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Old 06-22-2011
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Question Encephalopathy question

A 40 year old man suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?

A. Jaundice
B. Spider Angiomas on the face and hands
C. Heme positive stool
D. Asterixis of the hands
E. Increased serum albumin levels
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Old 06-22-2011
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D. Asterixis of the hands
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Old 06-22-2011
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D. Asterixis of the hands

The mildest form of hepatic encephalopathy is difficult to detect clinically, but may be demonstrated on neuropsychological testing. It is experienced as forgetfulness, mild confusion and irritability. More severe encephalopathy is characterised by an inverted sleep-wake pattern (sleeping by day, being awake at night), marked irritability, tremor, difficulties with coordination and trouble writing.[1]
More severe forms of hepatic encephalopathy lead to a worsening level of consciousness, from lethargy to somnolence and eventually coma. In the intermediate stages, a characteristic jerking movement of the limbs is observed (asterixis, "liver flap" due to its flapping character); this disappears as the somnolence worsens. There is disorientation and amnesia, and uninhibited behaviour may occur. Coma and seizures represent the most advanced stage; cerebral oedema (swelling of the brain tissue) leads to death.[1]
Encephalopathy often occurs together with other symptoms and signs of liver failure. These may include jaundice (yellow discolouration of the skin and the whites of the eyes), ascites (fluid accumulation in the abdominal cavity), and peripheral oedema (swelling of the legs due to fluid build-up in the skin). The tendon reflexes may be exaggerated, and the plantar reflex may be abnormal, namely extending rather than flexing (Babinski's sign) in severe encephalopathy. A particular smell (foetor hepaticus) may be detected.
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