14th August 2024

You are asked to review a patient on the ward who has become progressively more drowsy

You are asked to review a patient on the ward who has become progressively more drowsy. He is a 59-year-old man who was admitted with abdominal distension.

On examination, you note palmar erythema, scleral icterus, and an ascitic but non-tender abdomen. His GCS is 9 (E2V2M5). His observations are stable.

You note that he has not opened his bowels for 3 days.

Which is the single most likely explanation for the deterioration in his conscious state?

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