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Hepatic encephalopathy — SCE Acute Medicine MCQ

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EasyAcute Gastrointestinal PresentationsHepatic encephalopathySCE Acute Medicine

A 69-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show cirrhosis with asterixis after constipation and GI bleeding. What is the most appropriate next step in management?

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Correct answer: E — Treat precipitants and give lactulose titrated to bowel motions

The key discriminator is that cirrhosis with asterixis after constipation and GI bleeding, which makes Treat precipitants and give lactulose titrated to bowel motions the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Arrange urgent CT imaging and Give intravenous fluids with reassessment are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG/BASL cirrhosis care bundle