Liver failure, toxin build-up, and its effects on the brain
Hepatic encephalopathy arises from chronic liver damage and leads to brain dysfunction due to toxin buildup, especially ammonia. Symptoms include altered sleep, confusion, tremors, and coma. Causes include cirrhosis, drugs, and infections. Diagnosis is clinical and supported by neuropsychometric tests like the number connection test. Prompt treatment is essential.
Vital Liver Functions Your liver is a vital organ that is essential for filtering blood, metabolism of nutrients and formation of bile. It also aids in detoxifying harmful products in the body. It is responsible for converting glucose into glycogen, and the bile it produces helps in the digestion of fats in the small intestine. Alongside, it stores fat-soluble vitamins like vitamin A, D, E and K (Images: Canva)
2/10
Chronic Liver Damage Chronic liver disease (a progressive condition that causes liver damage and fibrosis) can lead to neuropsychiatric syndrome known as hepatic encephalopathy, which causes a change in the mental status and cognition of the affected individual. It is also known as portosystemic encephalopathy.
3/10
Liver Fails to Detoxify When the liver is working normally, it metabolises the toxins. However, in conditions like cirrhosis, the gut-derived toxins (that can potentially harm the brain) are not cleared, thus leading to their accumulation. Co-existing infection and inflammation, along with oxidative stress, can lead to hepatic encephalopathy.
4/10
Ammonia Crosses Barrier Toxins like ammonia (which plays a major role) can bypass the liver and move directly to the brain. An increased permeability of the blood-brain barrier can easily allow the toxins to enter. Factors that can precipitate hepatic encephalopathy include increased protein load (through dietary protein), acute infections and gastrointestinal bleeding.
Drugs and Imbalances Other factors that may contribute to portosystemic encephalopathy include drugs like sedatives, antidepressants, narcotics and also alcohol. If one has pre-existing fluid and electrolyte disturbances like reduced levels of potassium or sodium because of excessive vomiting or diarrhea, it can predispose one to this condition.
6/10
Acute Condition Signs If hepatic encephalopathy occurs as an acute condition, the affected person can become drowsy and comatose within a few weeks to months. Collection of fluid in the brain (brain edema) can occur in several cases and lead to shifting of the brain tissue from its normal position inside the skull to any adjacent space due to increased pressure.
7/10
Early Sleep Changes Hypersomnia, or excessive sleeping, is one of the earliest features of chronic portosystemic encephalopathy. There can be other disturbances in consciousness and behaviour, and the sleep rhythm may change entirely, that is, the person begins to sleep during the daylight hours.
8/10
Behavioural Symptoms Vary Some individuals can potentially become violent and difficult to manage, while others may be extremely sleepy and waking them up can prove to be a herculean task. Irritability, confusion and disorientation is also common, along with slow and slurred speech patterns. Eventually, they can progress to a comatose state.
Typical Clinical Signs One of the signs that the doctor may identify is called fetor hepaticus, where a sweet smell may be noticed emanating from the affected person. Flapping tremors can also be elicited in case of portosystemic hypertension, usually seen in both wrists, but may also be found in the tongue, feet or any skeletal muscle.
10/10
Diagnosis and Testing The diagnosis is often based on the clinical features, and some neuropsychometric tests like the number connection test (25 numbered circles present randomly on paper must be joined together under 30 seconds) can be used to identify this condition. Similarly, digit symbol test and block design tests are also used. (Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis)
Rajeshwaari Kalla is a freelance health and wellness writer
