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Hepatic encephalopathy after variceal bleeding — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyHepatic encephalopathy after variceal bleedingSCE Acute Medicine

A 60-year-old man with decompensated cirrhosis becomes drowsy 3 days after admission for variceal bleeding. Ammonia is not available, sodium is 129 mmol/L and potassium is 2.9 mmol/L. He is constipated and has asterixis but no focal neurology. CT head is normal. What is the most appropriate next step in management?

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Correct answer: D — Treat hepatic encephalopathy with lactulose while correcting precipitating factors

Hepatic encephalopathy is a clinical diagnosis and is treated with lactulose plus correction of precipitants such as GI bleeding, constipation, hypokalaemia and infection. Routine protein restriction is no longer the main strategy and can worsen malnutrition. Normal CT head does not remove the need to treat encephalopathy and its triggers.

Reference: BSG/BASL decompensated cirrhosis guidance; NICE CKS cirrhosis