Hepatic encephalopathy is a condition where the brain is damaged by toxins normally processed by the liver, leading to a hepatic coma. It can occur suddenly or in patients with chronic liver disease. Symptoms include confusion, mood changes, and memory problems. Treatment involves addressing the underlying liver problem and limiting protein intake. In severe cases, a liver transplant may be necessary.
A liver coma is a loss of consciousness due to a liver problem or liver failure. When liver tissue is destroyed or diseased, it is unable to process toxins in the blood properly. These toxins can poison the brain, slipping the patient into a coma. Hepatic encephalopathy occurs when the brain is damaged by toxins normally processed by the liver and a hepatic coma is the last stage of the condition. In some cases, doctors can treat the underlying condition that affects the liver, but in severe cases with irreversible liver damage, the comatose patient will eventually die.
Hepatic encephalopathy typically occurs in patients who have chronic liver disease, such as cirrhosis or hepatitis, although it can occur suddenly in people who have no previously diagnosed liver problems. Gastrointestinal bleeding leads to excess ammonia and other toxins in the body, which cannot be adequately filtered if the liver is not functioning well. Eating excessive amounts of protein, dehydration, kidney problems, infections, and electrolyte imbalances can also lead to hepatic encephalopathy.
Patients who eventually enter a hepatic coma usually show mild symptoms before entering the coma. The most common symptoms of hepatic encephalopathy are confusion, mood changes, memory problems, inability to concentrate, changes in sleeping habits, and a sweet or musty breath smell. Since these symptoms can also be indicative of many other diseases, it is important to seek medical treatment if a patient exhibits sudden changes in breath odor or mental function. As the condition progresses, patients with hepatic encephalopathy may develop speech problems, drastic behavior changes, or abnormal hand or arm movements.
Doctors use several tests to diagnose hepatic encephalopathy in patients who are in a hepatic coma or who are progressing to this stage. Blood tests can measure ammonia levels and levels of other toxins in the blood. Electroencephalography (EEG) tests help doctors measure brain activity to show abnormalities that could be caused by brain tissue poisoning.
Patients in a liver coma are treated for the underlying problems that are preventing their liver from functioning normally. Doctors treat gastrointestinal bleeding and treat infections, kidney problems, and electrolyte imbalances with intravenous medications. Comatose patients may need life support machines to help them breathe and keep blood circulating through their bodies. Protein also needs to be limited. In severe cases, a liver transplant may be required to save the life of a patient in a hepatic coma.
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