GASTROENTEROLOGY LITERATURE REVIEW SESSION
October 4, 2001
Blei AT, Cordoba J. Practice Guidelines: Hepatic Encephalopathy. Am J Gastroenterol 2001;96:1968-1975.
1. Hepatic encephalopathy is diagnosed by
a. finding a high ammonia level in blood
b. finding a high ammonia level in CSF
c. excluding other causes of altered mental status in a person with cirrhosis
d. finding a normal EEG in a person with cirrhosis and altered mental status
e. finding asterixis in a person with cirrhosis and altered mental status
True or False
2. Correlation of blood ammonia levels with mental state in cirrhosis is inaccurate, blood levels correlate poorly with brain levels.
3. Constipation can be the trigger factor for hepatic encephalopathy
4. Metronidazole 250mg bid or zinc supplementation may be added to lactulose in patients with recurrent encephalopathy
5. Eradication of H. pylori is recommended to prevent recurrent hepatic encephalopathy
6. The onset of hepatic encephalopathy predicts a 1-yr survival of 40%
7. Bromocriptine, 30 mg po bid may be tried in patients with refractory recurrent encephalopathy.
8. Benzodiazepines are a good choice to induce nocturnal sleep and correct sleep pattern reversal seen in patients with cirrhosis and encephalopathy
9. Once encephalopathy develops, patients should be maintained with a low (0.5 g/k/d) protein diet indefinitely.
10. Lactulose for hepatic encephalopathy
a. results in acidification of the stool
b. traps ammonia in the colon
c. if used in excess, hypertonic dehydration may occur aggravating
encephalopathy
d. cleanses the colon by its cathartic effects
e. can worsen hyperglycemia in diabetics