Hepatic encephalopathy is the loss of brain function that occurs when the liver is unable to remove toxins from the blood.

Causes :

The exact cause of hepatic encephalopathy is unknown. Hepatic encephalopathy is brought on by disorders that affect the liver. These include :
Conditions that reduce liver function (such as cirrhosis or hepatitis)
Conditions in which blood circulation does not enter the liver
An important job of the liver is to make toxic substances in the body harmless. These can include substances made by the body as well things that you take in (such as medicines). However, when the liver is damaged, these "poisons" can build up in the bloodstream. Ammonia, which is produced by the body when proteins are digested, is one of the substances normally made harmless by the liver.
Other toxins may also build up. These things can cause damage to the nervous system.

When liver damage occurs, hepatic encephalopathy may occur suddenly, even in people who have not had liver problems in the past. More often, the problem develops in people with chronic liver disease.

Hepatic encephalopathy may be triggered by :

Dehydration
Eating too much protein
Electrolyte abnormalities (especially a decrease in potassium) from vomiting, or from treatments such as paracentesis or taking diuretics ("water pills")
Bleeding from the intestines, stomach, or esophagus
Infections
Kidney problems
Low oxygen levels in the body
Shunt placement or complications
Surgery
Medicines that suppress the central nervous system (such as barbiturates or benzodiazepine tranquilizers) .

Disorders that can appear similar to hepatic encephalopathy include:

Alcohol intoxication
Complicated alcohol withdrawal
Meningitis
Metabolic abnormalities such as low blood glucose
Sedative overdose
Subdural hematoma (bleeding under the skull)
Wernicke-Korsakoff syndrome
In some cases, hepatic encephalopathy is a short-term problem that can be corrected. It may also occur as part of a chronic problem from liver disease that gets worse over time.

Symptoms

Symptoms may begin slowly and slowly get worse. They may also begin suddenly and be severe from the start. Early symptoms may be mild and include :
Breath with a musty or sweet odor
Change in sleep patterns
Changes in thinking
Confusion that is mild
Forgetfulness
Mental fogginess
Personality or mood changes
Poor concentration
Poor judgment
Worsening of handwriting or loss of other small hand movements

More severe symptoms may include :

Abnormal movements or shaking of hands or arms
Agitation, excitement, or seizures (occur rarely)
Disorientation
Drowsiness or confusion
Strange behavior or severe personality changes
Slurred speech
Slowed or sluggish movement
People with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma
Patients are often not able to care for themselves because of these symptoms.

Tests may include :

Complete blood count or hematocrit to check for anemia
CT scan of the head or MRI
EEG
Liver function tests
Prothrombin time
Serum ammonia levels
Sodium level in the blood
Potassium level in the blood
BUN and creatinine to see how the kidneys are working

TREATMENT:

Anti coma line of treatment include lactulose,rifaximin,enema.