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Hepatic encephalopathy is an insidious, slowly progressive form of confusion and memory impairment, which occurs as a result of the liver's inability to clean the blood coming from the large and small intestine. Normally, bacteria in the gut break down the proteins we eat and create a waste product called ammonia as well as other toxins. In healthy individuals, ammonia gets broken down in the liver to glutamine and urea, two chemicals which can easily be excreted by the liver. In a person with cirrhosis, liver cells are replaced by scar tissue and this "clean up" of ammonia does not occur as efficiently so the ammonia builds up in the blood and ultimately interferes with the healthy normal functioning of our brain cells.