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Hepatic encephalopathy — ABIM Board MCQ

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ModerateGastroenterology/HepatologyHepatic encephalopathyABIM Board

A 59-year-old with cirrhosis presents with grade II hepatic encephalopathy after constipation and an upper-GI bleed. Infection and intracranial disease are excluded. Which initial plan is most appropriate?

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Correct answer: C — Give lactulose and treat the GI bleed and constipation concurrently

The best answer is “Give lactulose and treat the GI bleed and constipation concurrently”. Lactulose is first-line for an overt episode, but successful management also requires correction of precipitating bleeding and constipation. Rifaximin is commonly added for recurrence prevention rather than replacing initial precipitant management; protein deprivation and sedatives can worsen the clinical course.

Reference: AASLD Practice Guideline: Hepatic Encephalopathy in Chronic Liver Disease: https://www.aasld.org/practice-guidelines/hepatic-encephalopathy