تعريف
Hepatic encephalopathy is a problem with the brain that is caused by liver disease. The problem may be temporary or permanent. People with a liver disease calledcirrhosis are most commonly affected.
أسباب
A liver with disease cannot filter the harmful items in blood. These toxins build up in the blood, which reaches the brain and affects the brain’s ability to work properly.
عوامل الخطر
Factors that increase your chances of developing hepatic encephalopathy include:
- Certain conditions that affect the levels of fluids and electrolytes such as hyponatremia and hyperkalemia
- فشل كلوي
- الالتهابات
- Gastrointestinal bleeding
- Certain medicines such as sedatives and anti-epileptics
- إمساك
- التليف الكبدي
- Hepatitis—infectious or autoimmune
الأعراض
In the early stages, you may not notice any symptoms. As the condition progresses, symptoms may include:
- Changes in behavior and personality
- قصر فترة الانتباه
- الاكتئاب أو القلق
- أرق
- تعب
- Forgetfulness
- الارتباك
- كلام غير واضح
- Tremor, particularly a flapping tremor of the hands
- ارتباك
- فقدان الوعي
If you have liver problems and any of the above symptoms, call your doctor right away.
These problems can develop quickly. They may resolve when the underlying condition is reversed, but immediate treatment is needed.
التشخيص
This condition can be serious. It can quickly become an emergency. You may need to be hospitalized. Doctors will do an exam to assess the condition of your nervous system.
To assess your liver and kidneys your doctor may order:
- اختبارات وظائف الكبد
- Kidney function tests
- Imaging tests of the liver
Your doctor may also order tests to assess your brain and nervous system such as:
- Images of the brain with MRI scan or CT scan
- EEG to look at brain waves for evidence of encephalopathy and/or seizures
- Lumbar puncture to look for other causes of the encephalopathy
العلاج
Hospitalization and Emergency Care
The initial treatment will focus on treating and trying to reverse the underlying problems. If possible, toxins in your blood will be removed or neutralized.
الأدوية
Medications may be used to:
- Neutralize toxins in the intestine such as ammonia
- Prevent intestinal bacteria from creating ammonia
- Remove blood from the intestines
- Reduce ammonia production by intestinal bacteria
- Treat the condition that started the encephalopathy
- Reduce recurrence
Dietary Restrictions
Your doctor may recommend changes in your diet. Tube feeding may be needed to supply nutrients, especially in the case of coma.
Transplantation
If this condition is due to liver failure, you may need a liver transplant.
الوقاية
To help reduce your chance of getting this condition, take the following steps:
- Get early treatment for liver problems.
- If you have a disease such as cirrhosis, see your doctor regularly.
- Follow your doctor’s instructions regarding medication. Avoid overdosing.
- Avoid being exposed to poisons or toxins.
- Avoid excessive alcohol.
- Do not use IV drugs.