Hepatic encephalopathy also called as portosystemic encephalopathy (PSE), is a nervous system disorder brought on by severe liver disease.
When the liver doesn’t work properly, toxins build up in the blood. These toxins can travel to the brain and affect brain function. People with hepatic encephalopathy may seem confused. The liver filters toxins from the blood. When someone have liver disease, ammonia and other toxins can build up in his/her brain, causing him/her to lose brain function.
Hepatic encephalopathy is an often-temporary neurological (nervous system) disorder due to chronic, severe liver disease. A diseased liver struggles to filter toxins (substances created from the breakdown of food, alcohol, side effects of medications and even muscle) from the bloodstream. These toxins build up in the body and travel to the brain. Toxicity affects brain function and causes cognitive impairment.
Who might get hepatic encephalopathy?
Up to 50% of people with cirrhosis of the liver eventually develop symptoms of hepatic encephalopathy.
Cirrhosis is a buildup of scar tissue in the liver. This scar tissue blocks blood flow and affects the liver’s ability to filter toxins, hormones and nutrients.
There are two types of hepatic encephalopathy:
- Acute hepatic encephalopathy comes on fast and may be a sign of liver failure.
- Chronic hepatic encephalopathy takes longer to develop. Sometimes people recover only to have it recur later.
Severity of hepatic encephalopathy classified by stages.
- Stage 0: Minimal HE. Slight changes in memory and concentration.
- Stage 1: Mild HE. Mood changes and sleep problems.
- Stage 2: Moderate HE. Inappropriate behavior, slurred speech, trouble doing basic math.
- Stage 3: Severe HE. Disorientation, extreme sleepiness, or anxiety.
- Stage 4: Coma.
Risk factors and complications
Risk factors that make it more likely you’ll get hepatic encephalopathy include:
- Cirrhosis or other severe liver disease.
- Having a Trans jugular intrahepatic portosystemic shunt (TIPS) procedure.
- Having a previous episode of hepatic encephalopathy.
- Having portal hypertension.
If someone had hepatic encephalopathy once, these things could trigger another bout:
- Dehydration or electrolyte imbalance (sodium chloride, potassium etc).
- Eating too much protein.
- Bleeding from digestive.
- Infections.
- Kidney failure.
- Low oxygen levels.
- Surgery.
- Taking some allopathic drugs that act on the central nervous system, including antidepressants, sleeping pills, opiates, and opioids.
Causes
When someone have liver disease, the liver struggles to filter natural toxins out of the body. Toxins, such as ammonia, accumulate in the blood. Toxins in the bloodstream can travel to the brain and temporarily (or sometimes permanently) affect brain function. 
Thing usually triggers the condition are:
- Alcohol use.
- Allopathic drugs that affect the nervous system (sleeping pills and antidepressants etc).
- Constipation.
- Dehydration or electrolyte imbalance.
- Digestive tract bleeding.
- Infections.
- Kidney disease.
- Liver shunt.
Symptoms of hepatic encephalopathy
Patients with hepatic encephalopathy experience impaired brain function. Symptoms include:
- Anxiety or irritability.
- Cognitive impairment (confused thinking or judgment).
- Coordination or balance problems.
- Difficulty concentrating or short attention span.
- Flapping hand motion (asterixis).
- Mood or personality changes.
- Muscle twitches (myoclonus).
- Reduced alertness.
- Sleep problems.
- Slurred speech.
Diagnosis
There isn’t a standard test to check for hepatic encephalopathy. However, blood tests can identify problems such as infections and bleeding associated with liver disease.
Other tests to rule out conditions that cause similar symptoms, such as strokes and brain tumors. These tests include magnetic resonance imaging (MRI), computed tomography (CT) scans, Ultrasound (US) and electroencephalogram (EEG).
Allopathic treatment for hepatic encephalopathy
Treatment varies depending on symptoms and overall health and how severe the condition is. Treatments can rid the body of toxins and reverse this temporary condition. With allopathic treatment, it’s possible to slow, and sometimes stop, the disease from getting worse.
- Antibiotics: Antibiotics, such as rifaximin, stop bacterial growth.
- Laxatives: Lactulose oral solution, a laxative made from lactose sugar or Sugar of milk (Homeopathic), draws toxins into the colon. The sugar of milk stimulates frequent bowel movements that help remove toxins from the body.
Homeopathic treatment for hepatic encephalopathy
Homeopathic treatment varies depending on symptoms and overall health and how severe the condition is. This treatments will rid the body of toxins and reverse all unwanted conditions. With Homeopathic treatment, it’s possible to completely treat the disease in few days or one or two weeks.
Here are few medicines for liver and related diseases:
Cardus Marianus
The action of Cardus Marianus is centered in the liver, and portal system, causing soreness, pain, jaundice. Has specific relation to the vascular system. Abuse of alcoholic beverages, especially beer. Varicose veins and ulcers. Diseases of miners, associated with asthma. Dropsical conditions depending on liver disease, and when due to pelvic congestion and hepatic disease. Disturbs sugar metabolism. Influenza when liver is affected. Debility. Hemorrhages, especially connected with hepatic disease, dropsical accumulation of water in abdomen (ascetic).
