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Hepatic encephalopathy precipitated by SBP — SCE Acute Medicine MCQ

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ModerateGastroenterology and hepatologyHepatic encephalopathy precipitated by SBPSCE Acute Medicine

A 65-year-old man with known alcohol-related cirrhosis is admitted with increasing confusion. He is jaundiced, has asterixis and tense ascites. Sodium is 128 mmol/L, creatinine 142 micromol/L and CRP is 42 mg/L. No focal neurology is present. What is the most appropriate investigation to identify a common precipitant?

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Correct answer: A — Diagnostic ascitic tap for cell count and culture

Hepatic encephalopathy is commonly precipitated by infection, especially spontaneous bacterial peritonitis in a patient with ascites. Diagnostic paracentesis is urgent and should assess neutrophil count and culture. Ammonia levels are not required to diagnose hepatic encephalopathy and do not identify the precipitant.

Reference: BSG/BASL Decompensated Cirrhosis Guidance; NICE CKS