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Hepatic encephalopathy — RCPSC IM MCQ

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HardGastroenterology/HepatologyHepatic encephalopathyRCPSC IM

A 62-year-old man with cirrhosis is brought in with confusion and asterixis. He had melena yesterday. Hemoglobin has fallen from 108 to 82 g/L, urea is elevated, potassium is 3.0 mmol/L, and diagnostic paracentesis shows no neutrocytic ascites. What is the most likely cause?

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Correct answer: C — Upper gastrointestinal bleeding with hypokalemia precipitating hepatic encephalopathy

In cirrhosis, GI bleeding increases nitrogen load and hypokalemia promotes ammonia generation, both precipitating hepatic encephalopathy. Evaluation should search for precipitants such as bleeding, infection, constipation, dehydration and sedatives.

Reference: Canadian Association for the Study of the Liver cirrhosis guidance