In a patient with cirrhosis and ascites, what is the diagnostic step to evaluate for infection, and what is the initial therapy?

Study for the Medical Council of Canada Qualifying Examination (MCCQE) I. Engage with flashcards and multiple-choice questions with detailed feedback. Prepare confidently!

Multiple Choice

In a patient with cirrhosis and ascites, what is the diagnostic step to evaluate for infection, and what is the initial therapy?

In a patient with cirrhosis and ascites, infection is a major concern, especially spontaneous bacterial peritonitis. The first and decisive step to evaluate for infection is diagnostic paracentesis: removing ascitic fluid and testing it for cell count and type (with a neutrophil count ≥250 cells/mm3 suggesting SBP) and sending cultures. This test confirms infection quickly and guides antibiotic therapy. Once infection is suspected or confirmed, initial therapy focuses on rapidly starting antibiotics that cover the common Gram-negative enteric organisms responsible for SBP, with dengue choices like a third-generation cephalosporin (for example, cefotaxime or ceftriaxone). Alongside that, managing the patient’s circulatory and renal status is important, which is why diuretics (as part of the overall ascites management) are addressed and electrolytes are closely monitored during treatment. Albumin is considered in select patients to reduce the risk of renal failure. Other options wouldn’t correctly address SBP: imaging alone cannot diagnose SBP, antivirals aren’t indicated, and observation without intervention would miss a treatable infection.

In a patient with cirrhosis and ascites, infection is a major concern, especially spontaneous bacterial peritonitis. The first and decisive step to evaluate for infection is diagnostic paracentesis: removing ascitic fluid and testing it for cell count and type (with a neutrophil count ≥250 cells/mm3 suggesting SBP) and sending cultures. This test confirms infection quickly and guides antibiotic therapy.

Once infection is suspected or confirmed, initial therapy focuses on rapidly starting antibiotics that cover the common Gram-negative enteric organisms responsible for SBP, with dengue choices like a third-generation cephalosporin (for example, cefotaxime or ceftriaxone). Alongside that, managing the patient’s circulatory and renal status is important, which is why diuretics (as part of the overall ascites management) are addressed and electrolytes are closely monitored during treatment. Albumin is considered in select patients to reduce the risk of renal failure.

Other options wouldn’t correctly address SBP: imaging alone cannot diagnose SBP, antivirals aren’t indicated, and observation without intervention would miss a treatable infection.

More practice questions