You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicates that the paracentesis was effective?
A. Pruritus
B. Dyspnea
C. Jaundice
D. Peripheral Neuropathy
Correct Answer: B. Dyspnea
Ascites put pressure on the diaphragm. Paracentesis is done to remove fluid and reduce pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of cirrhosis that aren’t relieved by paracentesis. Dyspnea from tense ascites might only be relieved with large-volume paracentesis. Care should also be taken with this procedure because patients with cirrhosis who have unrecognized cardiomyopathy can develop pulmonary edema following large-volume paracentesis.
Option A: These medical treatments range from bile salts, rifampicin, and opioid receptor antagonists to antihistamines. Additionally, nonpharmacological management such as skin moisturizers, avoidance of skin irritants, and avoiding hot environments can also prove to be very beneficial in reducing pruritus.
Option C: The underlying disorder and any problems it causes are treated as needed. If jaundice is due to acute viral hepatitis, it may disappear gradually, without treatment, as the condition of the liver improves. However, hepatitis may become chronic, even if jaundice disappears. Jaundice itself requires no treatment in adults
Option D: Treatment of peripheral neuropathy has two goals: controlling the underlying disease process and treating troublesome symptoms. The former is usually achieved by eliminating offending agents, such as toxins or medications; correcting a nutritional deficiency; or treating the underlying disease.
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