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Hepatic encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsHepatic encephalopathySCE Acute Medicine

A 58-year-old man with cirrhosis is admitted with confusion and asterixis. He has constipation and has been taking codeine for back pain. Temperature is 36.8°C, glucose is normal and CT head is unremarkable. What is the most appropriate next step in management?

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Correct answer: B — Treat precipitating factors and start lactulose

The patient has hepatic encephalopathy precipitated by constipation and opioids; management includes treating triggers and giving lactulose, with rifaximin considered in recurrent disease. Diazepam can worsen encephalopathy. Long-term protein restriction is harmful and no longer routine. The pearl is that ammonia levels do not replace clinical assessment or a search for precipitants.

Reference: BSG/BASL cirrhosis guideline; NICE CKS