ROSH Gastrointestinal Practice Exam

For a patient with cirrhosis, which medication is the most appropriate next step in managing abdominal distension and pitting edema?

1. Hydrochlorothiazide

2. Lactulose

3. Omeprazole

4. Spironolactone

The correct answer is: Spironolactone

In a patient with cirrhosis presenting with abdominal distension and pitting edema, the most appropriate next step in management is the use of spironolactone. This medication is a potassium-sparing diuretic that is particularly effective in treating fluid retention associated with conditions like cirrhosis, which often leads to ascites and peripheral edema due to altered hemodynamics and fluid imbalance. Spironolactone works by antagonizing the effects of aldosterone, a hormone that encourages sodium and water retention. In patients with cirrhosis, elevated levels of aldosterone can lead to excessive fluid accumulation. By promoting diuresis, spironolactone helps remove excess fluid, thereby alleviating symptoms of abdominal distension and edema. Other options, while potentially useful in different contexts, are not as directly appropriate for the specific symptoms of abdominal distension and pitting edema. For instance, hydrochlorothiazide, while a diuretic, is less effective in the setting of cirrhosis due to its tendency to cause hypokalemia and because thiazides are generally less potent than spironolactone for managing ascites. Lactulose is typically used to manage hepatic encephalopathy rather than fluid retention