Why is my husband's liver disease causing confusion?

Question

Hello doctor,

My husband was just hospitalized last week because he suddenly became very confused, could not recognize me, and was saying things that made no sense. The doctor told us it was something called overt hepatic encephalopathy. He has had liver cirrhosis for a few years, but was doing okay until now. I am really scared because I have never seen him like this before.

What exactly happened to his brain, and what are the tests needed?
The doctor is saying he needs an EEG. Is it really needed? I am worried.
Why does liver disease cause someone to suddenly lose their mind like that?
Is this going to keep happening, or was it a one-time thing?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Overt hepatic encephalopathy is frightening to witness, but it is common, treatable, and often reversible. In cirrhosis, the liver cannot properly detoxify harmful substances, especially ammonia, produced by gut bacteria.

Normally, the liver clears ammonia, but when liver function declines, or a trigger occurs (constipation, infection, dehydration, bleeding), ammonia enters the bloodstream and reaches the brain. It alters brain cell function and neurotransmission, causing confusion, disorientation, personality changes, and drowsiness. This is a metabolic brain dysfunction, not permanent brain damage, if treated promptly.

I would recommend the following investigations:

Blood tests: Ammonia, electrolytes, kidney and liver function.Infection screen (urine, blood, ascitic fluid if present).Sometimes computed tomography (CT) of the brain is used to exclude stroke or bleeding.

An electroencephalogram (EEG) is not always mandatory, but it is helpful if the diagnosis is unclear, seizures are suspected, or confusion is severe. An electroencephalogram shows characteristic slowing in hepatic encephalopathy and helps exclude other brain disorders. It is safe and non-painful.

There is a risk of recurrence, but medicines like Lactulose and Rifaximin reduce this greatly. Preventing triggers is essential. With proper treatment and regular medication, most patients recover well and regain normal mental function.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.