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【 Major points】

  1. Hepatic encephalopathy is a change in the state of consciousness caused by an increase in the ammonia level in the blood. In severe cases, there will be a coma.
  2. Common symptoms are stupor, lethargy and confused speech.
  3. Eat more high fiber and plant-based protein food. Take medicine properly under doctor’s prescription.
 
What is hepatic encephalopathy?
    Hepatic encephalopathy is a condition of neuropsychiatric abnormalities following the change of consciousness in patients with liver cirrhosis and liver failure. Liver dysfunction results in the accumulation of protein metabolites that increase the level of blood ammonia. Factors associated with hepatic encephalopathy include gastrointestinal tract bleeding, infection, constipation, overtaking high-protein food, improper use of medicine(diuretics, hypnotic drug), electrolyte imbalance, and drinking.
 

What are the symptoms of hepatic encephalopathy?

In the early stage, stupor, poor concentration,sleep inversion, and personality changes may appear. Drowsiness, flapping tremor and musty odor from the mouth appear later. Severe hepatic encephalopathy can lead to coma.

  1. Grade I: confusion -confusion speech, sleep inversion, personality changes, tiredness, attention deficit and memory impairment.
  2. Grade II: drowsiness - impaired speech judgment, lethargy, flapping tremor (a tremor of the hand when the wrist is extended). 
  3. Grade III: semicoma -fetor hepaticus (musty odor on the breath), sleeping all the time, but capable of being woken up.
  4. Grade IV: coma - no response to pain. 
      If you have any of the above symptoms, it does not necessarily mean that it is hepatic encephalopathy, please go to a gastroenterology & hepatology clinic.
 
How to treat hepatic encephalopathy?
  1. To decrease of ammonia levels in the blood by using oral or rectal laxatives such as lactulose.     
  2. Remove the risk factors such as infection, gastrointestinal bleeding, and alcohol consumption.
  3. Avoid taking too much protein and choose suitable foods according to the advice of a nutritionist.
 
How should I care for a patient with hepatic encephalopathy?
  1. Diet: eat high-fiber foods (vegetables and fruit), eat more plant-based protein (tofu and beans), avoid high protein foods such as sausage, ham, bacon, and cheese, reduce high salt food, and take a probiotics supplement to regulate intestinal flora.
  2. Maintain a regular lifestyle: quit smoking, avoid alcohol drinks, avoid staying up late and overworking to reduce the burden of liver. 
  3. Prevent constipation. Maintain a bowel movement 2-3 times per day.
  4. Take medicine properly under doctor’s prescription. Do not take diuretics, sedative drugs and herbal medicine without doctor’s advice.
  5. If visiting a public place is necessary, wear a mask to prevent infections. 
  6. Regular outpatient visits. When consciousness changes, or flapping tremor appears, it could be the sign of early hepatic encephalopathy. Please visit a doctor as soon as possible.
 
Reference
  1. Blaney, H., & DeMorrow, S. (2022). Hepatic encephalopathy: Thinking beyond ammonia. Clinical Liver Disease, 19(1), 21-24. https://doi.org/10.1002/cld.1163
  2. Fallahzadeh, M. A., & Rahimi, R. S. (2022). Hepatic encephalopathy: Current and emerging teatment moalities. Clinical Gastroenterology and Hepatology, 20(8), S9-S19. https://doi.org/10.1016/j.cgh.2022.04.034
  3. Häussinger, D., Butz, M., Schnitzler, A., & Görg, B. (2021). Pathomechanisms in hepatic encephalopathy. Biological Chemistry, 402(9), 1087-1102. https://doi.org/10.1515/hsz-2021-0168
  4. Lin, K. M.,(2020). Digestive system disease care. In Hwu, Y. J(Ed.), Medical Surgical Nursing (6th ed., pp.809-810). Farseeing.
  5. Nardelli, S., Gioia, S., Faccioli, J., Riggio, O., & Ridola, L. (2023). Hepatic encephalopathy - recent advances in treatment and diagnosis. Expert Review of Gastroenterology & Hepatology, 17(3), 225-235. https://doi.org/10.1080/17474124.2023.2183386
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    Taipei Veterans General Hospital 
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