What is hepatic encephalopathy?
Hepatic encephalopathy (HE), or portosystemic encephalopathy or PSE, is a condition that causes worsening of brain function in people with advanced liver disease. When the liver is damaged, it can no longer remove toxic substances from the blood. These toxins may reach the brain and cause the brain cells to swell. This hampers brain function.
HE is classified into three types:
- Type A: It is associated with acute liver failure.
- Type B: It occurs when there is no primary liver damage, and encephalopathy occurs due to the portosystemic shunting of the blood (an abnormal vein that bypasses blood purification by liver bypassing called shunting). Portosystemic shunts can be either congenital (present at birth) or acquired.
- Type C: It is an encephalopathy associated with severe liver disease or severe liver damage. Encephalopathy can either be episodic (acute) or persistent (chronic).
The stages of HE include the following:
- Grade 0 (Minimal): Difficult to detect clinically; subtle impairment in memory, concentration, and intellectual functions. Slight impairment of coordination such as poor work performance or ability to drive (incidences of traffic violations while driving)
- Grade 1 (Mild): Presence of mood changes, depression, irritability, a decreased attention span, and sleep issues
- Grade 2 (Moderate): Associated with increasing forgetfulness, slurred speech, inappropriate behavior, inability to do simple mental tasks such as basic math, shaking of hands, and writing difficulties
- Grade 3 (Severe): Characterized by marked sleepiness, disoriented in space and time, extreme anxiety, and strange behavior
- Grade 4 (Coma): Patient loses consciousness and passes into a comatose state.