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Cirrhosis with Ascites — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyCirrhosis with AscitesRACP Adult Medicine

A 52-year-old man with decompensated alcohol-related cirrhosis (Child-Pugh C) develops a large-volume ascites. Diagnostic paracentesis shows an ascitic fluid albumin of 8 g/L (serum albumin 26 g/L) and a neutrophil count of 280 cells/mm³. What is the most appropriate management?

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Correct answer: D — Large-volume paracentesis with albumin replacement

The serum-ascites albumin gradient (SAAG) is 18 g/L (>11 g/L), confirming portal hypertension as the cause. The ascitic neutrophil count is <250 cells/mm³, excluding spontaneous bacterial peritonitis (SBP). Management of large-volume ascites includes large-volume paracentesis with IV albumin replacement (6–8 g per litre removed) and initiation of diuretics (spironolactone ± frusemide).

Reference: eTG – 2025 – Gastrointestinal; EASL – 2018 – Decompensated Cirrhosis Guidelines