<prompt> Earliest sign In hepatic encephalopathy is -AsterixesAlternate constriction and dilated pupilConstructional apraxiaPsychiatric abnormalities  <response>: Davidson;s principles and practice of medicine 22nd edition. Earliest features are very mild and overlooked but as the conditions become more severe ,apathy ,inability to concentrate,confusion,disorientation,drowsiness,slurring of speech and eventually coma developed.Examination usually shows a flapping tremor asterixis,inability to perform simple mental arithmetic task or to draw objects such as a star constructional apraxia. 