Liver Encephalopathy (hepatic coma, hepatic encephalopathy, or portal-systemic encephalopathy) is a medical condition, where function of brain is deteriorates because of toxic substances, that must be normally removed from a person’s liver, build up in the bloodstream. Normally, such substances are absorbed into the blood from the person’s intestine passing through the liver where toxin is removed.
However, in Liver Encephalopathy, the toxin can’t be removed because of impaired liver function. Also, because connections can be formed between the general circulation and portal system, certain toxins can bypass the person’s liver altogether. No matter, what cause, the outcome is the same: toxin may pass to the person’s brain and damage it. Which substance is toxic to the brain is unknown; but high protein blood level breakdown products, including ammonia, may play a role. In a patient, who has long standing liver disorder, encephalopathy is commonly triggered by acute infections or alcoholic binge, which increases damage of the liver, or it can be triggered by eating excessive amount of protein, which increases the protein’s levels breakdown products in the bloodstream.
Some medications, especially, diuretics, analgesics, and sedatives may also cause Liver Encephalopathy. When the specific cause is removed, the Liver Encephalopathy can disappear. The Liver Encephalopathy’s symptoms are the result of reduced brain’s function, particularly, impaired consciousness. In the early stages of the Liver Encephalopathy, subtle changes occur in behavior, personality, and logical thinking. The individual’s mood can change and judgment can be impaired. As the Liver Encephalopathy develops, a patient commonly becomes confused and drowsy, and speech and movements becoming sluggish. Common symptoms also include disorientation. A patient with Liver Encephalopathy can be excited and agitated, but it is not common.
Sometimes, an individual can lose consciousness and lapse into the coma. The procedure, called EEG (electroencephalogram) can help to diagnose Liver Encephalopathy, EEG reveals abnormal waves of brain. A blood test generally reveals abnormality of high ammonia levels.
The treatment of the Liver Encephalopathy consists of trying to remove any precipitating causes such as infection or medications which a patient uses. The physician also tries to rid off toxic substances from the intestine. Protein should be avoided in the diet and intravenous or oral carbohydrates should be given as a major source of calories. Lactulose (synthetic sugar), used orally, has 3 beneficial effects:
1. lactulose decreases ammonia absorption
2. lactulose works as laxative (cleansing enemas can also be given)
3. lactulose alters intestine’s acidity, changing the type of bacteria present
Sometimes, the doctor prescribes antibiotic Neomycin instead of synthetic sugar lactulose. Prescription drug Neomycin decreases intestinal bacteria quantity, the bacteria that usually helps digest proteins. Liver Encephalopathy is often reversible with a proper treatment. In fact, complete cure is possible, particularly if the Liver Encephalopathy is precipitated by a reversible causes. However, for a patient with severe coma, caused by acute liver inflammations, the condition is fatal in about 80% of the cases.