Hepatology (Last Q)
harry206 - 05-07-09 08:49

A 45-year-old Caucasian man is brought to the emergency department by his wife. She states that he has been having fever, loss of appetite, nausea, vomiting, abdominal pain with distention, and hallucinations. He has chronic hepatitis C; he was diagnosed eight years ago. Treatment with ribavirin and pegylated interferon failed two years ago. He does not drink alcohol. His temperature is 38.3 C (101 F), blood pressure is 100/50 mmHg, pulse is 108/min, and respirations are 20/min. He is currently awake, but irritable. Physical examination reveals dry, icteric mucus membranes and clear lung fields. His abdomen is tender and distended; bowel sounds are present; shifting dullness is observed. There is no rebound tenderness and hepatomegaly. Fecal occult blood is negative. There are no focal motor or sensory deficits. Mild intention tremors are present. The patient’s laboratory tests reveal the following:

CBC

Hb
8.8 g/dL

Ht
26%

Platelet count
80,000/cmm

Leukocyte count
8,000/cmm

Segmented neutrophils
80%

Bands
3%

Lymphocytes
17%



LFT

Total bilirubin
5.2 mg/dL

Direct bilirubin
2.5 mg/dL

Alkaline phosphatase
520 U/L

Aspartate aminotransferase
98 U/L

Alanine aminotransferase
85 U/L

Albumin
2.8 g/dL



Coagulation Profile:

Prothrombin time
20 sec

PTT
38 sec



A paracentesis is performed. The results are the following:

Leukocytes
900/mm3

Neutrophils
65%

RBC
3/cmm

Which of the following is the most appropriate pharmacotherapy?