What is the priority intervention for a patient with acute liver failure?

Choice A reason: Lactulose does not correct vitamin B1 (thiamine) deficiency. Thiamine deficiency, common in alcoholics with cirrhosis, is treated with thiamine supplements. Lactulose targets ammonia in hepatic encephalopathy by acidifying the colon, trapping ammonia for excretion, making this response incorrect for its mechanism.

Choice B reason: Lactulose reduces intestinal ammonia absorption in hepatic encephalopathy by acidifying the colon, converting ammonia (NH3) to ammonium (NH4+), which is less absorbable and excreted in stool. This lowers serum ammonia, alleviating neurotoxicity in cirrhosis, making this the accurate explanation for its use.

Choice C reason: Lactulose does not primarily destroy ammonia-producing bacteria. While it may alter gut flora, its main action is acidifying the colon to trap ammonia for excretion. Antibiotics like rifaximin target ammonia-producing bacteria, making this an incorrect description of lactulose’s primary mechanism.

Choice D reason: Lactulose is not used for diagnostic test preparation in this context. It is a treatment for hepatic encephalopathy, reducing ammonia levels. While used as a laxative for colonoscopy prep, this is irrelevant to managing elevated ammonia in cirrhosis, making this response incorrect.

Choice A reason: Oral analgesics are less effective in acute pancreatitis due to severe pain and potential gastric dysmotility from inflammation. IV opioids provide faster, more reliable pain relief, as oral absorption may be impaired, making this a less appropriate choice for acute pain management.

Choice B reason: A high-fiber diet is contraindicated in acute pancreatitis, as it stimulates digestion, increasing pancreatic enzyme secretion and worsening inflammation and pain. Patients are typically kept NPO (nothing by mouth) to rest the pancreas, making this an inappropriate intervention for pain control.

Choice C reason: IV opioid analgesics, such as morphine or fentanyl, are the preferred treatment for severe pain in acute pancreatitis. They provide rapid, effective analgesia by acting on central pain receptors, reducing discomfort without stimulating pancreatic activity, making this the priority intervention for pain management.

Choice D reason: Applying a warm compress to the abdomen is contraindicated, as heat may increase inflammation and blood flow to the pancreas, worsening pain and tissue damage. Pain management in pancreatitis relies on pharmacological interventions, making this an incorrect and potentially harmful action.