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Cirrhotic ascites outpatient management — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Cirrhotic ascites outpatient managementUSMLE Step 3

A 57-year-old man with cirrhosis from alcohol-associated liver disease comes for follow-up after a first episode of ascites. Paracentesis showed SAAG 1.5 g/dL and no infection. He is abstinent from alcohol. Creatinine is 0.9 mg/dL and sodium is 137 mEq/L. Which of the following is the most appropriate next step in management?

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Correct answer: E — Start sodium restriction with spironolactone and furosemide

Ascites due to portal hypertension is managed with sodium restriction and diuretics, typically spironolactone with furosemide. Alcohol abstinence and cirrhosis care remain essential.

Reference: AASLD cirrhosis ascites guidance