Hepatic encephalopathy is a state of confusion or altered level of consciousness, which results from advanced liver disease. It is caused by accumulation in the bloodstream of toxic substances that are ordinarily removed by the liver. It is typically seen in patients with advanced chronic liver disease.


In its mildest form, hepatic encephalopathy may be very subtle and only demonstrated by neuropsychological testing. As the condition worsens, patients may become forgetful and confused. They may experience difficulty sleeping. More severe forms of hepatic encephalopathy may present with severe lethargy and even coma.


The diagnosis of hepatic encephalopathy is made by confirming underlying chronic liver disease and testing for an elevated ammonia level in the blood. The condition can also be confirmed by electroencephalography.


Encephalopathy is often precipitated by other underlying conditions such as infection, gastrointestinal bleeding, chemical imbalances, and medication side effects. These conditions should be investigated and treated. Hepatic encephalopathy will often respond to medication such as lactulose or an antibiotic called rifixamin. Patients with severe encephalopathy may require protein restriction in the diet.