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    What is HE?

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    HEPATIC ENCEPHALOPATHY (HE) IS A COMPLICATION OF CIRRHOSIS, A SEVERE FORM OF LIVER DISEASE.

    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.

    Why does HE develop?

    Liver disease is common in the United States. About 30 million people in the US have some type of liver disease. Common types of chronic liver disease include:

    • Alcohol-related liver disease, a result of drinking too much alcohol
    • Nonalcoholic fatty liver disease (NAFLD), or too much fat in liver cells
    • Hepatitis, or inflammation of the liver caused by viruses (most commonly classified as A, B or c)
    • Liver cancer

    All types of long-term liver disease can 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 - when scar tissue replaces healthy tissue. As cirrhosis becomes worse, the liver has less healthy tissue. A healthy liver 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.

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    Why does HE develop

    EACH PATIENT'S JOURNEY WITH HE IS DIFFERENT, BUT REMEMBER THAT YOU ARE NOT ALONE IN YOUR DIAGNOSIS - THERE ARE OTHER PATIENTS GOING THROUGH SIMILAR EXPERIENCES. CHECK OUT THIS CANDID CONVERSATION WITH HE PATIENT, STEVEN, AND HIS PHYSICIAN AS THEY DISCUSS THE IMPORTANCE OF HAVING A TRUSTED CARE TEAM THAT IS DEDICATED TO SUPPORTING YOU IN YOUR DIAGNOSIS.

    How is HE managed
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    What are the symptoms of hepatic encephalopathy?

    HE may 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.

    Your doctor may tell you what “Grade” of HE you or your loved one has. Minimal and Grade 1 is considered covert. Grades 2, 3 and 4 are overt hepatic encephalopathy.

    Grade 2 is the least severe overt HE and grade 4 is the most severe overt HE.

    HE symptoms outlined by Grade include:

    Grade 1:
    • Lack of awareness
    • Euphoria
    • Depression or anxiety
    • Shortened attention span
    • Difficulty with addition or subtraction
    • Altered sleep patterns,
      including insomnia
    Grade 2:
    • Lack of energy or interest
    • Confused sense of date and time
    • Obvious personality change
    • Inappropriate behavior
    • Uncoordinated movements
    • Tremor or flapping of the wrists
    Grade 3:
    • Sleepiness or stupor
    • Responds to stimuli
    • Confused sense of place,
      where one is
    • Extreme disorientation
    Grade 4:
    • Complete unresponsiveness (hepatic coma)

    To help track your symptoms at home and talk to your doctor about your symptoms over time, complete this symptom tracker.

    If you have 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.

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    How is HE managed

    How is HE managed?

    It will take teamwork among you, your loved ones and your doctors to help manage HE. Be honest with your doctors about your symptoms, experiences and challenges you may be having.

    Your doctor may put you on guideline-recommended therapy, that can include more than one medication. These practice guidelines are published by The American Association for the Study of Liver Disease (AASLD) and provide doctors with recommendations for managing chronic liver disease. These guidelines are recognized as the standard of care for the management of HE.

    Speak to your doctor to find out if the AASLD guidelines could impact your management plan.

    Going to doctor appointments are important for managing HE because the doctor can confirm if your management plan is working. The doctor may also recommend lifestyle changes, which could include not drinking alcohol or changes to your diet. If your liver disease or HE becomes severe, your doctor may recommend a liver transplant.

    It is important to follow the recommendations by your doctor, including taking your medicine correctly and making lifestyle changes.

    To learn more about a medication that may help adult patients with overt HE, click here.

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    Watch this video to review the information found on this webpage, including an overview of HE, symptoms and Disease management.

    How is HE managed
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