Hepatobiliary Disease USMLE Step 1 Practice Question
A 52-year-old man with cirrhosis secondary to hepatitis C presents with acute abdominal distention, confusion, and asterixis. Vital signs show BP 118/76, HR 92, RR 18, Temp 37.2°C. He consumed a large protein-rich steak meal yesterday. Serum ammonia is markedly elevated at 180 μmol/L (normal <50). Laboratory studies reveal preserved synthetic function with INR 1.2. He denies fever or abdominal pain. Which intervention is most appropriate initially?
Answer choices
- ASpironolactone initiation
- BImmediate portosystemic shunt placement
- CFresh frozen plasma transfusion
- DAlbumin infusion
- ELactulose and rifaxomicinCorrect answer
- FImmediate therapeutic paracentesis with albumin replacement
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