A 43-year-old man is known to have hepatitis B virus infection presented with fever and confusion. On examination, he is disoriented, has asterixis, and positive shifting dullness.... A 43-year-old man is known to have hepatitis B virus infection presented with fever and confusion. On examination, he is disoriented, has asterixis, and positive shifting dullness. Ascitic fluid analysis showed serum albumin ascitic fluid gradient (SAAG) of 1.2 and 350 neutrophils. Culture is bending. Which of the following is the best management? A. IV diuretics and metronidazole B. Lactulose enema and IV ceftriaxone C. Oral lactulose and sedation with diazepam D. High volume ascitic fluid aspiration and propranolol
Understand the Problem
The question is asking for the best management option for a patient with hepatitis B and ascitic fluid analysis results that indicate a certain condition. It requires knowledge of medical management in this specific context.
Answer
Lactulose enema and IV ceftriaxone.
The best management for this patient is B: Lactulose enema and IV ceftriaxone.
Answer for screen readers
The best management for this patient is B: Lactulose enema and IV ceftriaxone.
More Information
The patient likely has spontaneous bacterial peritonitis (SBP) indicated by the neutrophil count in ascitic fluid, and hepatic encephalopathy suggested by confusion and asterixis. Treatment involves antibiotics like ceftriaxone for SBP and lactulose for hepatic encephalopathy.
Tips
A common mistake is not addressing both conditions simultaneously. Ensure treatment covers potential infections and addresses encephalopathy.
Sources
- Cirrhosis: Practice Essentials, Overview, Etiology - emedicine.medscape.com
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