Final answer:
Hepatic encephalopathy is at its worst during acute liver failure or the advanced stages of liver disease, due to the buildup of toxins in the blood.
Step-by-step explanation:
Hepatic encephalopathy is typically at its worst during periods of acute liver failure or the advanced stages of liver disease. Acute liver failure can lead to hepatic encephalopathy very rapidly, often within four weeks of the onset of liver symptoms, and it can include severe symptoms such as confusion, stupor, and coma. During advanced stages of chronic liver diseases like cirrhosis, where the liver function is severely compromised over the long term, hepatic encephalopathy can also occur due to the buildup of toxins that the damaged liver cannot adequately remove from the blood. Therefore, the most accurate answer to the question is: C. During periods of acute liver failure and D. During advanced stages of liver disease.