23. Which of the following clinical situations are considered good indications for PVS?A. A 50-year-old cirrhotic man had an emergency portacaval shunt for bleeding varices and postoperatively had an ascitesleak and mild superficial wound infection.B. A 57-year-old woman with primary biliary cirrhosis (PBC) has difficult to control ascites and diuretic-inducedencephalopathy.C. A 46-year-old resistant alcoholic has chronic ascites uncontrolled by diuretics combined with repeat paracentesis.D. A 34-year-old woman taking BCPs had rapid onset of ascites and is found to have hepatic vein thrombosis causing theBudd-Chiari syndrome.Answer: C
DISCUSSION: Because of the high complication rate and the long-term failure rate, the PVS is used only when other, morelasting options for therapy either are not available or are contraindicated. The chronic alcoholic patient may benefit froma peritoneovenous shunt because his ascites is the dominant problem related to his chronic liver disease, and persistentalcoholism is a contraindication to liver replacement in most centers. PVS may be quite effective for the temporarymanagement of acute intractable postoperative ascites, such as in patient A; however, it is absolutely contraindicated inthe presence of infection. Patient B has ascites as her dominant problem as well; however, with PBC as the underlying liverdisease, she is an excellent candidate for transplantation. Patient D also has ascites as the major problem; however, theside-to-side portosystemic shunt is a far better long-term treatment option than PVS.24. Which of the following explanations account(s) for the fact that hepatitis C is the most common cause ofposttransfusion hepatitis?
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