A patient suffering from liver cirrhosis is admitted to the ward. Which of the following represents that hepatic Encephalopathy observable in patients?

1. A

   Pulmonary embolism

2. B

   Chest tightness

3. C

   Asterixis

4. D

   Shuffling gait

Appeared in: PGIMER NO - 2020

Explanation

• Asterixis, also known as a 'liver flap' or 'flapping tremor,' is a hallmark sign of hepatic encephalopathy.
• It is an involuntary, jerky movement of the hands, best elicited by asking the patient to extend their arms and bend their wrists back.
• The tremor is caused by the toxic effects of high ammonia levels on the brain, which the damaged liver cannot detoxify.
• Its presence indicates a significant disturbance in brain function due to liver failure.

Why Other Options Were Wrong

• Option A: Pulmonary embolism is a respiratory emergency caused by a blockage in the pulmonary artery. Its primary symptoms are dyspnea and chest pain, not a neurological sign of liver disease.
• Option B: Chest tightness is a non-specific symptom most commonly associated with cardiac (e.g., angina) or respiratory (e.g., asthma) conditions.
• Option D: A shuffling gait is a characteristic sign of Parkinson's disease, a neurodegenerative disorder affecting the basal ganglia. It is not a typical sign of hepatic encephalopathy.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Clinical manifestations of hepatic encephalopathy to guide bedside assessment, documentation, and the next nursing action.
• The appearance or worsening of asterixis is a critical sign that a patient's hepatic encephalopathy is progressing, requiring prompt medical intervention to lower ammonia levels.
• Nurses must perform regular neurological assessments, including checking for asterixis, in all patients with advanced liver disease to detect early signs of decompensation.
• Patient safety is a major concern. The confusion and motor impairment associated with encephalopathy create a high risk for falls and injury.

How to Approach the Question

• First, identify the key concepts in the question: 'liver cirrhosis' and 'hepatic encephalopathy'. This directs your thinking to the neurological complications of severe liver failure.
• Second, recall the specific signs and symptoms associated with hepatic encephalopathy. The most distinctive sign is a motor disturbance.
• Third, evaluate each option. Asterixis is a well-known 'flapping tremor' directly linked to this condition.
• Fourth, eliminate the other options by connecting them to different body systems or diseases. Pulmonary embolism and chest tightness are cardiorespiratory. Shuffling gait is characteristic of Parkinson's disease.
• Finally, confirm that Asterixis is the most specific and correct answer for hepatic encephalopathy among the choices.

Concept Tested & Keywords

• Concept Tested: Clinical manifestations of hepatic encephalopathy
• Stem keywords: liver cirrhosis, hepatic encephalopathy
• Lead-in keywords: represents, observable
• Clinical cues: A patient with a known history of liver cirrhosis presenting with neurological changes.

Question ID

QvFwZqQBRSn4s8DheLvKNl

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 pp. 620-622, 252-254, 534-536