Cirrhosis Complications

A 48-year-old woman with biopsy-proven cirrhosis (primary biliary cholangitis) presents with acute-onset confusion, asterixis, and fetor hepaticus. She denies recent alcohol use or NSAIDs. Serum ammonia is 180 µmol/L (normal <50). Abdominal ultrasound shows no ascites. She is afebrile; WBC 6.5 × 10^9^/L, creatinine 0.9 mg/dL. What is the most appropriate next step in management?

A 52-year-old man with known cirrhosis secondary to hepatitis B presents to the emergency department with haematemesis and melaena. On examination, blood pressure is 95/60 mmHg, heart rate 118/min, and he appears icteric. Upper endoscopy reveals large oesophageal varices with active bleeding. After fluid resuscitation and blood transfusion, he receives terlipressin and antibiotics. Which of the following is the most appropriate next step in management?

A 58-year-old woman with alcoholic cirrhosis (Child–Pugh B) presents with progressive abdominal distension, weight gain of 3 kg in 2 weeks, and ankle oedema. On examination, she has ascites, hepatomegaly, and no signs of spontaneous bacterial peritonitis (SBP). Serum sodium is 128 mEq/L, and her urine sodium is 5 mEq/L. She is currently on spironolactone 100 mg daily. What is the most appropriate next step in management?

A 48-year-old woman with cirrhosis presents with spontaneous bacterial peritonitis (SBP) confirmed by ascitic fluid analysis (PMN count 250/μL, positive culture for E. coli). What is the drug of choice for empirical antibiotic therapy?

A 52-year-old man with decompensated cirrhosis (Child-Pugh C) presents with acute variceal bleeding. Endoscopy confirms bleeding esophageal varices. After initial resuscitation and blood product transfusion, what is the drug of choice for pharmacological control of variceal bleeding?