What is Hepatic encephalopathy?

What is Hepatic Encephalopathy?
Hepatic encephalopathy is a condition which affects the thinking and behavior of patients with liver disease. The changes may be minimal (slight changes in mood, sleep, behavior) which may not be apparent on routine evaluation, and require specialized testing. However, the more severe changes are more apparent, and include confusion, disorientation, drowsiness, even deep coma.
What causes hepatic encephalopathy?
Patients with liver failure are at a risk of developing hepatic encephalopathy. The liver is unable to remove the toxins in the blood, which then reach the brain and affect it. It may be precipitated by infections, bleeding in the stomach or intestines, constipation, certain medications and electrolyte abnormalities.
How is hepatic encephalopathy treated?
Treatment mainly includes treating the precipitating cause like infections or bleeding, and use of medications like lactulose and specific antibiotics. Lactulose changes the environment of the intestines, reducing the build up of toxins by the bacteria. In the process, it increases the frequency of stools passed, and make them softer. To achieve this effect, the dose of lactulose is titrated such that it causes 2-3 soft stools every day. Antibiotics used in treating this condition act only in the intestines, and are not absorbed in the body. They kill the toxin producing bacteria. Apart from these, there are few other drugs which act by different mechanisms.
What are the side effects of lactulose?
Lactulose is the main drug in treating an episode of hepatic encephalopathy, as well as preventing further episodes. However, around a third of patients complain of bloating, nausea, bad taste, diarrhea etc. Some patients may not be comfortable with the increase in frequency of stools, which is to be kept at 2-3 times a day. More frequent stools may actually be harmful, as they may lead to electrolyte imbalance, and worsen the condition.

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