MKSAP: 58-year-old man with hepatitis C-related cirrhosis

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 98/60 mm Hg, pulse rate is 65/min, and respiration rate is 16/min; BMI is 26. He appears chronically ill. Scleral icterus, jaundice, and spider angiomata are noted. The abdomen is distended with ascites. The spleen tip is palpable. Laboratory studies reveal a serum creatinine level of 2.2 mg/dL (194.5 µmol/L). The Model for End-Stage Liver Disease (MELD) score is 21. Which of the following is the most appropriate next step in management? A. Continuation of current medical therapy B. Evaluation for liver transplantation C. Surgical portosystemic shunt D. Transjugular intrahepatic portosystemic shunt Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Gastroenterology Hospital-Based Medicine Surgery Source Type: blogs