What is hepatic encephalopathy (HE)?

When a healthy liver is damaged, it usually repairs itself by replacing the damaged cells with new healthy cells. With chronic liver disease, however, permanent damage can occur in the form of cirrhosis.4

When a liver is severely damaged, as it is in cirrhosis, it cannot filter out the harmful substances from our blood as it normally would. These toxins continue to flow through the blood, and into the brain where they accumulate. This can lead to hepatic encephalopathy.3

About 70% of people who have cirrhosis develop symptoms of HE.5 It is important to recognize the symptoms early, and to deal with them effectively. If diagnosed and treated early enough, HE can even be reversed completely.3

Early signs and symptoms of hepatic encephalopathy

The first signs of HE are often very subtle and easily missed.5 Once the toxins start to accumulate in the brain, symptoms may appear episodically.1

HE is associated with many different symptoms that can develop over time. These symptoms can be physical, mental or a combination of both.3 In the early stages, your friends and family may often identify your symptoms before you do. Ask friends and family to point out any changes they notice in your behaviors.7

The first signs of hepatic encephalopathy usually are:

  • Reduced attention span
  • Personality changes
  • Confusion
  • Memory loss
  • Difficulty with small hand movements
  • Changes in sleeping patterns 3

If you experience any of these symptoms, you should discuss them with your doctor to identify the cause. Your doctor will examine you, and may carry out some of the tests described earlier, to help them decide whether you need treatment.3 The tests used to diagnose HE aim to measure certain mental and physical abilities: memory, reaction time, problem solving ability and co-ordination.6

Don’t forget, the earlier HE is recognized, the more effective your treatment is likely to be!3

Ältere Frau blickt in die Ferne

It is important to recognize the symptoms early, and to deal with them effectively.


1. Sethi S. HealthLine. Hepatic Encephalopathy. Available at: https://www.healthline.com/health/hepatic-encephalopathy. Last accessed: October 2020

2. Wolf, D. Medscape. Hepatic Encephalopathy Differential Diagnoses. Available at: https://emedicine.medscape.com/article/186101-overview#a6. Last accessed: November 2020

3. Melinosky C. MedicineNet. What is Hepatic Encephalopathy? Available at: https://www.medicinenet.com/hepatic_encephalopathy/article.htm. Last accessed: October 2020.

4. University of Iowa Hospitals & Clinics Staff. University of Iowa Healthcare. Liver Diseases: Frequently Asked Questions. Available at: https://uihc.org/health-topics/liver-disease-frequently-asked-questions. Last accessed: November 2020

5. Wolf, D. Medscape. Hepatic Encephalopathy Available at: https://emedicine.medscape.com/article/186101-overview. Last accessed: October 2020

6. Nabi E, Bajaj JS. Useful Tests for Hepatic Encephalopathy in Clinical Practice. Curr Gastroenterol Rep. 2014 Jan; 16(1): 362.

7. American Liver Foundation staff. American Liver Foundation. Caring for a Loved One with Hepatic Encephalopathy. Available at: https://liverfoundation.org/wp-content/uploads/2019/11/Caring-for-a-Loved-One-With-Hepatic-Encephalopathy-HE-2013.pdf. Last accessed: November 2020

May 2021. GL-HEP-XIF-2000178

Other articles you might also be interested in...