21st April 2024

A 52-year-old male with known decompensated cirrhosis secondary to alcoholic liver disease

A 52-year-old male with known decompensated cirrhosis secondary to alcoholic liver disease presents with breathlessness and abdominal discomfort. He has known oesophageal varices and was admitted to hospital the previous year with hepatic encephalopathy. On examination, his abdomen is grossly distended and he is significantly malnourished. Blood tests reveal Bilirubin 27, ALT 232, Albumin 18, Platelets of 90 and INR of 1.4. His current medication includes spironolactone 400 mg/day, furosemide 80 mg/day, rifaximin 400 mg TDS, lactulose 15 mls TDS and propranolol 80 mg BD. What is the next best step for managing his ascites?

Select the SINGLE most appropriate option from the list below. Select ONE option only.