hepatic encephalopathy

Nurses General Nursing

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Has anyone worked with someone with hepatic encephalopathy? What causes this?:nurse:

Has anyone worked with someone with hepatic encephalopathy? What causes this?:nurse:

Nobody knows exactly what causes hepatic encephalopathy. The most common theory revolved around ammonia. Ammonia is produced by bacteria in the gut. It is absorbed into the blood and circulated. The liver plays a major role in detoxifying ammonia by converting it to urea. In the case of cirrhosis there are two effects. There are not as many hepatocytes to detoxify the ammonia and cirrhotics frequently develop portal shunts that move the blood around the liver. There are a couple of other theories that revolve around astrocytes and GABA formation. Its probably multifactorial.

Hepatic encephalopathy usually is treated in the US with lactulose. This is an artificial sugar that is non-digestible by humans but is digestible by bacteria in the gut. This produces an acidic environment which promotes non digestible ammonia over digestible ammonia. In Europe oral antibiotics are favored. Particularly Xifaxan which is a non absorbable oral antibiotic. This works by decreasing the gut flora which causes it to produce less ammonia.

There are a number of causes of cirrhosis. The most common cause is probably still alcohol, but HCV and NASH are becoming more common. In more than 30% of cases no definitive cause can be found and many of the behaviors that cause cirrhosis have occurred in the remote past.

You can also see hepatic encephalopathy in cancer where the cancer has invaded the liver and in cases where the blood has been shunted around the liver even without cirrhosis.

Overall hepatic encephalopathy can usually be treated. In my experience its rare for someone to die from hepatic encephalopathy. Others sequelae of cirrhosis such as SBP or variceal bleeding are more common causes of death.

David Carpenter, PA-C

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Not all people with hepatic encephalopathy are alcoholics. My mother had it back in 2002, and she was definitely not a drinker.

My mom contracted HCV from a tainted blood transfusion in the early 1980s, which was a period in time when donors were not being screened for HIV and Hep prior to donating blood products.

Please do not assume that all people with this horrible affliction are alcoholics or illicit drug users. My mother did nothing to deserve the years of pain and suffering brought on by liver disease.

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Not all people with hepatic encephalopathy are alcoholics. My mother had it back in 2002, and she was definitely not a drinker.

so very true, commuter.

he is mostly triggered by cirrhosis or hepatitis.

it can also occur as a result of renal disease, infection, certain meds, and even some lyte abnormalities.

i think many nurses have been exposed to those w/cirrhosis...even though cirrhosis isn't always r/t etoh consumption either.

leslie

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
Not all people with hepatic encephalopathy are alcoholics. My mother had it back in 2002, and she was definitely not a drinker.

My mom contracted HCV from a tainted blood transfusion in the early 1980s, which was a period in time when donors were not being screened for HIV and Hep prior to donating blood products.

Please do not assume that all people with this horrible affliction are alcoholics or illicit drug users. My mother did nothing to deserve the years of pain and suffering brought on by liver disease.

My mother had a very similar experience with cirrhosis and hepatic encephalopathy. She too contracted Hepatitis from a transfusion, probably in the 60's. Her first indication that something was amiss was in 1993 when she suffered a near fatal hemorrhage from ruptured esophageal varices. She ended up in ICU where she remained for several days, coding numerous times. After a TIPS procedure, she improved and was released from the hospital. The next few years of her life were clouded by encephalopathy. Under the watchful eye of my father and a regimen of medications and strict dietary restrictions, she lived 7 more years.

Yes, cirrhosis is many times associated with alcoholism, and thus carries with it a certain stigma. But, like the Commuter's mom, my mom was not an alcoholic. When I tell people of my mom's years of suffering from cirrhosis, I feel compelled to add.....she was not an alcoholic.

This is a terrible disease that creeps upon it's victims silently.

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Ya, that is what the doctor ordered was Lactulose. So then it can also be caused by other chronic liver diseases?

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Ya, that is what the doctor ordered was Lactulose. So then it can also be caused by other chronic liver diseases?

Cirrhosis is just a condition that is defined by scarring of the liver. It can happen for any number of reasons. When every thing is said and done, we never find the reason in 25+% of the cases. NASH and HCV are probably the most common other causes. In Asia almost all the cases are caused by HBV.

I would agree with the other posters about not judging people. Even if the cirrhosis was somewhat self inflicted, people can and do change.

David Carpenter, PA-C

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Thank you guys for all of your responses it has been very helpful. I am getting a better understanding of this. THANKS!!:D

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Specializes in Jack of all trades, and still learning.

I often work with ppl who have hepatic encephalopathy. And yes, lactulose is the 'cure-all', well the preventative anyhow. The ppl who I care for have the condition due to alcoholism. Its a really hard choice when you think about it, to drink if you are an alcoholic, or have constant diarrhoea from the lactulose, or not to have the lactulose and become encephalopathic. Imagine having to take lactulose for the rest of your life

I wouldn't call it a peaceful death. I have seen ppl who are aggressive, or very confused and a danger to themselves. Its horrible.

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Specializes in Home Care, Hospice, OB.

my goodness, how did we get from a nursing view of a disease process to folks being offended that "all pts w/he are drunks who deserve what they get?"

saying that most pts have a precipitating factor is in no way saying they all do! please......let's not assume ill intent where none was intended..:heartbeat

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

I don't think anyone has assumed ill intent.

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So does people live with this chronically? Or does it eventually get tooken care of?:confused:

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

It depends on the underlying cause of the hepatic encephalopathy.

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