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Chapter 22. Portal Hypertension and Cirrhosis

The police bring a 54-year-old man to the emergency department after he is found wandering aimlessly on a college campus. He is alert and oriented × 1 (he knows his name) but doesn’t know the season or where he is. His initial physical examination is noncontributory with the exception of moderate jaundice, scleral icterus, and a distended abdomen. A toxicology screen is negative for drugs and alcohol, but his serum ammonia level is elevated. Which of the following initial therapies is most appropriate?

A. Lactulose

B. Metronidazole

C. Neomycin

D. Rifaximin

E. Flumazenil

A patient with known cirrhosis has complaints of abdominal pain. The medical resident performs a therapeutic paracentesis and removes 6 L of fluid. What is the most appropriate adjunct therapy?

A. Give 50 g of 25% albumin

B. Give 10 g of 25% albumin

C. Give 100 g of 5% albumin

D. Do not give albumin

Fluid obtained from a cirrhotic patient during paracentesis was sent to the laboratory for analysis with the following results: PMN count 340 cells/μL (340 × 106/L), SAAG 1.3 g/dL (13 g/L), gram stain negative. What is the most appropriate therapy?

A. No drug therapy necessary

B. Intensify diuresis

C. Initiate narrow-spectrum antibiotics

D. Initiate broad-spectrum antibiotics

What is the most appropriate drug regimen to decrease the accumulation of peritoneal fluid (ascites) in a patient with low blood pressure and no peripheral edema?

A. Spironolactone

B. Furosemide

C. 25% albumin

D. Midodrine

E. A and C only

How should an SAAG of 1.3 g/dL (13 g/L) be interpreted?

A. Indicates peritoneal infection as cause of ascites

B. Indicates portal hypertension as cause of ascites

C. Indicates heart failure as cause of ascites

D. Indicates malignancy as cause of ascites

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