Chronic Liver Disease And Cirrhosis Care Practice Test
•15 QuestionsA 55-year-old man with known cirrhosis from chronic hepatitis C presents with new confusion and progressive abdominal distension over 3 days. He completed direct-acting antiviral therapy 2 years ago but has had intermittent follow-up. He denies alcohol use for 10 years. He reports decreased appetite and constipation. No fever, cough, dysuria, or GI bleeding symptoms. Exam shows somnolence but arousable, asterixis, scleral icterus, and shifting dullness. Vitals are stable. Labs: Na 130 mEq/L, creatinine 1.3 mg/dL, AST 52 U/L, ALT 40 U/L, total bilirubin 3.6 mg/dL, albumin 2.8 g/dL, INR 2.1, platelets 70,000/µL. Ultrasound shows a nodular liver and large-volume ascites. Diagnostic paracentesis shows PMN 320 cells/mm³; culture pending. He has no focal neurologic deficits. He is admitted for suspected hepatic encephalopathy and ascites. What is the next best step in management for this patient?
A 55-year-old man with known cirrhosis from chronic hepatitis C presents with new confusion and progressive abdominal distension over 3 days. He completed direct-acting antiviral therapy 2 years ago but has had intermittent follow-up. He denies alcohol use for 10 years. He reports decreased appetite and constipation. No fever, cough, dysuria, or GI bleeding symptoms. Exam shows somnolence but arousable, asterixis, scleral icterus, and shifting dullness. Vitals are stable. Labs: Na 130 mEq/L, creatinine 1.3 mg/dL, AST 52 U/L, ALT 40 U/L, total bilirubin 3.6 mg/dL, albumin 2.8 g/dL, INR 2.1, platelets 70,000/µL. Ultrasound shows a nodular liver and large-volume ascites. Diagnostic paracentesis shows PMN 320 cells/mm³; culture pending. He has no focal neurologic deficits. He is admitted for suspected hepatic encephalopathy and ascites. What is the next best step in management for this patient?