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New ascites — MCCQE Part 1 MCQ

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HardAbdominal DistensionNew ascitesMCCQE Part 1

A 61-year-old man with alcohol-related liver disease presents with new tense ascites. He is afebrile but uncomfortable and has ankle oedema. Which of the following is the most appropriate diagnostic step?

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Correct answer: D — Diagnostic paracentesis with cell count, culture and albumin/protein analysis

New ascites requires diagnostic paracentesis to identify portal hypertension, infection or malignancy and to calculate the serum-ascites albumin gradient. Diuretics may be appropriate later, but sampling should not be skipped. Tense ascites does not by itself define malignancy.

Reference: Canadian Association for the Study of the Liver ascites practice