Encephalopathy is a generic medical term for diseases and disorders that alter the function or structure of the brain. Hepatic means liver, so hepatic encephalopathy is a disorder of the brain due to problems with the liver. The liver plays an important role in the removal of toxins from the body, so liver disease and dysfunction tends to result in the accumulation of toxins, such as ammonia, which can alter brain function by affecting both neurons and astrocytes. Hepatic encephalopathy can be acute (short-term, reversible) or chronic (long-term) depending on the underlying cause in the liver. Here are some liver issues that result in encephalopathy.
Cirrhosis is a chronic liver disease caused by scarring of the liver tissue. The disease is irreversible and often seen in conjunction with alcoholism or hepatitis C infection (chronic hepatitis). Cirrhosis compromises liver function by damaging the tissue directly via disruption of the liver’s architecture, but also by increasing the risk of liver cancer, bleeding disorders and fluid accumulation.
Hepatitis is inflammation of the liver, often as the result of viral infection, but it can also be caused by acetaminophen overdose. Hepatitis can be acute or chronic, depending on the cause. This disorder is sometimes complementary with cirrhosis. The condition can lead to swelling of the liver (disrupting efficiency of function), liver failure or even liver cancer.
Internal bleeding, dehydration, low oxygen levels and surgical complications can potentially interrupt the balance of compounds in the blood or compromise blood flow to the liver. Problems with the kidneys, another organ responsible for filtering the blood, may also increase the burden on the liver and result in the accumulation of ammonia and other toxins.
Tumors in the liver can disrupt its function in a number of ways. First, the tumor may grow where it can block off blood vessels, causing a lack of blood flow to or from the organ. Second, the tumor can cause the liver to lose functioning mass, making it work harder to do the same amount of work. Third, the tumor can result in damage to surrounding areas of the liver via invasion, causing progressive worsening of liver function and leading to liver failure.
Medications and diet
Eating too much protein can lead to excess ammonia in the blood despite normal liver function because ammonia is a byproduct of protein degradation. Some medications can also suppress the central nervous system after being metabolized by the liver, or the liver may be incapable of metabolizing them.
Symptoms and treatment of hepatic encephalopathy
Individuals with hepatic encephalopathy exhibit confusion and personality or mood changes, and they may have stale or sour breath. Ammonia accumulation in the brain can have a number of dire neurological and neuropsychiatric effects:
- memory loss
- short attention span
- sleep disturbances
Patients with hepatic encephalopathy will also likely exhibit symptoms of their liver disease, as it is the underlying cause of the encephalopathy.
Treatment of the disease attempts to correct the underlying condition and prevent future episodes. The American Liver Foundation offers treatment options and support.