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Hepatic encephalopathy — SCE Acute Medicine MCQ

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EasyAcute GI PresentationsHepatic encephalopathySCE Acute Medicine

A 63-year-old man is assessed on the acute medical unit. He has cirrhosis and increasing confusion after constipation and diuretic escalation. Asterixis is present and infection screen is pending. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Treat precipitant and give lactulose

Treat precipitant and give lactulose is the best answer because hepatic encephalopathy is managed by treating precipitants and reducing gut ammonia absorption with lactulose. Give activated charcoal within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Look actively for infection, bleeding, constipation and sedatives.

Reference: BSG cirrhosis guideline