Hepatic coma is a common and serious complication of all types of liver diseases. The pathogenesis is still unclear, but it is generally believed that the liver’s inability to remove toxins from the bloodstream leads to the loss of brain function, which is why it is also known as hepatic encephalopathy. For some patients with decompensated liver function, hepatic coma has become a common occurrence, just like the arrival of the “great aunt”. Most of them need to be hospitalized and treated many times, and patients and their families have to pay a huge economic price while suffering from physical and mental torture, so how to do a good job of family prevention is very important. We often say “know your enemy and know yourself, and you will not be in danger in a hundred battles”, so is the treatment of hepatic encephalopathy. A large number of clinical experiences have confirmed that, for patients with cirrhosis, about 70% of them have suffered from hepatic encephalopathy of different degrees. Since the onset of hepatic encephalopathy may be rapid or slow, and the condition may be mild or severe, mild cases may only have personality and behavioral changes, while severe cases may have coma or even life-threatening conditions, early detection and early treatment are very crucial. What are the abnormal manifestations of hepatic encephalopathy? Early abnormalities 1. Character change: people with extroverted personality can show depression, and people with introverted personality can show excitement and talk a lot, and even have radical character, etc. 2. Behavior change: it is mainly the increase of minor problems, like “returning to childhood”, and a lot of behaviors are like that of a child, such as scribbling and drawing, littering and putting away, talking and moving, urinating and defecating at will, and so on. Action. Changes in sleeping habits: it often manifests as sleeping during the day, waking up at night, dreaming and other sleep inversion and confusion, which is a manifestation of the disturbance of excitation and inhibition of the central nervous system and a sign of the imminent arrival of hepatic encephalopathy. If the early symptoms are not obvious or undetected, it may further evolve into changes in intelligence, which may be manifested as unclear concepts of time and space, fuzzy concepts of characters, slurred speech, inversion of words, difficulty in writing, decreased ability of calculation and counting, and incorrect connection of numbers. Third, late abnormalities at this time, mainly manifested as impaired consciousness, can be detected by family members, may appear drowsy, sleepy or even coma, sleepy can be called to wake up but turn his head to sleep, sleepy state only to external stimuli have a reflection, and coma is a variety of reactions, reflexes have disappeared. Under what circumstances is hepatic encephalopathy prone to occur? 1.Dehydration:This kind of dehydration is mostly triggered by ascites of liver cirrhosis, and a large amount of ascites leads to tissue dehydration; there are also many patients with liver disease who seldom drink water because of fear of ascites, which leads to no ascites but the cells in the body are dehydrated; there is also a part of the patients who are not taking furosemide, spironolactone, and other diuretic drugs for a long period of time in an incorrect manner leading to dehydration of the organism, and then electrolyte disorders, such as low potassium and low sodium, occur. 2, indiscriminate use of drugs: many drugs can lead to liver function damage, aggravate the burden on the liver, and even large swaths of hepatocellular necrosis, which may induce hepatic encephalopathy, common drugs such as cold and flu medicines, psychotropic medicines and some traditional Chinese medicines, etc. So when these medicines are needed, they must be used in the same way as other medicines. So when you need these medicines, you must ask the professional hepatologist first. Alcohol consumption: alcohol is one of the common factors of liver cirrhosis, but many patients can not control or avoid alcohol due to some emotional reasons, especially after drinking a lot of alcohol, hepatic encephalopathy is very easy to occur. 4, exertion: patients with liver disease need to avoid exertion in the principle of treatment, for patients with decompensated liver cirrhosis, simple housework, or even an occasional physical activity may induce hepatic encephalopathy. 5, diet: high protein diet is the key factor leading to intestinal toxins, especially early hepatic encephalopathy patients, animal protein such as fat meat, animal offal, blood products, etc. Do not consume too much, preferably not more than 20 grams per day, even if it is a high level of animal protein, such as milk, fish and shrimp, and egg whites and so on, can not be too much. Vegetable protein such as soy milk and other do not drink too much, can do 1 cup per day is best. 6, mental stress: mental stress can also lead to the occurrence of hepatic encephalopathy, it is important to learn to relax. 