Pressing Matters: The 101 On Hepatic Encephalopathy

Bringing a new dog into your home and family's life is an exciting experience. Unfortunately, you may not be ready for the physical, emotional, and financial responsibilities that go along with caring for a dog. Considering your dog may face many health issues, understanding common signs and symptoms is smart to ensure proper diagnosis and treatment. If your dog presses their head against a surface periodically, it may be a cause for concern. While you may think head pressing is not a significant problem, it is actually a sign of a serious medical condition known as hepatic encephalopathy. Using this guide on hepatic encephalopathy, you will understand this disorder and find the best pet hospital treatment for your dog.

Hepatic Encephalopathy 101

Hepatic encephalopathy is a degenerative disease of the brain that stems from severe liver damage. If your dog's liver is unable to filter out ammonia and other substances, they may develop liver disease. Over time, this excess ammonia causes the brain to swell, resulting in hepatic encephalopathy.


Since the disease causes your dog's brain to swell, many of the symptoms are neurological. Here are a few neurological signs of hepatic encephalopathy:

  • Head Pressing – Pressing head into walls or other surfaces
  • Disorientation – Circling, stumbling, falling, wandering, pacing
  • Gazing – Staring off into space
  • Fatigue – Intense sluggishness, lethargy
  • Inability to Understand – Unable to follow commands
  • Desire to Move into Small, Tight Spaces
  • Vision Impairment
  • Seizures
  • Sudden Aggression

In addition, you may notice the following digestive and urinary symptoms in your dog:

  • Decreased Appetite, but Increased Thirst
  • Difficulty Urinating
  • Dark, Discolored Urine
  • Vomiting
  • Diarrhea

Again, you may feel head pressing is an unimportant act. However, this overlooked sign of hepatic encephalopathy is a pressing matter that needs urgent attention. If your dog is displaying one or more these symptoms, visit your veterinarian immediately.


A liver shunt is a vessel that transports blood around the liver instead of directly through it, resulting in abnormal processing of ammonia and other substances. If your dog develops hepatic encephalopathy due to a liver shunt, surgery may be necessary.

During the surgery, your veterinarian will place an ameroid constrictor. This device will close the shunt over a period of 4 to 6 weeks. After surgery, your dog will need a series of oral antibiotics to attack bacteria in their bloodstream.

If your dog does not have a birth defect causing the hepatic encephalopathy, your vet will suggest the following treatments:

  • Antibiotic Therapy - Your dog will need to take a series of oral antibiotics. These medications will reduce bacteria in the liver, resulting in less ammonia in the bloodstream.
  • Lactulose - While surprising to hear, your vet may prescribe a laxative to treat hepatic encephalopathy. Lactulose not only prevents constipation, but it also increases acid production in your dog's bloodstream to reduce toxic bacteria in the liver and bloodstream. Your dog will most likely take 15 to 30 ml of lactulose, four times a day, to treat their hepatic encephalopathy.
  • Diet - Improving your dog's liver health is key to treating their hepatic encephalopathy, so a veterinarian may suggest revamping their diet. Processed foods and red meat increase ammonia production, which leads to hepatic encephalopathy. To prevent and treat the condition, remove processed foods from your dog's diet. In addition, decrease the consumption of red meat.

          To ensure your dog receives sufficient protein, add cottage cheese and eggs to their daily diet. Both cottage cheese and eggs are healthy sources of protein that do not increase ammonia production.

Watching your dog press their head against a surface is a pressing matter that deserves immediate attention. Using this guide, you will understand hepatic encephalopathy in more detail and learn the best treatments to save your dog.