What is Hepatic Encephalopathy?
Hepatic encephalopathy (HE) is a complication of cirrhosis, a severe form of chronic liver disease. One of the important functions of the liver is to clean the blood; when the liver is damaged, it can no longer properly clean toxins (like ammonia) from the blood. This buildup of toxins can reach the brain, potentially causing HE and worsening brain function. Early HE symptoms can start slowly and may go unnoticed. Symptoms of HE can be both physical and mental. Medications and appropriate lifestyle management, with the help of a doctor, may help manage the disease.
Hepatic encephalopathy can be considered either “covert” or “overt”:
Covert hepatic encephalopathy
Symptoms are minimal and can go unnoticed, even by a doctor.
overt Hepatic encephalopathy
Symptoms are more noticeable to other people.
Hepatic Encephalopathy May Develop From Liver Disease
Liver disease is common in the United States. About 30 million people in the U.S. have some type of liver disease.
Common types of chronic liver disease include:
Alcohol-related liver disease A result of drinking too much alcohol
Non-Alcoholic fatty liver disease Often caused by obesity, insulin resistance or imbalance of lipids in the blood
Hepatitis Inflammation of the liver caused by viruses (most commonly classified as A, B, or C)
LIVER CANCER When cells in the liver grow out of control
All types of long-term liver disease may lead to liver damage, liver scarring or even liver failure. Several factors contribute to liver damage, including infections, uses of certain medications, alcohol ingestion, blocked or damaged tubes that carry bile from the liver to the intestines, exposure to toxic chemicals, and more.
Living with liver disease, or a liver injury, for a long time can lead to cirrhosis – a condition when scar tissue replaces healthy tissue. As cirrhosis becomes worse, the liver has less healthy tissue, which is needed to help your body process food and nutrients into energy and to remove harmful toxins.
As the liver damage gets worse, it can no longer remove toxins from the blood and HE symptoms may develop.
Download this tip sheet to help talk to others about your HE.
Watch this video for an overview of HE, symptoms and disease management.
WATCH VIDEO
Watch this video for an overview of HE, symptoms and disease management.
WATCH VIDEOThe Symptoms of Hepatic Encephalopathy
Your doctor may tell you what "Grade" of HE you or your loved one has. Minimal hepatic encephalopathy and Grade 1 is considered covert HE. Grades 2, 3 and 4 are overt HE. Grade 2 is the least severe overt HE and grade 4 is the most severe overt HE.
Hepatic encephalopathy symptoms outlined by grade include:
- Lack of awareness
- Euphoria
- Depression or anxiety
- Shortened attention span
- Difficulty with addition or subtraction
- Altered sleep patterns, including insomnia
- Lack of energy or interest
- Confused sense of date and time
- Obvious personality change
- Inappropriate behavior
- Uncoordinated movements
- Tremor or flapping of the wrists
- Sleepiness or stupor
- Responds to stimuli
- Confused sense of place or where one is
- Extreme disorientation
- Complete unresponsiveness (hepatic coma)
If you have chronic liver disease, such as cirrhosis, and are experiencing any of these symptoms, talk to your doctor about the possibility of HE. Early diagnosis and treatment are key to help manage the disease state.
After someone starts to show HE symptoms or has an overt hepatic encephalopathy episode, they are at risk of having more overt episodes in the future. Hospitalizations may occur as a result of overt HE.
Use our symptom tracker to track your symptoms at home and talk to your doctor about your symptom progression.
Managing Hepatic Encephalopathy
It will take teamwork among you, your loved ones, and your doctors to help manage HE.
Going to your doctor appointments is important for managing HE because the doctor can confirm if your management plan is working, and shift plans as needed. Be honest with your doctors about your symptoms or challenges you may be facing.
Managing Hepatic Encephalopathy
It will take teamwork among you, your loved ones, and your doctors to help manage HE.
Going to your doctor appointments is important for managing HE because the doctor can confirm if your management plan is working, and shift plans as needed. Be honest with your doctors about your symptoms or challenges you may be facing.
Talk to Your Doctor
It is important to follow the recommendations by your doctor, including taking your medication correctly and making lifestyle changes.
Learn more about a medication option that may help adult patients with overt hepatic encephalopathy
While each patient’s journey with HE is different, remember that you are not alone in your diagnosis. There are other patients going through a similar experience.
Watch this video to hear from Steven and his physician as they discuss the importance of having a trusted care team that is dedicated to supporting you in your diagnosis.
WATCH VIDEO
While each patient’s journey with HE is different, remember that you are not alone in your diagnosis. There are other patients going through a similar experience.
Watch this video to hear from Steven and his physician as they discuss the importance of having a trusted care team that is dedicated to supporting you in your diagnosis.
WATCH VIDEO