USMLE Step 3 Quiz
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GASTROENTEROLOGY
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A 60-year-old woman with cirrhosis due to chronic hepatitis C (treated with sustained virologic response) presents for follow-up. She reports increasing abdominal girth and ankle swelling despite limiting salt "most days." She denies confusion or GI bleeding. Medications include spironolactone 100 mg daily and furosemide 40 mg daily. Exam shows ascites and 2+ leg edema without asterixis. Labs: Na 129 mEq/L, creatinine 1.0 mg/dL, albumin 2.7 g/dL, INR 1.6, total bilirubin 2.2 mg/dL. Ultrasound 6 months ago shows nodular liver and moderate ascites; no mass. She has not had paracentesis before. What is the next best step in management for this patient?
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