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Chapter 40. Liver Cirrhosis and Complications

DT is a 42-year-old man with a 20-year history of alcohol abuse who presents with altered mental status, anorexia, mild weight loss over the past 3 months, recent abdominal swelling, and general malaise. Upon examination he was found to have palmar erythema and splenomegaly and his labs were significant for mildly elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and blood glucose. He is diagnosed with hepatic cirrhosis and the following medications are initiation: nadolol 20 mg daily, spironolactone 100 mg daily, furosemide 40 mg daily, and lactulose 45 mL three times daily. Which of DT's new medications is indicated to manage portal hypertension?

a. Furosemide

b. Lactulose

c. Nadolol

d. Spironolactone

Answer c is correct. The non-selective β-adrenergic blocker nadolol is a recommended first-line option to manage portal hypertension and reduce the risk for variceal bleeding in patients with esophageal or gastric varices due to cirrhosis.

Answer a is incorrect. Furosemide would be part of the management of ascites, not portal hypertension.

Answer b is incorrect. Lactulose would be part of the management of hepatic encephalopathy, not portal hypertension.

Answer d is incorrect. Spironolactone would be part of the management of ascites, not portal hypertension.

DT is a 42-year-old man with a 20-year history of alcohol abuse who presents with altered mental status, anorexia, mild weight loss over the past 3 months, recent abdominal swelling, and general malaise. Upon examination he was found to have palmar erythema and splenomegaly and his labs were significant for mildly elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and blood glucose. He is diagnosed with hepatic cirrhosis and the following medications are initiation: nadolol 20 mg daily, spironolactone 100 mg daily, furosemide 40 mg daily, and lactulose 45 mL three times daily. Which of DT's new medications is being utilized to manage his altered mental status?

a. Furosemide

b. Lactulose

c. Nadolol

d. Spironolactone

Answer b is correct. The nonabsorbable disaccharide osmotic laxative lactulose is a first-line option for the management of hepatic encephalopathy. It reduces the nitrogenous waste from the gut, lowering ammonia levels, in patients with symptoms of hepatic encephalopathy.

Answer a is incorrect. Furosemide would be part of the management of ascites, not encephalopathy.

Answer c is incorrect. Nadolol would be part of the management of portal hypertension, not encephalopathy.

Answer d is incorrect. Spironolactone would be part of the ...

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