A 45-year-old man with known alcoholic cirrhosis portal hypertension and ascites is brought to the ED by his family due to increasing confusion

A 45-year-old man with known alcoholic cirrhosis, portal hypertension, and ascites is brought to the ED by his family due to increasing confusion. The family states that he had been stumbling for several days but had not fallen. The family also noted that he had been “flapping his hands” as well. Labs in the ED reveal Hgb 9.4 g/dl, Hct 28.0 %, ammonia (NH3) level is 159 μmol/L. The APRN informs the family that the patient has developed hepatic encephalopathy (HE).

Question:

Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.