When the liver has been damaged by
cirrhosis, it may not be able to filter poisons from
the bloodstream, especially substances in the blood produced by bacteria in the
large intestine. As a result, these substances (which include ammonia) may
build up in the bloodstream and cause problems in your brain called
encephalopathy. High ammonia levels are a sign of encephalopathy.
Symptoms of encephalopathy may include:
- Irritability.
- Depression.
- Drowsiness.
- Difficulty
with word-finding.
- Poor short-term memory.
- Poor
concentration.
- Confusion and
disorientation.
- Insomnia.
- Coma.
Encephalopathy is most likely to occur in people who have high blood
pressure in the portal vein system (portal hypertension). However, it may also occur in people with severe acute
liver damage who do not have portal hypertension. Certain procedures (such as
shunting, which redirects the flow of blood or fluid through other areas of the
body) that help lower portal hypertension and prevent variceal bleeding may
actually increase your risk for developing encephalopathy. Other factors that
can contribute to encephalopathy include use of sedatives or narcotics,
gastrointestinal bleeding, abnormal levels of
electrolytes in the blood (especially low potassium
levels), excess protein in the diet, infection such as
peritonitis, dehydration, and constipation.
Without treatment, encephalopathy often becomes worse. Treatment may
include reducing protein in the diet and taking lactulose, a type of sugar that
the body cannot absorb, to help move stools through the intestines. Lactulose
helps remove ammonia and other toxins that can cause encephalopathy. Lactitol,
a food additive similar to lactulose, may be used in some countries to treat
cirrhotic encephalopathy; it is not approved for use in the United States.
Taking a supplement of the mineral zinc may help; talk to your doctor before
adding a zinc supplement. You may also need antibiotics.
