Hepatic Coma

Hepatic Coma General Information

Hepatic Coma or hepatic encephalopathy (hepatoencephalopathy) refers to damage that affects the brain and generally the nervous system, which occurs as a complication to several liver disorders. These medical conditions that affect the liver range from chronic (as cirrhosis or hepatitis) to acute. Hepatic Coma is considered a reversible neuropsychiatric disorder that has an unknown exact cause. It is pretty hard to put the exact diagnose when dealing with this disease because health care providers can only discover it after they have eliminated other metabolic, neurological, infectious and psychiatric etiologies. If the impairment of the liver is severe, the toxic substances that are normally removed by this major organ are accumulating in the blood. The result of this is that the functions of the brain cells are impaired as well. In some cases, these toxic substances are not modified or purified and pass directly to the brain. This is the result of subsequent bypassing of the filter function that the liver has over the blood flowing in directly from the small and large intestines, and of portal hypertension. The signs and symptoms that are specific for Hepatic Coma can range from mild to severe, ending up with the death of the individual. The ultimate level of this medical disorder occurs if the illness is not discovered in time and treated properly. This disease can also occur in people with otherwise stable liver problems. In their case, hepatic encephalopathy is triggered by the excess of consumed proteins or the appearance of gastrointestinal bleeding.

Hepatic Coma Symptoms

Hepatic Coma has specific signs and symptoms which can be mild or severe, affecting the functioning of the nervous system. Asterixis (flapping tremor) may be accused by some of the persons suffering from this serious medical condition. The main changes that affect the personality, mental status, behavior and consciousness are: delirium, decreased responsiveness, confusion, dementia, forgetfulness, disorientation, as well as decreased alertness, daytime sleepiness, changes in mood and even coma. There are many other signs of Hepatic Coma which can include decreased self care ability, muscle tremors, in rare cases seizures, deterioration of the handwriting and of other small hand movements, uncontrollable movement, agitation, speech impairment and dysfunctional movement. If this medical condition is not treated in an early stage or if it is treated improperly, it can cause more severe complications such as brain swelling, brain herniation, progressive and irreversible coma, permanent nervous system damage which can affect the patient’s movement, senses and mental state, an increased risk of developing other severe conditions such as sepsis, respiratory failure, cardiovascular collapse or kidney failure. Other complications that can be encountered by the patient are side effects of certain medications. This kind of coma usually affects individuals who consume alcohol excessively, and is diagnosed only after coma due to the intracranial space occupation. It is very important to treat the condition in an early stage to prevent future complications or even the death of the individual.

Hepatic Coma Treatment

If you know you have or you are suspected of having a liver disorder and in the case that changes in your mental status have occurred along with any other neurological problems, we strongly advise you to immediately call your health care provider. It is very important to contact a medical professional in time, as soon as the symptoms and signs that may indicate Hepatic Coma appear. It is highly important for a patient’s general health that this disorder is discovered and treated in time. When seeing your health care provider, you will be first asked about your medical history and about the signs and symptoms that you have experienced lately. If the patient is believed to suffer from a certain liver disorder, then he may complain of signs and symptoms specific for this kind of medical disorder, such as collection of fluid in the abdomen or yellow skin and eyes, known as jaundice. In some cases, the urine and breath may have a specific musty odor. Then, a physical exam will be performed. The mental status of any patient suspected of Hepatic Coma will be carefully tested. The examination may appear uncommon because the main tests will consist of thinking (cognitive) tasks - for example, trying to connect lines with numbers. It is well known that when dealing with this type of condition the neurological symptoms have a big potential in changing their course. During voluntary movement, flapping muscle tremor may be easily seen; an example that we can offer is that when a patient suffering from Hepatic Coma attempts to hold his or her arms out in front of the body. The blood exams can sometimes show failure of the liver or can be nonspecific. The abnormalities that may be revealed by the blood chemistry are the high levels of albumin, serum ammonia and high concentrations of bilirubin. A reading of the brain’s electrical activity (EEG) can also show several minor abnormalities. Once the diagnosis is established and it is sure, the health care provider can proceed with the adequate treatment. Hepatic Coma is an acute medical disorder that can often become a medical emergency so that hospitalization is always needed. The main aims of any treatment against Hepatic Coma are the treatment and the elimination of the causes, neutralization and elimination of the ammonia and other similar toxins, together with offering life support. Some measures for the life support of the patient can include the support of blood and breathing circulation. The health care providers must be very careful because the brain may swell causing life threatening conditions. In the severe cases, the diet is also very important because the levels of consumed proteins must be reduced so that the levels of ammonia get low. But this must be done under medical guidance due to the fact that if the proteins are too low, malnutrition could develop. In critical cases, the patients are administered perfusions. Medications broken down by the liver, such as sedatives and tranquilizers must be avoided.