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Hepatic Encephalopathy — RACP Adult Medicine MCQ

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EasyGastroenterologyHepatic EncephalopathyRACP Adult Medicine

A 55-year-old man with cirrhosis (Child-Pugh C, MELD 22) presents with confusion, asterixis, and a fetor hepaticus. He was well 2 days ago but developed constipation. Ammonia is elevated at 120 μmol/L. What is the most likely diagnosis?

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Correct answer: D — Hepatic encephalopathy

Confusion and asterixis in a cirrhotic patient with elevated ammonia and identifiable precipitant (constipation reducing ammonia clearance) is hepatic encephalopathy. Management includes lactulose (target 2–3 soft stools/day), rifaximin for secondary prevention, identification and treatment of precipitants (constipation, infection, GI bleeding, medications, electrolyte disturbance).

Reference: GESA – 2024 – Hepatic Encephalopathy; EASL 2024 Decompensated Cirrhosis