Page 1 of 1: medicine: liver cirrhosis

trinity · Credits: 13371 My Scrapbook

A 60 yr old male comes to the ward wid massive ascites & pedal edema. He is proven by biopsy to have liver cirrhosis. On examination theer are no signs of hepatic encephalopathy or respiratory compromise. His electrolytes are

Na - 130 mmol/L

K - 3.6 mmol/L

Cl - 85mmol/L

HCO3- - 30mmol/L

S.creat - 1.0 mg/dl

BUN - 18mg/dl

The patient was put n bed rest, water restriction & diuretics. (spironolactone) for 4 days but there was no significant weight change.

The most appropriate step now is:

a) I.V frusemide 80mg immediately

b) Oral acetazolamide 250 mg/dl

c) peritoneovenous shunt

d) Therapeutic paracentesis

ardy · Credits: 12764 My Scrapbook

therapeutic paracenetesis?

bhavu · Credits: 9481 My Scrapbook

I will go with d.therapeutic paracentesis.

after giveing diuretics no weight changes.that means ascitis is not resoving.

so definately we wouldgo for therapeutic paracentesis.
plus in hepatic enceph pt. frequent paracentesis is avoided becoz of chance of precipitting enceph.but here no signs of hepatic enceph.

so no c/i of theraputic paracentesis.and so the answer.

i have myself done paracentesis same condition.at that time my professor told me to do paracentesis and explainedme above things.during my medicine postings in internship.

ardy · Credits: 12764 My Scrapbook

the patient is 60 yr old, cirrhosis ....it can be a case of malignant ascites.
symptomatic t/t wth diuretics i.e spironolactone and therapeutic paracentesis.
Peritoneovenous shunting (DENVER SHUNT) should be considered in patients refractory to conservative methods and survival time<2months.
shunt nt effective in loculated ascites
blood stained ascites
high cell count
viscous ascites

ans is therapeutic paracentesis.
whts given trinity?

manpreet108 · Credits: 30682 My Scrapbook

i agree..

ref--1763--harrison chart-15the edition

trinity · Credits: 13371 My Scrapbook

thx so much friends!!

that is the answer given!!

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