Existing in an acute form and in a chronic form and characterized by an alteration of the mental state, hepatic encephalopathy is a brain disease that occurs in the presence of liver failure .
The term liver failure indicates a serious morbid condition, which derives from a liver that is irremediably damaged and incapable of fulfilling several of its functions, such as protein synthesis or the elimination of infectious agents and toxins from the blood.
According to the experts, particular factors and circumstances contribute to favoring the appearance of hepatic encephalopathy, starting from a state of liver failure, including:
- Dehydration
- Improper intake of drugs, such as benzodiazepines, narcotics or antipsychotics
- Electrolyte and / or metabolic imbalances (hyponatremia, hypokalemia, alkalosis, etc.)
- Nitrogen overload, due for example to exaggerated protein intake, gastrointestinal bleeding or constipation
- Alcohol poisoning
- Infections, in particular pneumonia, urinary tract infections, bacterial peritonitis, etc.
- Hypoxia
- Surgical interventions
The presence of a hepatic encephalopathy causes alterations in mental, consciousness and behavioral status .
The signs and symptoms typical of such alterations are numerous and vary according to the severity of the disease, namely: the more hepatic encephalopathy is in an advanced stage, the more severe the symptomatology.
To simplify the consultation of the symptomatic picture, doctors and experts have assigned to the pathology four phases or stages ( West Haven Criteria):
- During stage 1, the patient experiences an initial initial loss of awareness, a slight lack of attention, nightmares, disturbed nocturnal sleep with consequent daytime sleepiness, restlessness, depression, anxiety and / or irritability.
- During stage 2, the patient shows personality changes, an aggravation of sleepiness, inability to solve even simple problems of daily life, responses to slowed stimuli, episodes of disobedience, gloom and / or disorientation in time and space. In general, in these phases we talk about lethargy or apathy.
- During stage 3, the patient incurs bizarre behavior, sudden and unjustified outbursts of anger, severe mental confusion, use of incomprehensible language, paranoia, very severe sleepiness and / or constant irritability.
At this stage of the disease, the examination of the signs reveals the presence of myoclonus, that is involuntary tics of one or more muscles, and of the Babinski sign, or an abnormal movement of the big toe triggered by a particular stimulation at the level of the plant of the foot.
- During stage 4, the patient is in a coma, therefore he does not respond to any external stimulus.
