Hepatic encephalopathy (HE): Causes, types, symptoms, and home remedies

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Hepatic encephalopathy (HE) is a condition in which the liver cannot remove toxins found in the blood. It results in a loss of brain function and can lead to liver failure. This neuropsychiatric syndrome is caused by metabolic abnormalities. The liver is unable to remove and break down toxins found in blood either because it is damaged or because the blood does not circulate properly in the liver.

Often, if liver health improves, hepatic encephalopathy may be reversed. This can be done by treating the liver condition or increasing blood flow. Consequences of prolonged HE can result in a coma or even be fatal.

Causes of hepatic encephalopathy

Hepatic encephalopathy develops when the liver becomes damaged as a result of a chronic disease, such as hepatitis. When the liver cannot function properly, cleaning out toxins in the bloodstream becomes increasingly difficult. When this buildup of toxins occurs, it can lead to mental and physical symptoms.

Three types of hepatic encephalopathy

There are three main types of hepatic encephalopathy: acute, chronic, and chronic cerebral degeneration and myelopathy.

Acute encephalopathy: Rapidly progresses over a short time span. This is a complication of acute liver disease and is a sign of terminal liver failure. It is commonly found in patients who have acute fulminant viral hepatitis, toxic hepatitis, and Reye’s syndrome (the syndrome causes swelling of the liver and the brain).

Chronic encephalopathy: Occurs multiple times and requires long-term treatment to minimize and prevent symptoms during intervening periods. Cirrhosis patients who have extensive portal collateral circulation and/or shunts typically experience this type of HE. In this case, patients have redundant circulation to their organs, meaning, the blood can travel in different pathways to the same spot. In-between episodes, chronic HE may be mild and symptoms may not be noticeable. Chronic HE is a sign of deterioration caused by cirrhosis, a liver disease resulting from alcoholism and hepatitis.

Chronic cerebral degeneration and myelopathy: Possible permanent neurological abnormalities that don’t respond well to treatment. It can affect a person’s ability to walk or stay balanced. It is quite rare. Tremors similar to those in Parkinson’s disease may be present.

Four stages of hepatic encephalopathy

Stage 1: Symptoms in this stage affect sleep patterns and may include anxiety, depression, and restlessness.

Stage 2: Personality changes can occur in stage two. The ability to complete mental tasks is impaired and disorientation occurs.

Stage 3: Behavior becomes bizarre, aggression and rage are present, speech becomes harder to understand. and there is a sense of paranoia.

Stage 4: Coma may occur. Patient becomes unresponsive to pain stimuli.

Risks and symptoms of hepatic encephalopathy

The liver’s main role is to filter out toxins from the body. These toxins could be introduced by environmental factors, diet, and even the medications we take. When the liver is healthy, it can filter our these toxins without problems. But a sick and damaged liver cannot complete this function, which results in a toxin buildup.

Risks of hepatic encephalopathy

To avoid HE, people should take care to maintain a healthy liver. Avoid used needles, minimize alcohol intake, and maintain a healthy weight to protect your liver. There are other triggers that can increase one’s risk of developing HE, as well. They include:

• Dehydration
• Excessive protein intake
• Electrolyte abnormalities – low levels of potassium
• Bleeding from intestines, stomach, or esophagus
• Infections
• Kidney problems
• Low oxygen
• Shunt placement or complications
• Surgery
• Medications that suppress the central nervous system.

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Symptoms of hepatic encephalopathy

Early stage symptoms of HE

• Musty or sweet odor breath
• Changes in sleep patterns
• Changes in thinking
• Mild confusion
• Forgetfulness and mind fog
• Changes to mood and personality
• Lack of concentration
• Impaired judgment
• Fine motor skills – like writing – become impaired

These symptoms can be seen in early stages of HE, but as the illness progresses, so do the symptoms.

Severe symptoms of HE:

• Abnormal movements of limbs
• Agitation, excitement
• Disorientation
• Drowsiness or confusion
• Dramatic changes to behavior and personality
• Slurred speech
• Slowed movements

Depending on the severity of symptoms, patients with HE have trouble caring for themselves and often require the assistance of a caregiver.

Home remedies to manage hepatic encephalopathy

By maximizing liver health, you can better treat and even prevent hepatic encephalopathy. One way of doing this is through nutrition and diet. Diet plays a large role in liver health as everything we consume passes through the liver. By eating to promote liver health, you can lower your risk of developing HE.

Here’s what you can do to prevent hepatic encephalopathy:

• Avoid alcohol
• Eat alternative sources of protein – vegetables, legumes, beans, etc.
• Consume small and frequent meals – avoid periods of fasting
• Eat whole grains
• Limit salt, sugar, and fatty foods
• Stay properly hydrated – six to eight glasses a day

By following these prevention tips, you can have greater success in reducing your risk of hepatic encephalopathy.

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