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HE Precipitating Factors — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareHE Precipitating FactorsSCE Palliative Medicine

A patient with decompensated cirrhosis becomes drowsy with asterixis. He has passed melaena, is constipated and is febrile. Which management priority is most important alongside lactulose?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Investigate and correct common reversible precipitants of hepatic encephalopathy

Hepatic encephalopathy is commonly precipitated by infection, gastrointestinal bleeding, constipation, dehydration, renal dysfunction or electrolyte disturbance. These causes must be sought and treated promptly while bowel-clearing therapy is used. Ammonia concentration does not provide a therapeutic target, routine protein restriction is harmful, and sedatives can worsen mental status.

Reference: BSG/UK-PBC guideline: primary biliary cholangitis and hepatic encephalopathy: https://gut.bmj.com/content/67/9/1568; NHS Borders: Cirrhosis: https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/gastroenterology/liver-and-biliary/cirrhosis/