20th April 2024

A 59-year-old male develops acute liver failure secondary to ischaemic injury following a hypotensive episode

A 59-year-old male develops acute liver failure secondary to ischaemic injury following a hypotensive episode during a routine inguinal hernia repair. He is managed supportively in the ICU with IV fluids, NG feeding and vitamin K. He is also given lactulose for encephalopathy and prophylactic antibiotics. He appears to be making good progress but on the third day of his admission he becomes increasingly drowsy with reduced GCS. Blood tests all continue to show improvement, there is no evidence of hypoglycaemia, and culture results are negative.

Which of the following further investigations would be the most likely to identify the cause for his deterioration?

Select the SINGLE most appropriate option from the list below. Select ONE option only.