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For those who struggle with alcoholism, there exists a kaleidoscopic variety of syndromes and diseases that can result from excessive alcohol consumption over a long period of time. One such disease that can result from alcoholism is hepatic encephalopathy. Despite the link between neuropsychiatric behavior and liver disease having been observed since ancient times, the disease itself was not described and formally recognized until the late 19th century/early 20th century.

Hepatic encephalopathy is quite rare, but if recognized, diagnosed, and treated properly, it can be overcome with guidance. Caused by a small variety of conditions and organ issues, hepatic encephalopathy is primarily the result of liver issues. Up to 50% of those with cirrhosis develop symptoms of hepatic encephalopathy. It is most often temporary, but can be fatal within a year if the diagnosed individual does not undergo treatment.

Types of hepatic encephalopathy

Three types of hepatic encephalopathy exist: A, B, and C. Type A is an acute form of liver failure without underlying chronic liver disease. Type B shows up in some people with a shunt connecting two veins inside the liver without underlying liver disease. Type C occurs when there is underlying chronic liver disease and cirrhosis. If the liver is damaged to the degree at which it can no longer regularly function, the toxins in your body that are produced through alcohol consumption will reach the brain and cause the psychological symptoms of hepatic encephalopathy. It is most commonly diagnosed through exclusion of other diseases.

The West Haven Grading System measures the progression of hepatic encephalopathy in patients over 5 different levels. Starting with Grade 0, which is mild, it goes up to Grade 4, which is the level at which you become comatose, experience marked amounts of brain damage, and possess decerebrate posturing. Some cases of hepatic encephalopathy are impossible to reverse at the point when it is found and tragically result in failed treatment. Severe cases of hepatic encephalopathy require some form of round-the-clock nursing care, and can often mean that an individual requires a feeding tube and frequent intubation due to the risk of respiratory arrest. Type A hepatic encephalopathy may require a liver transplant as soon as possible. Type B can be solved almost immediately with medical attention and treatment. Type C must be treated after the underlying cause of the condition is determined, and then treatment is prescribed based on the causes.

Common symptoms of hepatic encephalopathy

One of the most significant signs someone may be experiencing hepatic encephalopathy is if they are displaying behavior typical of someone with Alzheimer’s due to the way the condition affects the brain and brain matter over time. Mild forms of hepatic encephalopathy can be detected with neuropsychological testing, but does not necessarily exhibit itself behaviorally.

Worsening levels of consciousness can be a sign that something negative is happening neurologically, and can show up as anything between lethargic tendencies to a coma. A patient’s memory can fail in small or large ways, including amnesia. Coma, seizures, and brain swelling can lead to death in the patient. Sweet-smelling breath and jaundice can occur as well at any time after developing hepatic encephalopathy. One classic symptom of hepatic encephalopathy is the “liver flap” or “flapping tremor” due to the buildup of ammonia in the body, which is a form of asterixis which can be used to help narrow the cause down. This occurs when the hands begin moving back and forth like the wings of a bird while the hands are held up.

The dangers of a condition like hepatic encephalopathy are quite apparent, and should illuminate the risks of excessive drinking over a long period of time. Alcoholism is a drain on your health and is yet another reason why you should seek help when possible to make sure you do not get trapped by a condition like this.

Learn more

If you are suffering from an alcohol use disorder and need further guidance and help, give Landmark Recovery a call today at 888-448-0302 to learn more. Our staff are ready to help you begin your journey of recovery and live beyond addiction.

About the Author


Dr. Elijah Wilder - DO

Dr. Elijah Wilder is the Regional Medical Director for our Indiana, Kentucky, and Ohio locations at Landmark Recovery. Currently located in the Midwest, Dr. Wilder is a graduate of the Philadelphia College of Osteopathic Treatment. Dr. Wilder completed his residency at Duke University and a fellowship at the University of Cincinnati. Dr. Wilder is dual board-certified in psychiatry and addiction treatment and a member of the American Psychiatric Association and the American Medical Association. Focusing on ensuring Landmark Recovery fulfills its medical obligations to the patients, Dr. Wilder is pioneering the development of cutting-edge addiction treatments to help our patients live beyond substance abuse as successfully as possible. Dr. Wilder also serves as a Psychiatrist for the Community Mental Health Center in Lawrenceburg, Indiana and an Assistant Clinical Professor at the University of Cincinnati’s Department of Psychiatry and Behavioral Neuroscience.

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