Evaluation of New Onset Ascites in a Patient with Chronic Hepatitis C
| Author: | Atif Zaman, MD, MPH |
Last Updated: July 3, 2010
- Understand the appropriate steps required to perform diagnostic paracentesis.
- List the appropriate initial tests to order when performing a diagnostic paracentesis.
A 45-year-old male patient with chronic hepatitis C infection 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 interferon-based treatment is immediately stopped.
What would you recommend in the initial evaluation of this patient’s new-onset ascites?
