How is asterixis assessed?

• A. Have patient extend the arms and dorsiflex the wrist
• B. Have patient perform deep knee bends
• C. Ask patient to repeat a phrase
• D. Check for reflex changes

Answer: (A)

Assessing asterixis involves having the patient hold the arms outstretched with wrists dorsiflexed and fingers extended. Observe for a brief, irregular flapping tremor of the hands as the person tries to maintain that posture. This “liver flap” appears when the brain’s ability to sustain posture is impaired, most classically in hepatic encephalopathy due to metabolic dysfunction. The other actions don’t elicit this flapping tremor—deep knee bends test strength, repeating a phrase assesses speech/cognition, and checking reflexes evaluates reflex pathways—so they don’t assess asterixis.