HE Not SBP — SCE Infectious Diseases MCQ

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EasyHepatitisHE Not SBPSCE Infectious Diseases

A 55-year-old man with cirrhosis develops new-onset confusion without fever. He has a history of SBP 6 months ago. His ascitic fluid shows 10 neutrophils/µL. Ammonia is elevated at 95 µmol/L. What is the most likely diagnosis?

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Correct answer: A — Hepatic encephalopathy — NOT SBP (ascitic neutrophils <250/µL); ammonia elevation supports the diagnosis

With ascitic neutrophils of only 10/µL (well below the 250 threshold for SBP) and elevated ammonia, this is hepatic encephalopathy (HE). The history of prior SBP is a distractor. HE is precipitated by: constipation, infection (but no evidence here), GI bleeding, electrolyte disturbance, dehydration, or medication non-compliance. Management: identify and treat the precipitant, Lactulose (titrated to 2–3 soft stools/day), and Rifaximin (if recurrent HE). SBP should always be excluded with paracentesis in a cirrhotic patient with confusion — which has been done here.

Reference: NICE NG50 2016 – Cirrhosis; EASL 2024 – Hepatic encephalopathy