If the liver is failing due to heart failure and causes hepatic encephalopathy, can this altered mental status and confusion come and go, or is it permanent due to brain damage from toxin buildup?

The liver filters the toxins that build up in everyone’s body as a result of normal metabolism.

When this organ is severely damaged it can’t filter effectively, and hence, the toxins end up in the general blood circulation and make it to the brain, affecting cognitive status.

The patient is “off” or sluggish in thinking, confused and very foggy.

The liver can become injured from poor blood flow due to heart failure. If the injury is severe enough, the level of toxic buildup in the brain will affect thinking.

Can this hepatic (liver) encephalopathy (brain disease process) come and go?

“Yes, depending on the underlying cause of decompensation,” says Daniel Motola, MD, a top board certified gastroenterologist and hepatologist providing same-day and next-day services in NYC with Gotham Medical Associates.

Dr. Motola continues, “If reversible it can be transient, but often still requires treatment to remove ammonia from the digestive tract.”

Conditions Under Which Cardiac Hepatic Encephalopathy Can Come and Go or Is Transient

• The decompensated heart failure resulted from a heart attack.

• The decompensated heart failure resulted from fluid around the heart.

• The decompensation resulted from a traumatic injury.

If the acute decompensation occurs because the heart is very old and weak, and it’s lost so much steam over time that finally, other organs are failing, then this is not reversible.

Such a patient would be considered too sick and old (or sometimes just too sick, regardless of age) to survive a transplant.

How is the ammonia removed?

“This is accomplished using a medication call lactulose, which changes the pH in the digestive tract and creates diarrhea,” says Dr..

“Together this allows evacuation of ammonia. Another medication used is Rifaximin, an antibiotic that reduces bacteria in the intestine and thus reduces generation of ammonia.”

If you are interested in a consultation with one of Gotham Medical Associates’ gastroenterologists please call 212-227-3688 or book online. Our staff will be happy to assist you, your family member or friend. 

In addition to his liver transplant expertise, Dr. Motola offers expertise in chronic liver disease, GERD, IBS, colon cancer screening, endoscopy and disorders of the bile ducts and gallbladder.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  



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