Quiz #142 Cirrhosis TIPS: Acute Complications
Test your knowledge on managing the acute complications of cirrhosis
A 44 M with history of decompensated cirrhosis presents from home to the Kashlak Memorial Hospital emergency department after a fall from standing. The patient has cirrhosis secondary to chronic alcohol use disorder and continues to drink. On evaluation, the patient is afebrile, mildly tachycardic, and has a blood pressure in the low-normal range. He has a hemostatic cut on his right shin and a head wound, although the patient cannot recall this injury. Remainder of the exam is most notable for the sequelae of cirrhosis, including tense abdominal ascites. Patient is able to state he does not see any doctors and has never been this “bloated.” Labs are notable for mild hyponatremia Na 128, mild thrombocytopenia and INR of 1.8. Given his apparent head injury, the decision is made to admit the patient for observation. Which of the following is the next best step for management of this patient?
Start on prophylactic antibiotics
Obtain diagnostic paracentesis
Obtain serum albumin level and supplement with albumin if hypoalbuminemic
Treat the patient’s INR with intravenous vitamin K
A diagnostic paracentesis is performed on the patient from question 1 which reveals a polymorphonuclear leukocyte count of 325 cells/mm3. He has not been on any recent antibiotics to include prophylaxis for spontaneous bacterial peritonitis. Which of the following is the next best step in management?
Initiate therapy with piperacillin-tazobactam and vancomycin
Monitor for fever, evidence of decompensation but defer antibiotic therapy at this time until cultures have resulted
Initiate therapy with ampicillin and tobramycin
Initiate therapy with cefotaxime
The 44M mentioned in questions 1 and 2 is successfully treated for spontaneous bacterial peritonitis and deemed appropriate for discharge. Which of the following is recommended prior to discharge?
Prescription for norfloxacin for spontaneous bacterial peritonitis prophylaxis
Prescription for ampicillin-sulbactam for spontaneous bacterial peritonitis prophylaxis
Counsel patient on need for spontaneous bacterial peritonitis prophylaxis should he have a single recurrence of spontaneous bacterial peritonitis
Right upper quadrant ultrasound with vascular Doppler to screen for portal venous thrombosis
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