7, insomnia: for people with liver disease who have sleep disorder, they must learn to utilize their own biological clock therapy to regulate their sleep. Sleeping for less than 8 hours, especially sleeping for less than 6 hours, puts the liver in a state of fatigue for a long period of time, which is very easy to induce hepatic encephalopathy, and it is not suitable for patients with early stage of hepatic encephalopathy to take sleeping pills and so on. 8, constipation: long-term constipation is not conducive to the elimination of intestinal toxins, especially for more than 1 week, it is recommended that people with liver disease combined with constipation can use lactulose, intestinal probiotics, etc. to regulate the intestinal function and solve the problem of constipation at an early date. Bleeding: Upper gastrointestinal bleeding is a common factor that induces hepatic encephalopathy, due to the decomposition of hemoglobin in the intestines, a large amount of blood ammonia in the intestines can not be metabolized in time, and it will trigger the change of brain function after entering into the bloodstream. Infection: cold, acute enteritis, dysentery and diabetes mellitus combined with infection can induce hepatic encephalopathy. 11, trauma: accidental trauma and surgical trauma can induce hepatic encephalopathy, especially the upper gastrointestinal hemorrhage shunt surgery or liver cancer surgery patients, surgery is very easy to occur hepatic encephalopathy. A few simple tests can let you detect hepatic encephalopathy early? 1. Smell: Due to liver failure, sulfur-containing substances in the body are exhaled through the lungs or emitted through the skin as a characteristic odor. Like rotten apple flavor, garlic flavor, fish smell, etc., commonly known as liver odor. If there is such an odor, it should be highly valued and combined with the performance, and the possibility of hepatic encephalopathy should be considered. 2. Tremor: fluttering wing-like tremor is a common method used by doctors to check hepatic encephalopathy, and we can learn to use it at home, which has early diagnostic significance. The method is: ask the patient to stretch out the forearm, unfold the five fingers, or when the wrist is overextended and immobilized, the patient’s palm-finger and wrist joints can show rapid flexion and extension movements, which can often occur 1 to 2 times per second, and there are some cases that can reach 5 to 9 times per second, and are often accompanied by the lateral movements of the fingers. At this time, the patient may be accompanied by the entire upper limbs, tongue, palate, jaw microtremor and gait ataxia. The tremor may occur unilaterally or bilaterally. However, this kind of tremor is not characteristic. It is mostly seen in the early stage of hepatic encephalopathy and disappears after sleep and coma. 3, digital connection test: randomly print 25 Arabic numerals on paper, ask the patient to use a pen to connect them with a line according to the natural size, record the time of connection, check the frequency of connection error, the method is simple, and it can find early patients. 4.Signature test: patients can be allowed to sign and write their own names every day. If the handwriting is not neat, early encephalopathy can be detected. 5, building blocks test: such as using matches to build a five-pointed star, or draw a sketch, or do simple addition or subtraction. 6. Mental math experiment: give the patient the calculation of continuous addition or subtraction within 20, which is not easy to be too long. If the patient cannot answer correctly in time, it can indicate the possibility of hepatic encephalopathy. How to prevent hepatic encephalopathy at home? 1.Strictly control diet: in the early stage, it is advisable to choose the semi-liquid diet of low protein, low fat, low salt and high carbohydrate which is easy to be digested. If symptoms are found, all meat and other fishy foods should be stopped immediately. 2, laxative treatment: early can take honey water laxative, or direct use of four mill soup, hemp pill, lactulose, intestinal probiotics to regulate intestinal function, as soon as possible to solve the problem of constipation. However, it is not advisable to use senna, croton and other strong laxatives. Especially lactulose, intestinal probiotics for the family should always have. 3, seek help: found that early changes should be timely to seek the help of hepatologists, guidance to stop certain drugs or whether hospitalization is required. In conclusion, the control of hepatic encephalopathy is not an easy task. It requires a high degree of attention and systematic and standardized control of diet, medication and activities, as well as more exchanges and communication with the treating doctor, in order to prevent the recurrence of hepatic encephalopathy more effectively.