Skip to main content
Mother Nature AI
NeurologicalICD-10: K72.9Affects 30–45% of patients with cirrhosis at some point

Hepatic Encephalopathy

Also known as: Liver Brain Disease, Portosystemic Encephalopathy

Hepatic encephalopathy is a decline in brain function occurring when the liver cannot adequately remove toxins, particularly ammonia, from the blood. It is most commonly seen in advanced cirrhosis and ranges from subtle cognitive changes to coma. With appropriate treatment, episodes can be managed and recurrence reduced.

Symptoms

Confusion and disorientation
Forgetfulness and poor concentration
Personality and mood changes
Slurred speech
Asterixis (flapping tremor of the hands)
Drowsiness and lethargy
Sleep disturbances (day-night reversal)
Coma in severe cases

Causes

  • Accumulation of ammonia and toxins due to liver failure
  • Portal-systemic shunting bypassing liver detoxification
  • Precipitating factors: GI bleeding, infection, constipation, dehydration

Risk Factors

  • Advanced cirrhosis from any cause
  • Previous episodes of hepatic encephalopathy
  • TIPS placement
  • GI bleeding
  • Infection or sepsis
  • Kidney dysfunction

Diagnosis

  • Clinical assessment of mental status in a patient with liver disease
  • Blood ammonia level (elevated)
  • Psychometric testing for minimal hepatic encephalopathy
  • Exclusion of other causes of altered mental status
  • CT or MRI to rule out other conditions

Treatment

  • Lactulose to reduce ammonia absorption from the gut
  • Rifaximin for secondary prevention of recurrence
  • Identification and treatment of precipitating factors
  • Adequate nutrition with appropriate protein intake
  • Liver transplant evaluation for recurrent or severe episodes

When to See a Doctor

  • A person with liver disease becomes confused or disoriented
  • Personality changes or excessive drowsiness develop suddenly
  • Hand-flapping tremor (asterixis) is noticed
  • The person becomes unresponsive

Frequently Asked Questions

Related Conditions

Fatty Liver Disease

Digestive

Hepatitis C

Infectious

Liver Cancer

Cancer

Jaundice

Digestive

Have questions about Hepatic Encephalopathy?

Ask Mother Nature AI for personalized, evidence-based guidance.

Ask about Hepatic Encephalopathy

Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

Content reviewed against peer-reviewed medical literature and clinical guidelines. Read our editorial standards.