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Cirrhotic Ascites — RACP Adult Medicine MCQ

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ModerateGastroenterologyCirrhotic AscitesRACP Adult Medicine

A 50-year-old man with known hepatitis C cirrhosis (Child-Pugh B) presents with increasing abdominal distension over 2 weeks. Ultrasound confirms moderate-volume ascites. Diagnostic paracentesis shows ascitic fluid albumin 8 g/L with serum albumin 28 g/L (SAAG 20 g/L). Ascitic WCC is 80 cells/μL with 15% neutrophils. Culture is negative. What is the most appropriate initial management?

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Correct answer: D — Spironolactone and furosemide

New-onset ascites in cirrhosis with high SAAG (≥11 g/L) and low ascitic neutrophil count (<250/μL) indicates portal hypertension without SBP. First-line management is dietary sodium restriction (<2 g/day) plus diuretics (spironolactone 100 mg + furosemide 40 mg, titrated). Large-volume paracentesis is reserved for tense/refractory ascites.

Reference: GESA – 2024 – Cirrhosis and Ascites Management; EASL 2024