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Chapter 22. Portal Hypertension and Cirrhosis

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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?

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A. Lactulose

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B. Metronidazole

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C. Neomycin

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D. Rifaximin

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E. Flumazenil

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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?

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A. Give 50 g of 25% albumin

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B. Give 10 g of 25% albumin

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C. Give 100 g of 5% albumin

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D. Do not give albumin

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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?

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A. No drug therapy necessary

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B. Intensify diuresis

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C. Initiate narrow-spectrum antibiotics

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D. Initiate broad-spectrum antibiotics

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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?

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A. Spironolactone

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B. Furosemide

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C. 25% albumin

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D. Midodrine

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E. A and C only

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

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A. Indicates peritoneal infection as cause of ascites

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B. Indicates portal hypertension as cause of ascites

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C. Indicates heart failure as cause of ascites

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D. Indicates malignancy as cause of ascites

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