Cirrhosis Complications: Encephalopathy

Hepatic encephalopathy is a problem in the brain. It happens when the liver has been damaged and can't filter toxins from the blood. These toxins build up in your bloodstream and affect your brain. This can lead to sleep and mood changes. It can also make it hard to think clearly and remember things.

What are the symptoms?

Symptoms may include feeling cranky, grouchy, or depressed. You may have problems finding words, thinking, concentrating, or remembering things. Your sleep pattern may change, such as being sleepy during the day and awake at night. Symptoms such as twitching of muscles or jerking movements of hands may also occur.

What increases your risk?

A long-term (chronic) liver disease increases the risk of encephalopathy. Such diseases include cirrhosis, liver failure, or high blood pressure in the portal vein system (portal hypertension).

Many other things can affect your risk for encephalopathy. These may include the use of sedatives, opioids, or alcohol. Other things that may increase your risk include:

• Gastrointestinal bleeding.
• Abnormal levels of electrolytes in the blood (especially low potassium levels).
• The amount of protein in the diet.
• Infection, dehydration, or constipation.

Certain procedures (such as shunting, which redirects the flow of blood or fluid through other areas of the body) that help lower portal hypertension and prevent variceal bleeding may actually be a risk factor for encephalopathy.

How is it treated?

Your doctor will likely prescribe a medicine called lactulose. It increases bowel movements. This helps prevent the buildup of toxins in the blood that may lead to encephalopathy. Your doctor also may prescribe antibiotics, such as rifaximin. Treatment may also include medicine to treat any other problems, such as bleeding in the digestive tract.