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Hepatic encephalopathy precipitated by gastrointestinal bleeding — ABIM Board MCQ

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HardGastroenterology/HepatologyHepatic encephalopathy precipitated by gastrointestinal bleedingABIM Board

A 59-year-old man with alcohol-associated cirrhosis is brought in for confusion after 2 days of melena. He is disoriented, has asterixis, and ammonia is elevated. Hemoglobin is 7.5 g/dL. Which of the following is the most appropriate management?

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Correct answer: E — Treat gastrointestinal bleeding and start lactulose therapy

GI bleeding is a common precipitant of hepatic encephalopathy. Management includes identifying and treating precipitants, lactulose titrated to soft stools, and rifaximin for recurrence or inadequate response.

Reference: AASLD Hepatic Encephalopathy Guidance