Step 3 UWSA Practice Exam

Managing ascites from cirrhosis begins with addressing fluid retention through sodium restriction and diuretic therapy. Restricting dietary sodium (usually to about 2 grams per day) reduces the amount of fluid that shifts into the abdomen. The first-line diuretic is spironolactone, a potassium-sparing diuretic that blocks aldosterone’s effect, which is especially important because cirrhosis often drives aldosterone-mediated sodium and water retention. If needed for additional diuresis, a loop diuretic like furosemide can be added, but the combination should be monitored carefully for electrolyte disturbances and kidney function.

Immediate paracentesis is reserved for specific situations, such as tense ascites causing symptoms or when rapid relief is needed after diuretics have been tried. A high-sodium diet would worsen ascites, and doing nothing allows the condition to progress. So the initial management is sodium restriction with diuretic therapy.