What causes OHE in patients with liver cirrhosis?

Question

Hello doctor,

I have been living with liver cirrhosis for three years now. My liver got damaged because of hepatitis B. My doctor has been telling me that I am at risk of getting a serious problem called overt hepatic encephalopathy.

Last month, my brother had a bad episode of overt hepatic encephalopathy. He got it because of a stomach infection. My brother also has liver cirrhosis.

I do not want to go through what my brother went through. I am worried about my liver health.

What causes OHE in patients with liver cirrhosis?
I also want to understand what causes overt hepatic encephalopathy in someone with liver cirrhosis at the biological level.
Why certain triggers, like infections, constipation, and bleeding, suddenly push a stable cirrhosis patient into a brain crisis?
What can I do right now to reduce my own risk of the same thing happening to me?

Help me out.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

In the body, the liver is essential. When damaged severely, it can lead to overt hepatic encephalopathy. A damaged liver cannot remove toxins from the blood; one important toxin is ammonia. So the ammonia just builds up, goes to the brain, and affects how the nerves in the brain send messages to each other, leading to:

Confusion.
Drowsiness.
Personality changes.
Sometimes coma.

Triggers such as infections, constipation, gastrointestinal bleeding, dehydration, or certain medications increase toxin production or reduce the body’s ability to clear them. For example:

Constipation allows more ammonia to be absorbed from the colon.
Infections increase metabolic stress and inflammation.
Bleeding in the digestive tract provides extra protein that gut bacteria convert into ammonia.

These factors can suddenly push a stable cirrhosis patient into overt hepatic encephalopathy.

To reduce risk, prevention is crucial. Many patients are prescribed Lactulose, which lowers ammonia levels by trapping it in the bowel and promoting regular stools. If the problem keeps coming back, doctors may also give another medicine called Rifaximin.

To prevent problems, it’s important to go to the toilet regularly, treat infections early, drink lots of water, and avoid sleeping meds unless prescribed by a doctor.

Get help quickly if you feel confused, experience sleep reversal, act differently than usual, or experience shaky hands.

Hope this helps you.

Regards.