Have you ever noticed someone in your family, perhaps your father, uncle, or someone you know, suddenly acting strangely? Is it just memory loss, a little confused, getting angry at the smallest things, or being constantly sleepy during the day? We often think of these as normal things that happen as we get older. However, sometimes this can be due to a serious problem with their liver. That is what we call `Hepatic Encephalopathy` in medical terms. Although the name may sound scary, let's talk about it simply.
Simply put, what is Hepatic Encephalopathy?
This is very easy to understand. There are two parts to the name. “Hepatic” means ‘related to the liver’. “Encephalopathy” means ‘impaired brain function’. So when you put the two together, it means that the brain is affected by impaired liver function.
Imagine that the biggest 'filter' or 'filter' in our body is the liver. One of the main functions of the liver is to filter out toxins, such as ammonia, from the blood after we digest the food we eat and drink. Now imagine, what happens if this filter does not work properly? Those toxins (`Neurotoxins`) are not filtered and go directly into the blood. This toxic blood travels throughout the body and finally reaches the brain. The brain cells cannot handle these toxins. That's when the brain starts to function abnormally. That's why all those symptoms start to appear.
What are the symptoms of this condition?
Symptoms can vary from person to person. Some people may experience them suddenly, while others may develop them gradually. Some days, symptoms may subside, but they may reappear. These are your symptoms:
- Mood and personality
- Behavior and impulse control
- For memory, concentration and thinking
- Consciousness and sleep patterns
- Coordination and motor functions
It can affect. Doctors divide this condition into several stages depending on the severity of these symptoms. Let's see what those stages are.
Stages of symptoms (Grading System)
A common method used to diagnose this is the ``West Haven Criteria.'' This classifies the stages from 0 to 4.
| Grade | Symptoms that can be seen |
|---|---|
| Stage 0 | There are no outward signs. But only he himself or those who are very close to him can notice small changes in memory and attention. They can only be detected through medical tests. |
| Stage 1 | Now I'm starting to see some symptoms. I forget little things, my mood changes frequently (I'm happy one moment, sad the next). I have difficulty doing simple calculations like adding and subtracting. I have difficulty doing fine work like handwriting. One of the most important symptoms is drowsiness during the day and inability to sleep at night. |
| Stage 2 | A clear change in personality can be seen. They behave and speak in an inconsistent manner. They are often lethargic and uninterested. They forget the time, day, and year. Their speech becomes slurred (`Slurred speech`). |
| Stage 3 | The situation is now serious. The way of thinking, the movements of the body are very slow. Forgetting where you are (`Disorientation`). Excessive drowsiness and no interest in what is happening around you. Extremely confused, some things are completely forgotten. When you stretch out your arms, they just tremble like a bird flapping its wings. We call this `Asterixis`. |
| Stage 4 | You lose consciousness completely. That means you go into a coma. This is even life-threatening. |
Important: If you experience symptoms of stage 2 or 3, especially excessive sleepiness, disorientation, and shaking hands, it is an emergency. You should be taken to a hospital, preferably an Emergency Department (ETU), as soon as possible.
Why is this happening? What are the reasons?
As we discussed earlier, the main cause is the liver's inability to filter toxins. There are several ways this can happen. Doctors divide Hepatic Encephalopathy into three types based on these causes.
Type A
This is caused by sudden liver failure (`Acute Liver Failure`). This means that the liver of a person who has had no previous illness suddenly stops working within a few days. This can be caused by:
- Viral infections (e.g. hepatitis A, B)
- Overdosing on certain medications , especially paracetamol, is a major cause of this. If you or someone you know has overdosed on this, call the National Poison Information Center at the Colombo National Hospital immediately and get them to a hospital.
- Poisoning, like some types of mushrooms.
This is a very urgent and serious situation.
Type B
This is a bit complicated. Simply put, blood that should be going to the liver to be cleaned is bypassing the liver and going directly into the body's circulation through a different route (the `portosystemic shunt`). This allows the toxins in the blood to go to the brain without being filtered.
