Hepatic encephalopathy

Hepatic encephalopathy is a neuropsychiatric complication of liver failure in which toxins that a damaged liver cannot clear build up in the blood and impair brain function. It occurs in people with severe or chronic liver disease, such as cirrhosis from viral hepatitis, alcohol use disorder, autoimmune hepatitis or fatty liver disease. Episodes are triggered by infection, gastrointestinal bleeding, dehydration, constipation, electrolyte disturbance, kidney problems and sedative or narcotic medicines. Early symptoms are mild confusion, forgetfulness, changed sleep, mood change and poor concentration; later come disorientation, drowsiness, slurred speech, flapping tremor of the hands and, in some people, coma. Assessment relies on clinical signs and ruling out similar disorders, supported by liver function and electrolyte tests, head scans and electroencephalography. Management removes the trigger and uses lactulose as the mainstay, with rifaximin to prevent recurrence; neomycin is a further antibiotic option, and long-term therapy may be needed.

Seek urgent care for vomiting blood, black or bloody stools, severe abdominal pain, or difficulty swallowing. See a doctor for heartburn more than twice a week, a change in bowel habit lasting more than three weeks, or unexplained weight loss. Call the local emergency number for any symptom that is sudden and severe. This page is a reference for healthcare professionals and does not replace an assessment.