Management of Ascites Caused by Cirrhosis

You answered:

C Stop diuretics, perform large volume paracentesis as needed to control ascites, and refer for evaluation of possible liver transplantation.

This answer is correct. This patient clearly has decompensated cirrhosis that is progressive and she has diuretic-intolerant refractory ascites (defined as ascites not controlled by diuretics due to the development of electrolyte and renal abnormalities on reasonable doses of diuretics). Because of the patient's progressive electrolyte and renal abnormalities, the diuretics need to be stopped and as-needed large volume paracentesis should be performed to manage the ascites at this time. Based on her Child-Pugh-Turcotte class C and MELD score of 23, she has a very poor prognosis and evaluation for liver transplantation should be initiated at this time.

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