Inclusion Criteria:  Diagnosis of cirrhosis - must meet one of the following criteria:  liver biopsy, OR history of cirrhosis complication: ascites, variceal bleeding, hepatic encephalopathy, OR  2 of the following 4 criteria:  Ultrasound, Computed tomography (CT) or Magnetic resonance imaging (MRI) findings of cirrhosis (cirrhotic appearing liver, splenomegaly, varices, ascites) Fibroscan liver stiffness score >13 Kilopascal (kPa) Laboratory testing: aspartate aminotransferase (AST)/platelet ratio index (APRI) >2.0  CT, MRI or Esophagogastroduodenoscopy (EGD) showing presence of esophageal varices  Exclusion Criteria:  Non-English speaking Pregnancy (self-reported) Unable or unwilling to provide consent History of liver transplant Disorientation at the time of enrollment, Dementia, or Treated Memory Disorder History of prior lactulose use or HE within 6 months Metastatic solid malignancy or blood malignancy Hemoglobin A1C > 12 (within past year)