The next field is bleeding consequent to liver damage, liver pain and sensitiveness, feel fatigued or tired and have bouts of nausea and vomiting due to Liver Cirrhosis. Taste bitter. Aversion to salt meat. Appetite small; tongue furred; nausea; retching; vomiting of green, acid fluid. Stitches in left side of stomach, near spleen (Ceanoth). Gallstone disease with enlarged liver.
Pain in region of liver. Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrhea. Stools bright yellow. Swelling of gallbladder with painful tenderness. Hyperemia of liver, with jaundice. Cirrhosis, with dropsy.
Rectum: Hemorrhagic piles, prolapse or rectum, burning pain in anus and rectum, hard and knotting, clayey stools. Profuse diarrhea due to rectal cancer. 10 drops doses (Wapler).
Urine: Cloudy; golden-colored.
Skin: Itching on lying down at night. Varicose ulcers (Clematis vitalba). Eruption on lower part of sternum.
Extremities: Pain in hip-joint, spreading through buttocks and down thigh; worse from stooping. Difficult rising. Weakness felt in feet, especially after sitting.
Chelidonium Majus
A prominent liver remedy, covering many of the direct reflex symptoms of diseased conditions of that organ. The jaundiced skin, and especially the constant pain under inferior angle of right scapula, are certain indications. Paralytic drawing and lameness in single parts. The great general lethargy and indisposition to make any effort is also marked. Ailments brought on or renewed by change of weather. Serous effusions. Hydrocele. Bilious complication during gestation.
Tongue yellow, with imprint of teeth; large and flabby. Taste bitter, pasty. Bad odor from mouth. Prefers hot food and drink. Nausea, vomiting; better, very hot water. Pain through stomach to back and right shoulder-blade. Gastralgia. Eating relieves temporarily, especially when accompanied with hepatic symptoms.
Abdomen: Jaundice due to hepatic and gall-bladder obstruction. Gall-colic. Distention. Fermentation and sluggish bowels. Constriction across, as by a string. Liver enlarged. Gallstones (Berberis).
Urine: Profuse, foaming, yellow urine, like beer (Chenop) dark, turbid.
Stool: Constipation; stools hard, round balls, like sheep’s dung, bright yellow, pasty; clay-colored, stools float in water; alternation of diarrhea and constipation. Burning and itching of anus.
Skin: Dry heat of skin; itches, yellow. Painful red pimples and pustules. Old, spreading, offensive ulcers. Wilted skin. Sallow, cold, clammy.
Pain in nape. Stiff neck, head drawn to left. Fixed pain under inner and lower angle of right scapula. Pain at lower angle of left scapula. Pain in arms, shoulders, hands, tips of fingers. Icy coldness of tips of fingers; wrists sore, tearing in metacarpal bones. Whole flesh sore to touch. Rheumatic pain in hips and thighs; intolerable pains in heels, as if pinched by a too narrow shoe; worse, right. Feels paralyzed. Paresis of the lower limbs with rigidity of muscles.
Lycopodium
Corresponds to Grau ogle’s carbo-nitrogenous constitution, the non-eliminative lithaemic. Lycopodium is adapted more especially to ailments gradually developing, functional power weakening, with failures of the digestive powers, where the function of the liver is seriously disturbed. Atony. Malnutrition. Mild temperaments of lymphatic constitution, with catarrhal tendencies; older persons, where the skin shows yellowish spots, earthy complexion, uric acid diathesis, etc.; also precocious, weakly patients.
Dyspepsia, weakness of digestion. Excessive hunger. Aversion to bread, etc. Desire for sweet things. Food tastes sour. Sour eructation. Bulimia, with much bloating. After eating, pressure in stomach, with bitter taste in mouth. Eating ever so little creates fullness.
Deep-seated, progressive, chronic diseases. Carcinoma. Marked regulating influence upon the glandular (sebaceous) secretions. Pre-senility. Ascites lacks vital heat (immune system); has poor circulation, cold extremities. Pains come and go suddenly. Cirrhosis of Liver when the liver has atrophied due to long-standing Cirrhosis. Hepatitis. Liver sensitive. Brown spots on abdomen. Hepatic dropsy. Hepatitis, atrophic from of nutmeg liver.
Stool: Diarrhea. Inactive intestinal canal. Ineffectual urging. Stool hard, difficult, small, incomplete. Hemorrhoids; very painful to touch, aching.
Arsenic Album
A profoundly acting remedy on every organ and tissue. Its clear-cut characteristic symptoms and correspondence to many severe types of disease make its homeopathic employment constant and certain.
