Definition:

A group of symptoms that may occur when there is damage to the brain and nervous system as a
complication of liver disorders, characterized by various neurologic symptoms including changes
in reflexes, changes in consciousness, and behavior changes that can range from mild to severe.

Alternative Names:
Hepatic coma; Encephalopathy - hepatic

Causes, incidence, and risk factors:

Hepatic encephalopathy is caused by disorders affecting the liver. These include disorders that
reduce liver function (such as cirrhosis or hepatitis) and conditions where blood circulation
bypasses the liver. The exact cause of the disorder is unknown.
The liver cannot properly metabolize and detoxify substances in the body. Accumulation of toxic
substances causes metabolic abnormalities that lead to damage in the central nervous system
(brain and spinal cord). One substance believed to be toxicis ammonia, which is produced by the
body when proteins are digested, but normally is detoxified by the liver. Many other substances
also accumulate in the body and damage the nervous system.
In people with otherwise stable liver disorders, hepatic encephalopathy may be triggered by
episodes of gastrointestinal bleeding, excessive dietary protein, electrolyte abnormalities
(especially decrease in potassium, which may result from vomiting or treatments such as diuretics
or paracentesis), infections, renal disease, and procedures that shunt blood past the liver.
The disorder may also be triggered by any condition that results in alkalosis (alkaline blood pH),
low oxygen levels in the body, use of medications that suppress the central nervous system (such
as barbiturates or Benzodiazepine tranquilizers), surgery, or possibly a coincidental illness.
Disorders that mimic or mask symptoms of hepatic encephalopathy include alcohol intoxication,
sedative overdose, complicated alcohol withdrawal, Wernicke-Korsakoff syndrome, subdural
hematoma, meningitis, metabolic abnormalities such as low blood glucose.
Hepatic encephalopathy occurs in approximately 4 out of 100,000 people. It may occur as an
acute, potentially reversible disorder or as a chronic, progressive disorder.