Evaluation of New Onset Ascites in a Patient with Chronic Hepatitis C

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C The most valuable test to perform in this setting is an abdominal computed tomographic (CT) scan. A diagnostic paracentesis is not indicated since the procedure has a very high risk and is unlikely to yield useful information.

This answer is incorrect. In this setting of new onset ascites, a diagnostic abdominal paracentesis is clearly indicated and would provide immediately useful information. An abdominal computed tomographic study would not provide sufficient information for evaluating this patient’s new onset ascites. Further, complication rates with abdominal paracentesis are low and concerns for complications associated with this procedure should not serve as a deterrent.

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B Perform a diagnostic abdominal paracentesis, but the patient must receive fresh frozen plasma prior to the procedure because his prothrombin time is increased (INR = 1.6).
C Perform a diagnostic abdominal paracentesis and obtain the following studies on the ascitic fluid: cell count and differential, total protein, albumin, and culture. In addition, calculate the serum-ascites albumin gradient (SAAG).
D Perform a diagnostic abdominal paracentesis and obtain the following studies on the ascitic fluid: cell count and differential, total protein, albumin, and cancer antigen CA 125. In addition, calculate the serum-ascites albumin gradient (SAAG).

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