Gastroenterology Question 61

A 57-year-old man is evaluated during a routine examination. His medical history is notable for chronic hepatitis C infection with cirrhosis, which was diagnosed 3 years ago. He undergoes surveillance ultrasound for hepatocellular carcinoma every 6 months.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/82 mm Hg, pulse rate is 65/min, and respiration rate is 18/min; BMI is 22. Muscle wasting and scleral icterus are noted. There is no flank dullness and no asterixis.

Ultrasound demonstrates three new liver masses. A four-phase CT demonstrates three lesions (1.8 cm, 2.5 cm, and 2.9 cm in size) that show arterial enhancement with venous washout. Splenomegaly and esophageal varices are also noted.

Which of the following is the most appropriate next step in management?

A Liver biopsy

B Liver transplantation evaluation

C Sorafenib

D Surgical resection

E Transarterial chemoembolization

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