Type C
This is the most common type. This occurs when the liver gradually fails due to a long-term liver disease (`Chronic Liver Disease`). The main cause of this is cirrhosis. Cirrhosis is a condition in which the liver is damaged over time, scarred, and becomes hard and unable to function properly. This can be caused by:
- Drinking alcohol excessively over a long period of time.
- Chronic viral infections such as hepatitis B and C.
- Fatty Liver Disease.
Triggering Events
A person with chronic liver disease, such as cirrhosis, can live a normal life to a certain extent. However, symptoms of `Hepatic Encephalopathy` can suddenly appear. This is caused by an event that puts an unbearable burden on the liver. We call such events `Triggers`.
- Constipation: When constipation occurs, toxins stay in the intestines for longer, causing them to be absorbed into the bloodstream more.
- Dehydration: When there is not enough water in the body, the function of the kidneys also weakens, further reducing the removal of toxins.
- Infection: Any infection in the body (e.g. urinary tract infection, lung infection) puts a lot of strain on the liver.
- Bleeding from the digestive system: If there is bleeding, such as from a stomach ulcer, large amounts of toxins like ammonia are produced as the blood is digested in the intestines.
- Taking medications that are harmful to the liver, such as some sleeping pills and painkillers.
- Drinking too much alcohol at once.
How does a doctor diagnose this?
When you take a loved one to a doctor with these symptoms, the first thing he or she will do is ask you and the patient about the symptoms. Then, they will do a physical examination. They will check for asterixis (tremors).
In addition, several tests can be done to find the exact cause:
- Blood tests: These can measure liver enzyme levels, blood ammonia levels, and give a complete picture of liver function.
- Ultrasound scan: Check the condition of the liver and the blood vessels around it.
- Brain scan (CT scan or MRI): To check for swelling or other problems in the brain.
- EEG test: Measures the electrical activity of the brain to see if there are any abnormalities.
What are the treatments for this?
There are three main goals in treatment:
1. Managing the emergency: Finding and treating the trigger (e.g., infection, constipation) that caused the sudden increase in symptoms.
2. Treating the underlying cause: Planning treatment based on the cause of liver disease.
3. Reducing the level of toxins in the blood: This is the most important thing.
There are two main types of medications that are given to reduce the level of toxins in the blood:
- Lactulose: This is a liquid medicine that is taken orally. It works by cleansing the stomach and quickly removing toxins from the intestines. It also controls the bacteria that produce toxins in the intestines.
- Rifaximin: This is an antibiotic. It works by killing harmful bacteria in the intestines and reducing the production of toxins.
These treatments can largely control the symptoms. However, if the underlying liver disease is not treated, the condition can recur. If the liver has completely failed, a liver transplant may be the only solution.
How to live with this situation?
Living with chronic liver disease and Hepatic Encephalopathy is challenging. However, with proper management, you can live a good life.
- Stay in touch with your doctor: Go to clinics on time. Take your medication on time. If you notice any changes in your symptoms, inform your doctor immediately.
- Get help from family: Since these patients can forget some things, the help of a family member is very important for things like giving medication and taking them to the doctor.
- Take care of your nutrition: Eat a balanced diet. Consult your doctor about the amount of meat you should eat.
- Prevent constipation: Drink plenty of water daily, eat fiber-rich foods (fruits, vegetables). Take `Lactulose` as prescribed by your doctor.
- Stop drinking alcohol completely: It is not good to drink even a single drop.
- Avoid driving: Driving is very dangerous if you have this condition, even slightly, as it can impair your concentration and decision-making ability.
When this condition affects you or a loved one, it can be devastating. But remember, with the right treatment and the love and care of your family, you can live with this condition.
Take-Home Message
- `Hepatic Encephalopathy` is a condition in which toxins accumulate in the blood and affect the brain because the liver is not working properly.
- Memory loss, behavioral changes, drowsiness, and confusion are the main symptoms.
- If you are experiencing symptoms such as excessive sleepiness and loss of consciousness, it is a medical emergency. See a doctor immediately.
- It is important to protect yourself from things like constipation, infections, and dehydration, as they can worsen this condition.
- With the right treatment (such as `Lactulose` and `Rifaximin`), symptoms can be reversed and well controlled.
- The support, love, and care of the patient's family are extremely important at this time.
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න