What could be the cause of signs of hepatic encephalopathy in a patient with cirrhosis?

Hepatic encephalopathy is a complex neuropsychiatric condition commonly seen in patients with liver disease, particularly cirrhosis. The underlying mechanism of hepatic encephalopathy primarily revolves around the accumulation of toxic substances that the liver is unable to adequately process.

Increased ammonia levels are a critical factor in the development of hepatic encephalopathy. Normally, the liver converts ammonia, a byproduct of protein metabolism, into urea, which is then excreted in the urine. However, in patients with cirrhosis, the liver's ability to perform this function is severely impaired due to the loss of hepatocyte function and the development of portosystemic shunts. As a result, ammonia accumulates in the bloodstream and can cross the blood-brain barrier, leading to neurological disturbances.

High ammonia levels interfere with neurotransmission in the brain, causing symptoms such as confusion, altered level of consciousness, and even coma in severe cases. This metabolic disturbance is the central mechanism linking liver disease to the neurological symptoms observed in hepatic encephalopathy.

In contrast, while other factors like lactate accumulation, decreased protein synthesis, and decreased bile production can occur in liver disease and contribute to various complications, they do not directly cause the neuro