This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Misc., Subject name: Medicine
Most likely precipitating cause for acute hepato-cellular failure is? 
Select and explain. 
A. Oral lactulose, B. Large IV albumin infusion, C. Large carbohydrate meal, D. Upper GI bleeding
D: Upper GI bleeding
Answer: D: Upper GI bleeding 
Explanation: Upper GI bleeding will provide the bacteria in the gut with lots of nutrition to multiply and this will lead to increase in production of ammonia.