You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her?
A. Asterixis
B. Chvostek’s sign
C. Trousseau’s sign
D. Hepatojugular reflux
Correct Answer: A. Asterixis
Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex. Asterixis is a clinical sign that describes the inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements. This motor disorder is myoclonus characterized by muscular inhibition (whereas muscle contractions produce positive myoclonus).
Option B: In the late 1800s, Dr. Chvostek noticed that mechanical stimulation of the facial nerve (as with the examiner’s fingertip, for example) could lead to twitching of the ipsilateral facial muscles. The long-accepted explanation is that this resulted from hypocalcemia, and this relationship became known as the Chvostek sign.
Option C: Trousseau’s sign for latent tetany is most commonly positive in the setting of hypocalcemia. The sign is observable as a carpopedal spasm induced by ischemia secondary to the inflation of a sphygmomanometer cuff, commonly on an individual’s arm, to 20 mmHg over their systolic blood pressure for 3 minutes.
Option D: Deep inspiration generates negative intrathoracic pressure, leading to an increased venous return to the right atrium and, subsequently, the right ventricle. This phenomenon, in the healthy adult, enhances blood flow in the right heart chambers and causes decreased jugular venous pressure (JVP).
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