Evaluation of New Onset Ascites in a Patient with Chronic Hepatitis C
Last Updated: June 24, 2012
A 45-year-old male patient with chronic hepatitis C infection (genotype 2) is receiving peginterferon and ribavirin therapy. Prior to treatment he was noted to have well-compensated cirrhosis. Eight weeks into treatment the patient develops worsening hepatic function, with increased total bilirubin, a decreased serum albumin level, and an increased prothrombin time (international normalization ratios [INR] of 1.6). He was also noted to have a low-grade fever and a distended, tender abdomen. “Shifting dullness” is observed on examination and an abdominal ultrasound confirms a moderate amount of ascites. The hepatitis C treatment is immediately stopped.
What one of the following would you recommend in the initial evaluation of this patient’s new-onset ascites?