A 60-year-old female with hepatitis C and cirrhosis presents with confusion and difficulty with concentration. She also has a flapping tremor in her hands. What are the potential causes and next steps?
This patient's confusion and flapping tremor (asterixis) suggest she might have developed hepatic encephalopathy, a complication of cirrhosis often seen in patients with hepatitis C. This occurs when the liver cannot adequately remove toxins from the blood, leading to their build-up in the brain. Further evaluation should include blood tests to assess liver function and measure ammonia levels, and potentially an EEG to evaluate brain wave activity. Management typically involves reducing the production and absorption of ammonia in the gut with lactulose and possibly antibiotics like rifaximin.