American Board of Internal Medicine (ABIM) Certification Practice Exam

What should patients with ascites associated with cirrhosis discontinue to manage their condition?

1. Beta-blockers

2. ACE inhibitors, angiotensin receptor blockers, and NSAIDs

3. Antibiotics

4. Anticoagulants

The correct answer is: ACE inhibitors, angiotensin receptor blockers, and NSAIDs

Patients with ascites due to cirrhosis need to manage fluid retention and prevent complications effectively. Discontinuing medications such as ACE inhibitors, angiotensin receptor blockers, and NSAIDs is critical in this context. These medications can lead to renal impairment and exacerbate fluid retention. Specifically, ACE inhibitors and angiotensin receptor blockers can cause alterations in renal hemodynamics, potentially leading to acute kidney injury in patients with cirrhosis, especially as their renal blood flow might already be compromised due to liver dysfunction. NSAIDs, on the other hand, can impair kidney function and worsen fluid retention by promoting sodium reabsorption, leading to increased blood volume and worsening ascites. Therefore, for patients suffering from ascites associated with cirrhosis, the discontinuation of these medications is a key strategy to help manage their condition and maintain renal function.