A 58-Year-Old Man Comes to the Office Due to Increasing

A 58-year-old man comes to the office due to increasing abdominal girth for the past several months.  The patient also reports progressive fatigue, weight gain, and nausea but no vomiting.  Medical history is significant for gastroesophageal reflux and hypertension.  He drinks 12 beers a day but denies smoking or intravenous drug use.  Temperature is 37 C (98.6 F) , blood pressure is 122/76 mm Hg, pulse is 80/min, and respirations are 18/min.  Mental status is normal.  Cardiopulmonary examination is unremarkable.  The abdomen is grossly distended, and shifting dullness is elicited.  There is no asterixis.  Chest x-ray is normal.  Basic metabolic panel is unremarkable.  Abdominal ultrasonogram shows splenomegaly, moderate ascites, and a shrunken liver with no masses.  Diagnostic paracentesis reveals straw-colored fluid.  In addition to recommending complete abstinence from alcohol use, which of the following is the best next step in management?

A) Fluid restriction
B) Furosemide alone
C) Furosemide and spironolactone
D) Lisinopril
E) Weekly large-volume paracentesis

Correct Answer:

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