Hepatic encephalopathy

Therapy of hepatic encephalopathy is a complex task, and it must begin with eliminating the causes of this condition, treating acute or chronic liver failure. The treatment regimen for hepatic encephalopathy includes diet therapy, bowel cleansing, lowering nitrogen levels, and symptomatic measures.

The amount of protein consumed from food should be reduced to 1 g/kg/day. (provided that such a diet is tolerated by the patient) for a sufficiently long time, since in some patients a return to normal protein content causes the reappearance of the clinical picture of hepatic encephalopathy. During the diet, amino acid preparations are prescribed and salt content is limited.

To ensure effective excretion of ammonia in feces, it is necessary to achieve bowel movements at least twice a day. For this purpose, regular cleansing enemas are performed and lactulose preparations are prescribed (their intake must be continued at the stage of outpatient treatment). Ornithine and zinc sulfate also improve the utilization of ammonia.

Antibacterial therapy includes the prescription of broad-spectrum drugs that are active primarily in the intestinal lumen (neomycin, vancomycin, metronidazole, etc.). For sedative purposes in hepatic encephalopathy, it is undesirable to prescribe benzodiazepine drugs; preference is given to haloperidol.

The course of hepatic encephalopathy can be complicated by cerebral edema, bleeding, aspiration pneumonia, pancreatitis; therefore, treatment of patients at stages 3-4 of the disease should be carried out in the intensive care unit.

Prognosis and prevention of hepatic encephalopathy

The prognosis for hepatic encephalopathy depends on several factors, but is generally unfavorable. Survival is better in cases where encephalopathy develops against the background of chronic liver failure. In liver cirrhosis with hepatic encephalopathy, the prognosis worsens in the presence of jaundice, ascites, and low protein levels in the blood. In acute liver failure, the prognosis is worse in children under 10 years of age and adults after 40 years of age, against the background of viral hepatitis, jaundice and hypoproteinemia. Mortality at stages 1-2 of hepatic encephalopathy is 35%, at stages 3-4 – 80%. Prevention of this pathology consists of abstaining from alcohol and uncontrolled use of medications, treatment of diseases that lead to the development of hepatic encephalopathy.

Causes of hepatoencephalopathy in alcohol dependence

The basis of brain disorders in this disease is liver failure against the background of hepatitis caused by alcohol. Ethanol has a direct damaging effect on liver cells. Hepatocytes are destroyed and cease to perform a number of their basic functions. The acute process is especially dangerous when drinking large quantities of alcoholic beverages.

Malfunction of the liver leads to:

accumulation of toxins selectively acting on neurons;
changes in the acid-base properties of blood, hemostasis;
deviations in the values of oncotic (created by plasma proteins) and hydrostatic pressure;
disturbance of the electrolyte and water balance of the body.

These pathological processes cause inhibition of the function of astrocytes - cells that act as a natural defense between the tissues of the nervous system and blood.

As a result of the destruction of hepatocytes and astrocytes in the central and peripheral nervous system:

Unneutralized poisons accumulate;
electrolyte imbalance occurs;
a malfunction of neurotransmitters—impulse transmitters—is formed;
the production of cerebrospinal fluid (CSF) increases sharply, leading to a pronounced increase in intracranial pressure;
There are increasing signs of cerebral edema.

The following has a particularly destructive effect on nervous tissue:

ammonia;
the appearance of false neurotransmitters - substances that replace the main mediators of the nervous system, which leads to insufficient functions of the latter;
some types of fatty acids and amino acids.

Complications

Complications of encephalopathy are associated with severe and irreversible damage to the brain and represent the extreme extent of the symptoms observed:

loss of self-care ability due to motor or cognitive impairment;
dementia: loss of knowledge and skills up to complete collapse of personality;
loss of vision and hearing;
severe mental disorders;
convulsions;
disturbances of consciousness: stupor, coma;
death.

Our specialists

Tarasova Svetlana Vitalievna
Expert No. 1 in the treatment of headaches and migraines. Head of the Center for the Treatment of Pain and Multiple Sclerosis.
Cephalgologist.
Somnologist. Epileptologist. Botulinum therapist. The doctor is a neurologist of the highest category. Physiotherapist. Doctor of Medical Sciences.
Experience: 24 years.
Derevianko Leonid Sergeevich
Head of the Center for Diagnostics and Treatment of Sleep Disorders.
The doctor is a neurologist of the highest category. Vertebrologist. Somnologist. Epileptologist. Botulinum therapist. Physiotherapist. Experience: 24 years.
Bezgina Elena Vladimirovna
The doctor is a neurologist of the highest category. Botulinum therapist. Physiotherapist. Ozone therapist Experience: 25 years.
Dyachenko Ksenia Vasilievna
Head of the center for the treatment of dizziness and balance disorders.
The doctor is a neurologist of the highest category.
Angioneurologist. Neurorehabilitation specialist. Physiotherapist. Candidate of Medical Sciences.
Experience: 20 years.
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Drozdova Lyubov Vladimirovna
The doctor is a neurologist of the first category. Vertebroneurologist. Ozone therapist. Physiotherapist. Experience: 18 years.
Zhuravleva Nadezhda Vladimirovna
Head of the center for diagnosis and treatment of myasthenia gravis.
The doctor is a neurologist of the first category. Physiotherapist. Ozone therapist Experience: 17 years.
Palagin Maxim Anatolievich
The doctor is a neurologist. Somnologist. Epileptologist. Botulinum therapist. Physiotherapist. Ozone therapist Experience: 7 years.

