102) A 65 year old man presents to your office with increasing abdominal distension and bilateral leg swelling. He reports his symptoms started 3 months ago and progressively worsening. He smokes about one pack cigarettes per day and drinks one pint vodka every day. His last drink was 1 day ago. On examination, he is afebrile and he has abdominal distension and ascites with out any tenderness on palpation. Lab studies show WBC 8k/µl, Hemoglobin of 10.2 gm%, Platelets 90k/µl, Total protein of 6.4, Albumin 2.2, SGOT 300, SGPT 130, Total Bilirubin 4.2 , Direct Bilirubin 3.3, Prothrombin time of 19 seconds and Creatinine 2.2. The patient undergoes diagnostic paracentesis which reveals a total protein of 1.4, albumin of 0.6, WBC count of 400 with polymorphonuclear neutrophils of 100cells/ml. Bacterial cultures are pending. The most important step in managing this patient is :
A) Intravenos Ceftriaxone
B) Intravenos Corticosteroids
C) Intravenos Albumin Infusion
D) Trans-jugular Intrahepatic Porto-systemic Shunt (TIPS)
E) Arrange for Liver Tranplant
103) The most important factor that should be considered in determining the etiology of this patient’s Ascites:
A) Fluid WBC
B) Fluid Albumin
C) Fluid Total protein
D) Serum – Ascites- Albumin – Gradient
E) Serum Albumin and Prothrombin time
A
D
a & d
F,D
a,d
A , D