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Hepatic encephalopathy — ESEGH MCQ

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HardHepatologyHepatic encephalopathyESEGH

A 63-year-old man with non-alcoholic steatohepatitis cirrhosis is brought in by his daughter because of sleep reversal and disorientation. Examination shows asterixis, mild ascites and no focal neurological deficit. He opened his bowels once in 5 days after starting codeine for back pain. Sodium is 128 mmol/L, creatinine 96 micromol/L and CT head is normal. What is the most likely cause?

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Correct answer: E — Constipation precipitating hepatic encephalopathy

Constipation and opiates are common precipitants of hepatic encephalopathy, and the time course plus asterixis support this diagnosis. SBP remains an important screen in any decompensated cirrhotic patient, but the stem gives a clear precipitant and no ascitic inflammatory data. Normal CT and absence of focal signs make subdural haemorrhage less likely. The clinical pearl is that encephalopathy management means correcting precipitants as well as giving lactulose.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/digestive-tract-conditions