Liver Cirrhosis with fatigue as the main symptom. The patient feels totally exhausted from doing a little labor. Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Nausea, retching, vomiting, after eating or drinking. Anxiety in pit of stomach. Burning pain. Vomiting of blood, bile, green mucus, or brown-black mixed with blood. Stomach extremely irritable. Everything swallowed seems to lodge in the esophagus. Ill effects of vegetable diet, melons, and watery fruits generally.
Gnawing, burning abdominal pains; relieved by heat. Liver and spleen enlarged and painful. Ascites and anasarca. Rectum painful, spasmodic protrusion of rectum. Tenesmus. Burning pain and pressure in rectum and anus.
Stool small, offensive, dark, with much prostration. Dysentery dark, bloody, very offensive. Cholera, with intense agony, prostration, and burning thirst. Body cold as ice. Hemorrhoids burn like fire, relieved by heat. Skin excoriated about anus.
Nux Vomica
Nux Vomica is greatest of polychrest. Liver Cirrhosis of alcoholic abuse, chronic acidity and constipation. Sour mouth taste, and nausea in the morning, after eating. Weight and pain in stomach. Flatulence and pyrosis. Sour, bitter eructation. Nausea and vomiting, with retching. Ravenous hunger, especially about a day before an attack of dyspepsia. Epigastrium bloated, with pressure s of a stone, loves fats and tolerates them well. Dyspepsia from strong tea and/or coffee. Wants to vomit but cannot. Region of stomach very sensitive to pressure, soreness or stitching pain in liver region. Hepatomegaly.
Mentally anger some and irritable nature, being sensitive to external impressions like noise and odor and also, a sensitivity to cold air. Spasmodic colic. Colic from uncovering. Forcing in lower abdomen towards genitals. Constipation, with frequent ineffectual urging, incomplete and unsatisfactory; feeling as if part remained un expelled. Constriction of rectum. Irregular, peristaltic action. Alternate constipation and diarrhea-after abuse of purgatives. Itching, blind hemorrhoids. Frequent small evacuations. Scanty stool, with much urging. Dysentery: stools relieve pains for a time. Constant uneasiness in rectum. Diarrhea, with jaundice.
Phosphorus
Phosphorus is a destructive metabolism. Causes yellow atrophy of the liver and sub-acute hepatitis, jaundice in patients with Cirrhosis of Liver, stool very offensive, vomiting of blood, desire for cold drinks, juices and ice creams.
Hunger soon after eating. Sour taste and sour eructation after every meal. Belching large quantities of wind, after eating. Throws up ingests by the mouthfuls. Vomiting: water is thrown up as soon as it gets warm in the stomach. Postoperative vomiting. Cardiac opening seems contracted, too narrow; the food scarcely swallowed, comes up again. Pain in stomach; relieved by cold food, ices. Region of stomach painful to touch, or on walking. Inflammation of stomach, with burning extending to throat and bowels. Bad effects of eating too much salt.
Abdomen feels cold. Sharp, cutting pains. A very weak, empty, gone sensation felt in whole abdominal cavity. Liver congested. Acute hepatitis. Fatty degeneration (Carbon tetrachloride; Ars. Chlorof). Jaundice. Pancreatic disease. Large, yellow spots on abdomen.
Stool: Very fetid stools and flatus. Long, narrow, hard, like a dog’s and difficult to expel. Desire for stool on lying especially on left side. Painless, copious debilitating diarrhea. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool. White, hard stools. Bleeding hemorrhoids.
Urine: Hematuria, especially in acute Bright’s disease. Turbid, brown, with red sediment.
Apocynum Cannabinum
Increases secretions of mucous and serous membranes and acts on cellular tissue, reducing edema and dropsy.
Nausea, with drowsiness. Thirst on walking. Excessive vomiting. Food or water is immediately ejected. Dull, heavy, sick feeling. Oppression in epigastrium and chest, impeding breathing (Lobelia infl). Sensation of sinking in stomach. Abdomen bloated. Ascites.
Stool: Watery, flatulent, with soreness in anus; worse after eating. Feeling as if sphincter were open and stools ran right out.
Urine: Bladder much distended. Turbid, hot urine, with thick mucus and burning in urethra, after urinating. Little expulsive power. Dribbling. Strangury. Renal Dropsy.
Quassia Amara
Acts on gastric organs as a tonic. Seems to possess marked action on eyes, producing amblyopia and cataract. Pain in right intercostal muscles above the liver. Pressure and stitches in liver, and sympathetically in spleen.
Stomach: Atonic dyspepsia, with gas and acidity. Heartburn and gastralgia. Regurgitation of food. Abdomen feels empty and retracted. Dyspepsia after infectious diseases; especially grip, dysentery. Tongue dry or with brown sticky coating. Cirrhosis of liver with ascites.
Urinary: Excessive desire-impossible to retain urine; copious micturition day and night. As soon as the child wakes up the bed is drenched.
Inclination to yawn and stretch. Sensation of coldness over back. Prostration, with hunger. Cold extremities, with sensation of internal coldness.
P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.
For proper consultation and treatment, please visit our clinic.
Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
Location: Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.
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