Symptoms of hepatic encephalopathy
Doctors classify symptoms of hepatic encephalopathy into two broad categories, covert and overt. Covert means that those symptoms need some stimulation to appear, usually in the form of specially designed tests, while overt means that those symptoms manifest by themselves without the need for special tests.
Symptoms of hepatic encephalopathy are, therefore, graded into four grades, and each grade represents a worsening neurological function. For example, patients with grade 0 symptoms have less severe symptoms and a better brain function than those with grade 1 symptoms and so on. The first area of cognition that is affected by hepatic encephalopathy is short-term memory. Afterwards, several symptoms follow including:
- Decreased ability to concentrate
- Insomnia, sleepiness, or both
- Mood swings
- Motor dysfunction in the form of tremors, decreased muscle strength and poor eye-hand coordination.
- Paranoia and psychosis
Coma is usually the final stage of hepatic encephalopathy and is a sign of liver failure. Some patients may experience a bad breath odor from the excessive amount of ammonia secreted in their saliva. They may also have cold extremities.