How can liver disease cause hypoproteinemia

Brain damage in liver disease

Brain damage caused by liver disease is also known as "hepatic encephalopathy". This is understood to mean functional disorders of the central nervous system, which can have different characteristics. The disorders can be in the brain as well as in the spinal cord. The name of the hepatic encephalopathy is always an indication that the disorders in the central nervous system are the result of advanced, severe liver diseases. This brain damage can also be referred to as "portosystemic encephalopathy".

The liver in the context of detoxification

The liver is a central organ for detoxification in the human body. It can weigh up to 2 kg and is divided into lobes. The detoxification and conversion of toxic substances in the body is so important because this is how waste products leave the organism. For example, alcohol and medication are broken down with the help of the liver and passed out of the body via the kidneys and bile. The liver can convert fat-soluble toxins into water-soluble ones so that they can be eliminated through the urinary tract.

The liver plays a particularly important role in the metabolism of ammonia and amino acids. The liver processes these substances into urea and ensures that they find their way out via the kidneys and urinary tract. If the liver fails, these substances remain in the body and gradually cause fatal side effects. Metabolic products and toxic waste products accumulate and have harmful effects - the brain is particularly affected.

The cause of the hepatic encephalopathy

When the liver is working normally, ammonia is converted to urea and then excreted in the urine. If the self-cleaning program fails because the liver is no longer working as planned, high amounts of waste materials and metabolic products remain in the body.
Toxic substances, such as the excessive amount of ammonia, mainly damage the brain and lead to hepatic encephalopathy. They also disrupt the amino acid metabolism, which changes the transmitter substances in the brain.

Symptoms - How to Notice the Hepatic Encephalopathy

The condition of brain damage, which can be traced back to a failure of the liver function, is complex. In addition, it should be said that this is not a disease per se, but the consequence of the actual underlying disease in the liver. At the beginning of the neuropsychiatric condition, intellectual deficits and attention disorders as well as concentration disorders occur. In this phase, often only the immediate environment, which the person concerned knows well, notices that something has changed. In the next stage, the symptoms worsen. Additional sleep disorders and states of confusion now follow. Forgetfulness also increases rapidly, which can lead to a misdiagnosis of dementia or Alzheimer's disease.
In the next stage, a tremor typical of hepatic encephalopathy can be observed. It is known in technical terms as "flapping tremor". When patients are asked to stretch their arms sideways or forwards during an examination, movements that are reminiscent of flapping wings are noticed.
In the further course, severe personality disorders and uncontrolled aggressiveness become apparent. The changes in personality are reversible when treated for liver dysfunction. There are also disorientation and a "foetor hepaticus": this is the characteristic liver odor from the mouth that goes along with it.
In the last stage, the person concerned falls into a coma and is unconscious, which is also known as a hepatic coma.

It is impossible to predict how severe the encephalopathy will be. The correlation between little muscle mass and more pronounced forms of encephalopathy was shown again and again. This is because patients with few muscles, unlike more muscular patients, cannot at least partially compensate for ammonia by storing glutamine, even with liver dysfunction.

Diseases behind hepatic encephalopathy

A classic cause of brain damage in liver disease is hepatitis. Due to the inflammation of the liver, the liver tissue loses its functionality and therefore no longer manages to completely detoxify and convert toxic substances and ammonia. The waste products flow into the body and spread. Long-term alcohol consumption in large quantities or liver tumors can also cause brain damage as a result.


If there are signs of liver damage, the liver should be relieved as much as possible: alcohol and medication should be avoided. In order to get hepatic encephalopathy under control, the underlying disease of the liver must always be treated. The therapy depends on the clinical picture and the severity behind it. There are also drugs available that can support and increase the detoxification performance of the liver. It is important to see a doctor at the first signs. More than 90% of those affected with hepatic encephalopathy are diagnosed too late.