Q: Hepatic encephalopathy tends to worse after all of the following except

A) GI bleed
B) Bout of sepsis
C) Use of Rifaximin
D) Dehydration
E) After procedure TIPSS (transjugular intrahepatic portosystemic shunt)




Answer: C

GI bleed unloads huge amount of protein in GI tract and tends to make hepatic encephalopathy. Electrolyte and Metabolic disturbances in sepsis, dehydration, hypoxia etc. tends to do the same. TIPSS is commonly performed in liver patients to treat portal hypertension. In 30% of patients, hepatic encephalopathy transiently get worse after TIPPS, as intestinally derived compounds requiring hepatic detoxification bypass the liver and remain in the systemic circulation.

Rifaximin is the treatment of hepatic encephalopathy.