Hepatic Encephalopathy: How Liver Dysfunction Affects the Brain

February 13, 2026

Hepatic Encephalopathy: How Liver Dysfunction Affects the Brain

Verified By
KIMS-SUNSHINE
Specialist,
13 February, 2026

Hepatic Encephalopathy: How Liver Dysfunction Affects the Brain

The liver is the largest organ in the body, responsible for a variety of functions- foremost being filtering toxins from blood and producing bile for digestion of fats, among others. When the functioning of the liver is compromised due to a chronic condition or infection, the filtering capacity gets reduced- which can lead to high levels of toxic substances building up in the blood. This can even alter brain function. If you notice symptoms which may point towards liver damage and altered mental state, do not hesitate to reach out to a liver specialist at the best hospital in Hyderabad, today!

Causes for Hepatic Encephalopathy

The term ‘encephalopathy’ is used when the brain is not functioning normally and when this happens due to liver damage or failure, it is termed hepatic encephalopathy or portosystemic encephalopathy. Some of the most common causes for this condition to occur include

Acute liver failure
Portosystemic shunt- where blood flows in a new route, and not via the portal vein after digestion has occurred.
If you have chronic liver failure due to cirrhosis caused by some other issue.
If you take too much of a particular medication or consume too much alcohol
If you have a severe infection that can cause your body to get very stressed out. Viral infections can be serious if not treated in time.
If there is severe electrolyte imbalance or dehydration.

Liver Disease Brain Symptoms

Symptoms begin when the liver is not filtering toxins that remain after digestion- like ammonia, phenols, neurotransmitter-like molecules etc.This blood comes via the portal vein into the liver, is filtered and then sent out to systemic circulation, toxin free. When this process doesn’t work like usual, neurotoxins build up in the blood and affect brain function in different stages

Grade 0- when you have subtle memory issues or changes in reaction times.
Grade 1- Mild confusion due to liver failure, forgetfulness, mood swings, fine motor skills don’t work as well and not being able to sleep normally.
Grade 2- Personality changes are more pronounced, disorientation is present and slurred speech is also observed.
Grade 3- Altered mental status, drowsiness, delirium, tremors, amnesia, poor general awareness
Grade 4- The person goes into a hepatic coma.

If you notice grade 2 or 3 like symptoms, you should rush to a hospital for emergency treatment.

Diagnosis of Hepatic Encephalopathy

A liver specialist or gastroenterologist can help diagnose this condition. Approaches used include-

A physical exam where they check your vital signs
They will check for liver disease and/or a portosystemic shunt.

For this, they will recommend

Blood tests to check liver function and ammonia levels.
Ultrasound to check blood flow to your liver.
CT or MRI scans to check for inflammation or other structural abnormalities in the brain.
An electroencephalogram (EEG) is done to check brain activity.

Treatment for Hepatic Encephalopathy

The main point to remember is the brain gets better once treatment begins. Treatment depends on what problem is causing the encephalopathy in the first place-

If it is liver failure, then there is proper treatment that can cure this condition. Supportive care is given to prevent complications. If nothing works, then liver transplant is the only available option.
If you have a portosystemic shunt, then interventional radiology may be used to help blood flow in a different path and ease symptoms.
Reducing toxins involves the use of medications like antibiotics and laxatives like lactulose to help you excrete waste better and manage infections. Branched chain amino acids may be given to help clear ammonia via muscle tissue.
Hemodialysis is done so that filters can be filtered out of blood, when there is acute liver failure.

Conclusion

Managing hepatic encephalopathy involves timely treatment, but if you have chronic liver failure, then it is a medical emergency. Long term management will involve getting someone to help you when your symptoms get worse, eating a liver friendly diet, getting enough exercise and looking for a living liver donor, if possible. If you have liver failure and want to better understand how to prevent encephalopathy from affecting you, get in touch with our specialist at KIMS Sunshine hospital- the best multispeciality hospital in Hyderabad.

Frequently Asked Questions

How does liver disease affect brain function?

Severe liver disease can lead to hepatic encephalopathy, a decline in brain function caused by the liver’s reduced ability to remove toxins from the blood. When the liver fails, harmful substances accumulate and affect the brain, leading to confusion, altered behaviour, drowsiness and, in advanced cases, coma. Hepatic encephalopathy is often linked to conditions such as cirrhosis.

Why does ammonia buildup cause confusion?

Ammonia is produced in the gut when bacteria break down protein. A healthy liver converts ammonia into urea, which is excreted in urine. In liver failure, ammonia accumulates in the bloodstream and crosses into the brain. It disrupts neurotransmission, alters brain cell function and causes swelling of brain cells, leading to confusion, poor concentration and changes in consciousness.

How is hepatic encephalopathy diagnosed?

Diagnosis is based on symptoms, medical history and examination. Doctors assess mental status, coordination and the presence of a flapping tremor (asterixis). Blood tests may show raised ammonia levels, although levels do not always match symptom severity. Other causes of confusion, such as infection, bleeding or medication effects, must be excluded.

Can hepatic encephalopathy be reversed?

Yes, it is often reversible with prompt treatment. Management includes treating triggers such as infection or bleeding and reducing ammonia production using medications like lactulose and certain antibiotics. Long-term control depends on managing the underlying liver disease.

When should a liver patient seek urgent medical care for confusion?

Urgent medical care is needed if there is new or worsening confusion, marked drowsiness, personality change, disorientation, slurred speech or reduced consciousness. Rapid assessment is vital to prevent progression to coma.