Hepatic encephalopathy

Hepatic encephalopathy is a disorder of brain function that develops as a result of liver failure. Read more!

Hepatic encephalopathy

The hepatic encephalopathy (also: postosystemic encephalopathy) is a disorder of brain function that develops as a result of liver failure; this can happen creepingly or suddenly. Hepatic encephalopathy is subdivided into various stages, ranging from mild mood swings to deep unconsciousness (hepatic coma). Find out more about the cause and treatment here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. K74K76K70K71K72

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Hepatic encephalopathy

  • How does hepatic encephalopathy develop?

  • Hepatic encephalopathy: symptoms and stages

How does hepatic encephalopathy develop?

Hepatic encephalopathy is due to a dysfunction of the liver. One of the most important functions of the liver is to metabolize nutrients from the intestine and to reduce toxins in the body. However, various influences can damage the liver so much that it can no longer fulfill this task - for example, when liver cirrhosis develops as a result of years of alcohol or drug abuse. The liver tissue is then largely knotty scarred and loses its function.

Mostly flows on the basis of a chronic liver disease Finally, one of these factors is hepatic encephalopathy:

  • Bleeding in the gastrointestinal area
  • high protein food
  • Infections that lead to increased protein utilization
  • Diarrhea, vomiting or laxatives
  • certain medications (such as sedatives)

Sometimes doctors treat cirrhosis with a so-called portosystemic shunt, an artificial compound in the vascular system, which ensures that the blood from the intestine, stomach and spleen is no longer collected through the damaged liver. This can be useful, for example, before liver transplantation. One possible side effect of this procedure is hepatic encephalopathy, as the blood is no longer filtered.

Also a acute liver failure, for example as a result of viral infection or intoxication, can cause hepatic encephalopathy. In this case, the liver functions are destroyed within a few days.

If the liver is no longer able to break down toxins into innocuous components, the concentration of pollutants in the body increases. This has serious consequences for the whole body, especially the central nervous system (CNS) and its closely linked brain cells. Different substances are involved - above all ammonia, a degradation product of various amino acids (building blocks of proteins). Normally, the liver makes the ammonia non-toxic urea, which is eventually excreted. If this mechanism is disturbed, more and more ammonia gets into the brain and causes certain brain cells - the so-called astrocytes - to swell up. The intracranial pressure rises. Thus, a liver failure ultimately results brain edema.

Hepatic encephalopathy: symptoms and stages

The swollen astrocytes change the concentration of different messenger substances in the brain, and the nerve cells can no longer communicate properly. Therefore, hepatic encephalopathy involves several neurological symptoms, classified into four stages according to severity:

  • Stage 1: Sleep disorders, mood swings, euphoria, mild confusion, difficulty concentrating, eye flutter
  • Stage 2: Personality changes, disorientation, tiredness, memory disorders, altered facial expressions (grimacing), rough shaking of the hands ("flapping tremor")
  • Stage 3: Patient sleeps most of the time, strong disorientation, flapping tremor, unclear language
  • Stage 4: Hepatic coma, patient no longer woken up

By means of electroencephalography (EEG), it is also possible to record, from the second stage, changes in the brain waves that indicate hepatic encephalopathy.

While in acute liver failure the affected person usually lives through the individual stages very quickly and may fall into a coma within days, hepatic encephalopathy progresses slowly and gradually in people with chronic liver failure. Most of the time there is no pronounced cerebral edema during the course of the disease.

In many cases, the first stage is preceded by a phase in which hepatic encephalopathy hardly shows any symptoms and usually only close relatives notice that something is wrong with the person concerned. These are called also minimal hepatic encephalopathy, With various psychometric tests such as numbers or drawing tasks, however, one can uncover this stage.

Especially in older people with liver disease, it can happen that the hepatic encephalopathy is chronic.In their "ground state" they usually show slight neuropsychiatric symptoms, interrupted by acute phases with more pronounced symptoms.

These laboratory values ​​are important

  • Alkaline phosphatase
  • amylase
  • bilirubin
  • bile acid


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