. A noticeable Liver flap (asterixis). Sometimes incontinent and there may be some personality changes.

Stage 3 - Worsening confusion, sleepy but rousable, restless and agitation.

Stage 4 - Progression to coma (No response to painful stimuli).

What triggers encephalopathy?

• Constipation
• Dehydration
• Infections
• Electrolyte disorder
• Some medications (such as tranquilisers)
• Recent surgery or trauma

Treatment

Hepatic Encephalopathy is reversible.

Lactulose – a sweet syrupy medicine works by suppressing the production of toxic substances in the intestine and thereby acts as a laxative which helps the body remove the toxins that build up when the liver is failing.

You should take enough lactulose so that you have at least 2 – 3 bowel movements every day. You may also be given other laxatives and/or an enema.

Rifaxamin – This is a broad spectrum antibiotic in tablet form that is taken twice a day alongside the lactulose. It has proved effective in the prevention of recurrent encephalopathy.

As Hepatic Encephalopathy is a result of a chronic condition, there is no need for hospitalisation. Ensuring the bowels act often reverses the condition and this is something you can do at home.

Looking after yourself

In general, it is best to aim for as near to a normal life as possible. However, there are some points that you may keep in mind:

• A diet with adequate protein and energy is recommended
• Dietary supplement drinks may be of benefit
• Ensure your bowels act at least 2 to 3 times per day
• Always take your medicine as prescribed and avoid those that can cause constipation e.g. Codeine
• Ask close family members to read this booklet as they are often the first to notice any changes in your behaviour and can administer the lactulose
• Avoid smoking
• Exercise or to try to keep yourself physically active
• Avoid sleeping tablets or tranquillisers

Contact details

If you have any questions please contact the Gastroenterology Specialist Nurse Service. This service is provided by two registered nurses with specialist experience and who have qualifications in liver disease management.

Working hours 08:30am to 3:30pm, Monday to Friday
Please note we do not work on bank holidays

The Royal Oldham Hospital - 0161 656 1538
Mobile – 07805587375

You may leave a message on the office phone and your call will be answered as soon as possible, although this may not be on the same day.

This document was produced with thanks to the British Liver Trust (Registered Charity 298858)

www.britishlivertrust.org.uk or phone the helpline 08006527330.