MKSAP: 50-year-old man with cirrhosis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril.
On physical examination, temperature is 37.5 °C (99.5 °F), blood pressure is 120/70 mm Hg, pulse rate is 80/min, and respiration rate is 16/min; BMI is 31. Abdominal examination reveals a palpable spleen tip.
Laboratory studies disclose a platelet count of 100,000/µL (100 × 109/L), an INR of 0.9 (normal range, 0.8-1.2), and a total bilirubin level of 1.2 mg/dL (20.5 µmol/L). Abdominal ultrasound discloses a nodular-appearing liver, splenomegaly, and intra-abdominal venous collaterals consistent with portal hypertension. Upper endoscopy is notable for large (>5 mm) distal esophageal varices that persist despite air insufflation. There are no red wale signs.
Which of the following is the most appropriate treatment?
A: Endoscopic ligation
B: Endoscopic sclerotherapy
C: Propranolol
D: Transjugular intrahepatic portosystemic shunt
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions GI Source Type: blogs
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