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

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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).

This answer is incorrect. A diagnostic abdominal paracentesis should be performed in all patients with new onset ascites, but routine use of fresh frozen plasma in this setting is not recommended. Several studies have shown a very low rate of bleeding complications with abdominal paracentesis, even among patients with an increased prothrombin time.

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A 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.
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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