Which sign would most indicate hepatic encephalopathy in a client with cirrhosis?

Which sign would most indicate hepatic encephalopathy in a client with cirrhosis?

• A. Lethargy
• B. Amnesia
• C. Asterixis
• D. Behavioral changes

Answer: (C)

Hepatic encephalopathy happens when the liver can’t detoxify toxins like ammonia, so brain function becomes impaired. Asterixis is the classic sign of this condition: a brief, irregular flapping tremor that occurs when the patient’s arms are held out with the wrists dorsiflexed. It reflects fluctuating cerebral motor control caused by the toxin buildup and is strongly associated with liver failure.

Among the signs listed, this flapping tremor is the most specific for hepatic encephalopathy in someone with cirrhosis. Lethargy, amnesia, and behavioral changes can occur with many disorders and are less definitive on their own, whereas the presence of asterixis directly points to the neurotoxic effects of accumulated ammonia on the brain. Observing asterixis helps clinicians distinguish hepatic encephalopathy from other causes of altered mental status.