<prompt> Patient with hepatic insufficiency is being planned for surgery. Which vitamin deficiency has to be treated first?Vitamin AVitamin DVitamin KVitamin E  <response>: ANSWER: C Vitamin KREF: Harrisons 18th ed chapter 302Vitamin K deficiency in adults may be seen in patients with chronic small-intestinal disease e.g., celiac disease, Crohns disease, in those with obstructed biliary tracts, or after small-bowTel resection.Patients with liver disease may have an elevated prothrombin time because of liver cell destruction as wrell as vitamin K deficiency. If an elevated prothrombin time does not improve on vitamin K therapy, it can be deduced that it is not the result of vitamin K deficiency. 