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Missed HCC Surveillance — SCE Infectious Diseases MCQ

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HardHepatitisMissed HCC SurveillanceSCE Infectious Diseases

A man with HBV cirrhosis and suppressed HBV DNA is admitted with first-onset tense ascites. He is afebrile, has no abdominal tenderness and ultrasound confirms free fluid. What investigation should be prioritised on admission?

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Correct answer: E — Perform diagnostic paracentesis now for neutrophil count, culture and protein studies

New-onset ascites and hospital admission with cirrhotic ascites require prompt diagnostic paracentesis even without fever or tenderness, because spontaneous bacterial peritonitis may be clinically silent. Cell count with neutrophils, culture and biochemical assessment guide urgent management. HCC imaging remains important but does not replace the immediate ascitic-fluid assessment.

Reference: BSG/BASL ascites guideline: https://www.bsg.org.uk/clinical-resource/guidelines-on-the-management