Prevention

Encephalopathy is a complex disease. There is no clear method to prevent its occurrence and eliminate all risk factors. Doctors recommend adhering to the following rules:

provide yourself with a full daily routine with alternating work and rest, a full night’s sleep;
minimize stress;
eat properly and balanced, avoid overeating and excess body weight;
ensure sufficient supply of vitamins and microelements;
quit smoking, drugs, alcohol;
exercise in moderation (not professionally);
promptly identify and treat chronic diseases: hypertension, diabetes, atherosclerosis;
consult a doctor at the first signs of trouble.

Diagnosis of hepatoencephalopathy

If the damage to the liver and brain is alcoholic, the doctor is interested in:

symptomatic picture;
establishing the severity of the disease;
stage of the process.

Based on the data obtained, during a survey and examination, the doctor prescribes additional types of diagnosis of hepatic ecephalopathy.

These include:

A detailed clinical blood test with determination of the content of erythrocytes, leukocytes, hemoglobin, platelets.
Biochemistry data with liver tests, bilirubin, alkaline phosphatase, gamma globulin transferase.
Ultrasound of the parenchymal organs of the abdominal cavity. The specialist is especially interested in the condition of the liver, pancreas, and kidneys.
Computed tomography is the most informative method of x-ray diagnostics.
MRI in doubtful cases, as an additional diagnostic method.
Needle biopsy as the most accurate option for differential diagnosis.

Symptoms

Signs of encephaloptia depend on the location of the source of destruction, as well as the degree of development of the disease. Most often, patients and their relatives experience the following symptoms:

headache: can involve the entire head or concentrate in certain areas; the intensity depends on the degree of damage and gradually increases; pain is poorly relieved by taking analgesics;
dizziness: occurs sporadically, accompanied by loss of orientation in space; Often a person is forced to wait out this condition in bed, since the slightest movement worsens the symptom; the condition is often accompanied by constant nausea and vomiting;
impairment of cognitive functions: a gradual decrease in the ability to think adequately is a characteristic sign of encephalopathy; a person gradually becomes forgetful, absent-minded, has trouble concentrating on a specific process and has difficulty switching between different activities;
emotional and behavioral disorders: a person has difficulty controlling his emotions, becomes irritable, whiny, gets excited quickly; as the disease progresses, apathy, depression and complete reluctance to do anything arise;
increase or decrease in muscle tone; often accompanied by hyperkinesis (trembling in the limbs, obsessive movements, etc.);
decreased vision and hearing;
increased weather sensitivity.

In some patients, behavioral disorders predominate, others cease to have normal control of their body; in others, it is mainly the sense organs that are affected. In severe cases, a person requires constant care and supervision of others.

Treatment at the Energy of Health clinic

Doctors at the Health Energy Clinic are always ready to see patients of any age. We will conduct a thorough examination, identify possible causes of encephalopathy and take all measures to eliminate it:

we will prescribe the most appropriate therapy, describe the course of treatment and the frequency of its repetition;
We will carry out all the necessary manipulations (placement of a drip, intravenous and intramuscular injections) in the comfortable conditions of a day hospital and manipulation room;
We will complement the therapy with modern physiotherapeutic procedures;
We will conduct a massage course and prescribe exercise therapy for maximum effectiveness.

Our neurologists will monitor the patient’s condition and adjust treatment if necessary. Treatment of encephalopathy is a long and complex process, but we are ready to take on it.

Advantages of the clinic

If you require a full examination and high-quality treatment, welcome to the Health Energy clinic. Here you are waiting:

experienced specialists who regularly improve their skills to keep abreast of all new trends in the world of medicine;
modern diagnostic equipment;
everything necessary for physiotherapy, massage, exercise therapy;
own day hospital for slow drip administration of medications;
affordable prices for all services.

If you or your relatives have signs of encephalopathy, do not delay contacting a doctor. The sooner treatment is started, the better the result. Sign up for the Health Energy clinic and let our doctors choose the optimal therapy.

Total information

Liver pathology is extremely rarely complicated by hepatic encephalopathy. However, if the disease is nevertheless detected, its outcome is almost always tragic: for 2/3 of those affected, encephalopathy ends in death. Chronic liver diseases are more often complicated by hepatic encephalopathy than acute ones. They are potentially reversible, but significantly affect the patient’s ability to work and lifestyle.

Modern medical science does not yet have a clear idea of the causes of the development of the disease, but recent research allows us to hope for a solution to this problem in the near future. Discovering the mechanisms of the disease will contribute to the development of an effective treatment plan that will not only reduce the number of deaths, but will significantly improve the quality of life of those affected.