Asterixis is a sign of hepatic encephalopathy.

• A. Jaundice
• B. Asterixis
• C. Ascites
• D. Bruising

Answer: (B)

Asterixis, the flapping tremor of the hands, signals hepatic encephalopathy—the brain dysfunction that occurs when the liver can’t detoxify toxins like ammonia. When the arms are held out with the wrists dorsiflexed, neurotoxicity causes a rapid, irregular flapping movement. This neurologic sign accompanies changes in mental status ranging from confusion to coma as encephalopathy worsens. Other liver-related findings such as jaundice, ascites, and bruising reflect liver dysfunction overall, but they do not represent the neurotoxic effects on the brain seen in hepatic encephalopathy. Treatment aims to reduce ammonia levels (for example, lactulose, rifaximin) and address precipitating factors.