Hepatic encephalopathy is severe brain damage resulting from severe and prolonged liver disease. This condition most often occurs in patients with cirrhosis of the liver. Hepatic encephalopathy must be treated immediately because it can lead to coma and death.
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| Hepatic Encephalopathy, Causes, Diagnosis, Treatment, Prevention, Complications |
The liver has many functions for the body, one of which is cleaning the body from toxins. In patients with prolonged (chronic) liver disease, this function becomes impaired so that the liver cannot cleanse toxins.
Toxic substances that cannot be removed from the body over time will accumulate and flow to the brain, then damage the brain. This condition is known as hepatic encephalopathy.
Causes of Hepatic Encephalopathy
Hepatic encephalopathy is caused by toxins, such as waste products from protein digestion (ammonia), that build up in the body of people with liver disease. Under normal conditions, the liver processes ammonia into urea. Furthermore, the urea is then excreted by the kidneys through urine.
In the long run, toxins that accumulate in the blood will spread to the brain and cause damage to brain cells.
As much as 50% of hepatic encephalopathy occurs in patients with cirrhosis. Certain conditions or diseases that can trigger hepatic encephalopathy in people with cirrhosis are:
- Decreased oxygen levels in the body, for example due to pneumonia
- Gastric bleeding
- Infection
- Dehydration
- Kidney disorders
- Consumption of alcoholic beverages
- Constipation (constipation)
- Surgery or surgical procedure
- Consumption of certain drugs, such as sleeping pills, antidepressants, or antipsychotics
Apart from cirrhosis, hepatic encephalopathy can also occur in people with fulminant hepatitis, toxic chemical poisoning, alcohol-related liver disease, liver cancer, diseases of the bladder and bile ducts, and Reye's syndrome.
Symptoms of Hepatic Encephalopathy
Symptoms of hepatic encephalopathy can appear suddenly and then get worse quickly, or they can happen slowly. Early symptoms of hepatic encephalopathy can include:
- Difficulty concentrating
- Memory and learning disorders
- Irritability or even euphoria
- dazed
If not treated properly, hepatic encephalopathy can get worse and cause symptoms such as the following:
- Very severe drowsiness
- Behavioral disorders
- Slurred or garbled speech
- Shaking hands with a flapping motion (flapping tremor)
- Memory loss (amnesia)
- seizures
- Coma
When to see a doctor
Check with your doctor if you experience the above symptoms, especially if you have liver disease. This is because people with liver disease are often unaware of the symptoms of hepatic encephalopathy. Examination and medical assistance need to be done immediately to prevent complications.
Diagnosis of Hepatic Encephalopathy
The doctor will conduct questions and answers about the symptoms experienced by the patient and his medical history, followed by a physical examination. Physical examination can look at the yellow color in the eyes, swelling in the abdomen (ascites), examination for tremors, and the smell of ammonia on the patient's breath.
After that, the doctor will check the patient's state of consciousness, for example whether the patient is confused.
To confirm the diagnosis, the doctor will carry out the following supporting examinations:
- Blood tests, to check liver function, measure ammonia and electrolyte levels in the blood, and check kidney function
- CT scan of the head, to see if there is damage or bleeding in the brain
- Electroencephalography (EEG), to measure the brain's electrical activity by attaching sensors to the head
- Prothrombin and blood clotting tests, to measure the speed of blood clotting and signs of blood clotting disorders that often occur in liver disease
Hepatic Encephalopathy Treatment
Treatment of hepatic encephalopathy will be adjusted to the severity of the patient. If there is severe brain dysfunction, the patient will be hospitalized. The treatment that will be carried out by the doctor includes:
- Stop bleeding in the digestive tract
- Treat infection
- Perform dialysis procedures if the patient has kidney failure
- Treating electrolyte disturbances, which are common in dehydrated patients and with liver disease
To help lower ammonia levels in the blood, there are medicines that doctors can give, including:
- Lactulose, which is a drug to reduce the amount of ammonia that can be absorbed by the body
- Rifaximin, which is a drug to reduce or stop the production of ammonia by bacteria in the intestine
In addition to administering the drugs above, doctors can also provide other treatments according to the conditions that trigger hepatic encephalopathy. For example, if a bacterial infection triggers this condition, the doctor will treat it with antibiotics.
To speed up healing, the doctor will also advise the patient to do the following:
- Eat less meat to reduce ammonia levels
- Eat small portions but often
- Stop consuming alcoholic beverages
- Live a clean and healthy lifestyle to avoid infection
- Stop taking drugs that affect the liver, such as sedatives
- Eat more fiber and drink enough water to prevent constipation
Complications of Hepatic Encephalopathy
Untreated hepatic encephalopathy can cause complications in the form of:
- Swelling of the brain (brain herniation)
- Damage to multiple organs
- Death
In cirrhotic patients, hepatic encephalopathy can recur many times and get progressively worse.
Prevention of Hepatic Encephalopathy
Prevention of hepatic encephalopathy is to prevent liver disease. Efforts that can be made include:
- Avoid consuming alcoholic beverages.
- Maintain ideal body weight according to body mass index.
- Consume a balanced nutritious diet, and avoid foods high in fat and sugar.
- Do at least 30 minutes of exercise every day.
- Wash hands with soap and running water regularly.
- Don't use drugs.
- Avoid contact with sick people, especially those with viral hepatitis
- Do the hepatitis vaccine according to the doctor's schedule.
- Get regular checkups with your doctor to monitor liver health.
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