Q: Which doctor should be consulted for symptoms of encephalopathy in a patient with liver disease?
A: If the symptoms are acute, the patient may require emergency care in the emergency department. If the symptoms are mild, they may be treated by the treating hepatologist.
Q: How does ammonia affect the brain?
A: Ammonia is highly toxic to the nerve cells (neurons) and the supporting cells (glial cells and astrocytes) of the brain. These cells become severely damaged leading to neurological abnormalities, seizures and finally coma.
Q: Can hepatic encephalopathy be prevented?
A: There are a number of known triggers for the development of HE. It is essential that the patient is careful to avoid these triggers, and maintain a balanced and healthy diet and lifestyle to prevent HE.
Frequent assessment of neurological function is recommended to diagnose MHE, which is difficult to diagnose clinically.
Q: Is cirrhosis of the liver curable?
A: Cirrhosis signifies irreversible damage to the liver. The prognosis is better in patients with compensated cirrhosis who have not developed jaundice, variceal bleeding or ascites. In decompensated patients, the survival rates are poor and such patients are candidates for liver transplant.
Q: What is fetor hepaticus?
A: Fetor hepaticus is referred to as the ‘breath of the dead’ as it is commonly seen in end stage liver failure. The breath has a sweet fecal smell. It occurs in portal hypertension where portal blood containing thiols enter the lungs. Ammonia or ketones in the breath may also cause the distinctive odor.
