It is not possible for humans to survive for long without a functioning liver. This organ is able to sustain a great deal of damage and still recuperate, but there is a limit to hardiness of the liver. Those who chronically abuse alcohol can develop alcoholic liver disease. This leads to cirrhosis, a situation where it is no longer possible to repair the damage to the liver. Once this stage has been reached, the individual is at risk of developing life-threatening problems such as hepatic encephalopathy.
Hepatic encephalopathy is a change in mental functioning that is caused by liver failure. One of the vital roles of the liver is to remove toxins from the bloodstream. During liver failure, these toxins build up and begin to interrupt the normal brain function. The toxin that does the most damage is ammonia. If the situation is not treated, it can soon lead to hepatic coma and death.
Hepatic encephalopathy most often occurs to people with an existing liver problem such as alcoholic liver disease. It can be triggered by:
* Kidney problems
* Low oxygen levels
* Abnormalities in electrolyte levels in the blood
* Bleeding from the esophagus, stomach or elsewhere
* Excessive consumption of protein
* Certain medications such as barbiturates
* A complication of surgery
* Damage to the liver
* Complications from a shunt procedure
The Symptoms of hepatic encephalopathy include:
* Inability to concentrate
* A feeling of mental fogginess
* Mood swings
* Mild confusion
* Irrational behavior
* Problems with using the hands
* Deteriorated handwriting
* Memory problems
* Musty odor on the breath
* Changes in sleeping pattern
* Changes in personality
If the encephalopathy is severe, it can lead to symptoms such as:
* Disorientation concerning time and place
* Severe confusion
* Sluggish and slow movements
* Severe personality changes
* Agitation and aggression
* Slurred speech
Hepatic encephalopathy can occur in the final stage of alcoholic liver disease. Once cirrhosis has developed in the liver it leads to irreversible scaring. This means that the liver is unable to do its job properly. This organ is responsible for over 500 separate functions, so the effects of the damage soon become apparent. It is vital that anyone who has developed cirrhosis does not incur any further damage to the liver. This means complete abstinence from alcohol or anything else that could damage the organ further. It is also necessary to avoid any of the triggers that could lead to hepatic encephalopathy.
Alcoholics can sometimes develop another condition called Wernicke’s encephalopathy. This type of encephalopathy differs because it is not caused by the liver. It results from a deficiency of thiamine (Vitamin B1). It is not the alcohol itself that causes the problem, but the fact that alcoholics tend to have such a poor diet. Wernicke’s encephalopathy may lead to the development of Wernicke-Korsakoff Syndrome, more commonly known as alcoholic dementia or wet brain.
Hepatic encephalopathy can lead to death if it is not treated quickly. It is therefore considered a medical emergency. The goal of any treatment is to lower the blood ammonia levels. It will also be necessary to discover what exactly triggered the event and rectify the situation.
There are a number of actions that can be taken to reduce ammonia levels in the blood. One option is to put the individual on dietary changes. Protein increases ammonia levels so there may be restrictions put on how much of this nutrient the individual is allowed to consume. It will not be possible to completely avoid protein entirely because this will lead to malnutrition. It might also be necessary for people to take laxatives to discourage microbes in the intestine from producing ammonia. It can take about two weeks for the symptoms of hepatic encephalopathy to disappear fully, and during this time the individual will need to be medically supervised.
It is sometimes possible to miss hepatic encephalopathy symptoms in alcoholics. The symptoms can be mistaken for inebriation. It can be particularly hard to diagnose the condition if the individual is already suffering from alcoholic dementia.
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