What Is Hepatic Encephalopathy?

Hepatic encephalopathy is the brain’s neuropsychological experience with liver failure, due to the liver’s inability to properly rid the body of toxins in the blood stream. The buildup of toxins often causes people to report having a “foggy brain”, also known as brain fog.

Types of hepatic encephalopathy

There are three types of hepatic encephalopathy (HE), which are categorized based on the underlying cause that led to the hepatic encephalopathy’s occurrence. Type A is acute and is associated with acute liver failure and cerebral edema. Type B is caused by portal-systemic shunting that is associated with intrinsic liver disease. Type C occurs in patients who have cirrhosis of the liver. Type C patients have further divided into episodic, persistent, and minimal categories, based on the experience of the encephalopathy.

By recognizing a diagnosis of HE and by understanding the patient’s specific type (and sometimes subtype), medical professionals can offer the best possible care to minimize additional damage, to repair current damage, and to help the body to heal and function at its highest possible level, based on the amount of damage that has occurred and whether this can be reversed.

What does it have to do with hepatitis C?

People with hepatitis C often struggle with the health of their liver because the virus can cause significant and permanent liver damage if the virus is not treated shortly after the body becomes infected. In some cases, this damage occurs because the virus has had months or years to impact the body. Often, the most significant damage occurs within the liver’s function. This can result in cirrhosis of the liver, which can be fatal or require permanent care. When the liver has been damaged in a significant way, it is unable to do its job, which is to act as a filter in the body, allowing healthy blood cells to pass through and trapping toxic substances or damaged blood cells from ever reaching the rest of the body. Without this filter, the body can become overrun with harmful substances that can cause damage to other organs or to the brain.

How do I know if I have it?

Symptoms of HE often begin with confusion or irritability. Sometimes this appears to simply be a person having a forgetful moment or being unable to find the right word in a situation. Over time, this can become increasingly dangerous, both because the person is unable to articulate their needs to others and because this indicates an increasing build-up of toxins in the brain. If this continues without medical intervention, the body can eventually slip into a hepatic coma. In these cases, the patient is often tested via blood for both the hepatitis C virus and for a high level of ammonia in the blood, both of which might indicate HE and cause medical professionals to test for this. In addition, other signs of liver damage may be present, including jaundice or ascites.

HE occurs in stages. The first stage is recognized by a backwards sleeping pattern (sleeping in the daytime and being wide awake at nighttime). Next is the continuation of the sleeping pattern plus lethargy or exhaustion and some personality changes. The third stage is the significantly worsening of feelings and experiences of confusion and is often accompanied by jerking of the limbs outside of the patient’s control. The final stage is when the patient’s limb jerking stops, there may be signs of uninhibited behaviors, seizures may occur, and the body progresses into a coma.

Can it be cured?

In many cases, yes. If treatment begins early enough, it is possible to rid the body of the build-up of toxins. Most often, this occurs by using a medication to suppress the creation or production of these substances within the small or large intestine. This medication may be an antibiotic or a specific type of laxative. When this occurs, the body can recover from the damage. However, if the liver has already begun to fail by this time, a liver transplant may be required to keep the toxins from building back up in the body.

How do I prevent hepatic encephalopathy?

In the past, some medical professionals thought that avoiding protein would minimize the risk of HE. In recent years, however, this has been proven untrue. In reality, many people with chronic liver disease lack proper nutrients and may appear malnourished. One way to counteract this is through the consumption of protein and by taking proper amino acids. Some studies also recommend regular consumption of probiotics.^1-6