ROSH Gastrointestinal Practice Exam

Spironolactone is the medication commonly used to treat fluid retention, particularly in patients with cirrhosis. In this condition, patients often experience ascites, which is the accumulation of fluid in the abdominal cavity due to increased pressure in the portal vein and decreased plasma oncotic pressure. Spironolactone is a potassium-sparing diuretic that specifically acts at the distal tubules of the kidneys, where it inhibits the action of aldosterone. Aldosterone promotes sodium retention, and by blocking its effects, spironolactone helps to promote fluid loss while conserving potassium, making it especially useful in cirrhotic patients who are at risk for hypokalemia when treated with other diuretics. The choice of spironolactone in cirrhosis is also attributed to its favorable safety profile compared to other diuretics, as it helps manage fluid accumulation without causing significant electrolyte imbalances, which can be critical for patients with liver disease. Other medications mentioned, while they can have diuretic effects, are either less targeted for this particular issue or may not be the first-line treatment. Hydrochlorothiazide and furosemide are often used in other settings for fluid overload but can lead to electrolyte