@adah it does sound like HE and I presume the doctor must have felt that he did if he put him on lactulose. I never had a biopsy for my cirrhosis diagnosis, I believe I had a CT scan. I remember the test -- I had to drink some horrible liquid in three parts and then have a very brief test done -- but it was so long ago, and I am not a medically inclined person, that I forget which test it was!
From what I have heard people experience HE in many different ways. My HE episodes started with a really upset stomach and fatigue. They progressed to being irrational, sometimes minor, sometimes major. For the minor ones, I could sleep it off. The more major ones put me in a hospital.
I hope if it is his liver you are able to get him to a hepatologist. I live in NH and there is only one in the state, two hours away at Dartmouth, but Boston is only 55 miles away so I went there when it was determined that I had cirrhosis. The hospital at Dartmouth does not do liver transplants either.
JK