A 62-year-old woman with cirrhosis due to chronic hepatitis C presents to the clinic for routine follow-up. She reports increasing abdominal girth and early satiety over the past month. She takes lactulose. Temperature is 36.8°C (98.2°F), blood pressure is 118/70 mm Hg, pulse is 82/min, and respiratory rate is 14/min. Abdominal examination reveals shifting dullness and a fluid wave. There is no abdominal tenderness. Laboratory studies demonstrate stable liver function compared with previous measurements. Diagnostic paracentesis confirms uncomplicated portal hypertensive ascites.
Which of the following is the most appropriate initial long-term treatment?
The correct answer is:
B: Furosemide and spironolactone therapy with sodium restriction.
This patient has uncomplicated ascites due to portal hypertension. Initial outpatient management includes dietary sodium restriction and diuretic therapy, typically with spironolactone and furosemide. These interventions promote gradual mobilization of ascitic fluid while minimizing electrolyte disturbances.
Answer choice A: Daily broad-spectrum antibiotics, is incorrect.
Antibiotic prophylaxis is reserved for selected patients at high risk for spontaneous bacterial peritonitis and is not routine treatment for uncomplicated ascites.
Answer choice C: Immediate transjugular intrahepatic portosystemic shunt placement, is incorrect.
Transjugular intrahepatic portosystemic shunt (TIPS) placement is an important therapy for refractory ascites but is not first-line treatment for newly diagnosed uncomplicated ascites.
Answer choice D: Long-term albumin infusions only, is incorrect.
Albumin may be used in specific situations but does not replace standard diuretic-based management.
Answer choice E: Total parenteral nutrition, is incorrect.
Nutritional support does not address the underlying portal hypertension causing ascites.
Key Learning Point
Initial long-term management of portal hypertensive ascites includes sodium restriction and combination diuretic therapy with spironolactone and furosemide.
