Hepatic Encephalopathy

Alternative names:

encephalopathy - hepatic; hepatic coma

Symptoms:

• changes in mental state, consciousness, behavior, personality
  • forgetfulness
  • confusion, disorientation
  • delirium (acute, severe confusion with fluctuating level of consciousness)
  • dementia (loss of memory, intellect, reasoning, and other functions)
  • changes in mood
  • decreased alertness, daytime sleepiness
  • decreased responsiveness, progressive stupor
  • coma

• decreased self-care ability
• deterioration of handwriting or loss of other small hand movements
• coarse muscle tremors
• muscle stiffness or rigidity
• seizures (rare)
• yellow skin, jaundice
• speech impairment
• movement, uncontrollable
• movement, dysfunctional
• breath odor
• gynecomastia (breast development in males)
• agitation
• positive Babinski's reflex
• decerebrate posture

Signs and tests:

Neurologic symptoms may fluctuate. Asterixis (coarse "flapping" muscle tremor) may be observed during voluntary movement, such as when the person attempts to hold the arms out in front of the body. Liver disease may be known or may be suspected. Skin may be jaundiced (yellow skin and eyes). Ascites (fluid collection in the abdomen) may be noted because of increased body weight, abdominal enlargement, and abdominal examination that shows free fluid in the abdomen. Occasionally, there is a characteristic musty odor to the breath and the urine.

Blood tests may be nonspecific, or may show liver failure.

• Blood chemistry may show low albumin, high bilirubin, or other abnormality.
• Serum ammonia levels are commonly high.
• Prothrombin time may be prolonged and not correctable with vitamin K.
• CT scan of the head may be normal, or may show general atrophy (loss of tissue).
• EEG (electroencephalogram, a reading of electrical activity in the brain) shows characteristic abnormalities.