Hepatic encephalopathy is linked to an accumulation of harmful substances in the brain, particularly ammonia. The symptoms caused may be neurological disorders, personality disorders or disorders of consciousness. Treatment generally involves taking lactulose and an antibiotic. It is also necessary to identify and treat possible triggering factors.
What are the symptoms of hepatic encephalopathy?
The liver is the most important gland in the human body. The liver has many roles. The liver is involved in the metabolism of carbohydrates, lipids and proteins. It has an immune role and a blood reservoir role. The liver helps detoxify many molecules that are potentially toxic to the body. When the liver can no longer play these roles, particularly due to liver pathologies such as cirrhosis, then certain molecules can accumulate in the body and cause different symptoms. Certain toxic molecules can, in fact, accumulate in particularly sensitive tissues. This is the case, for example, of ammonia which can become dangerous for brain tissue. An accumulation of this substance then leads to more or less significant neurological and neuropsychiatric disorders.
Disorders may begin with slight changes in mood, behavior, or a reduction in reasoning skills. The intensity of these disorders can be classified into different stages, as stated in the Swiss Medical Review. At stage 1, the patient may suffer from impaired sleep and coordination disorders. In stage 2, confusion and lethargy may set in, as well as a disorder of muscle tone in the extensor muscles of the hand, called asterixis. In stage 3, disorientation may be marked. In stage 4, the patient may slip into a coma.
How is hepatic encephalopathy diagnosed?
The diagnosis of hepatic encephalopathy can sometimes be difficult to make, because many diseases can cause neuropsychiatric disorders. First, it is important to know the patient’s history and whether they have liver disease. Indeed, according to the summary of the new recommendations on hepatic encephalopathy from the website of the French Association for Continuing Medical Education in Hepato-Gastro-Enterology, hepatic encephalopathy, even minimal, will affect almost 2/3 of patients. suffering from cirrhosis. A neurological examination is then carried out. The presence of an asterixis, although it is often found in advanced stages of hepatic encephalopathy, is not specific for this condition, but can help in the diagnosis, especially if there is a context of liver failure.
Disorders of consciousness, personality or neurological disorders are important and must be analyzed. The use of medical imaging and in particular MRI (Magnetic Resonance Imaging) makes it possible to check whether there are any cranial lesions. An electroencephalogram is generally also performed and can highlight the slowing of certain brain waves. Finally, a blood test is always carried out and makes it possible in particular to evaluate, in addition to the usual parameters, the ammonia level (plasma ammonia level), or to look for a possible electrolyte disorder for example.
What are the treatments for hepatic encephalopathy?
The standard treatment consists of prescribing lactulose and rifaximin in particular. Lactulose is a laxative and a non-assimilable disaccharide (sugar composed of galactose and fructose) which has the effect of stimulating certain bacteria in the colon producing lactic acid, which acidifies the environment and reduces the bacteria which produce ammonia . Rifaximin is a broad-spectrum antibiotic that also helps reduce the population of ammonia-producing bacteria. Treatment also involves taking care of contributing factors. According to the MSD Manual, triggering factors can be an infection, digestive bleeding or even an electrolyte imbalance, for example. Taking certain medications (such as sedative medications) or toxins such as alcohol, or severe dehydration can also trigger hepatic encephalopathy. An episode of hepatic encephalopathy is reversible, however a recurrence is possible, it is therefore essential to regularly monitor patients suffering in particular from liver disease and to avoid triggering factors as much as possible.
Sources
- Hepatic encephalopathy in patients with cirrhosis: novelty and practical recommendationsSaskia Ditisheim and Laurent Spahr, Revue Médicale Suisse, September 8, 2010
- Hepatic encephalopathyFrench Association for Continuing Medical Education in Hepato-Gastro-Enterology, 2020
- Hepatic encephalopathyThe MSD Manual – Consumer Version, January 2023
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