A 50-year-old man with a history of alcoholic cirrhosis presents with new-onset ascites, fever, chills, and abdominal pain. His ascitic fluid is sampled and reveals a white blood cell count of 750/mL with $50 \%$ neutrophils. Gram stain of the fluid shows white blood cells but no organisms. Which of the following statements is correct regarding this patient's care?

Correct Answer: C

Rationale: This patient has more than 250 neutrophils in his ascitic fluid and presents with symptoms typical of bacterial peritonitis. He should be treated with antibiotics regardless of the Gram stain and culture results because they can often be negative. Empiric therapy usually consists of a broad-spectrum agent such as cefotaxime. Recurrent episodes are common, with $70 \%$ of patients experiencing a second episode within one year. Prophylactic therapy is indicated for patients with recurrent infections but not after the first infection. Clindamycin or ampicillin would be poor antibiotic choices; better coverage against enteric gram-negatives would be warranted (e.g., norfloxacin).

Correct Answer: B

Rationale: Fasting for 6-8 hours ensures an empty stomach, allowing clear visualization during gastroscopy and reducing aspiration risk.

Correct Answer: B

Rationale: A rigid, board-like abdomen indicates peritonitis from perforation, a surgical emergency in PUD.

Correct Answer: B

Rationale: Vagotomy reduces acid production by severing vagus nerve branches, used in severe, refractory PUD cases.

Correct Answer: D

Rationale: Restlessness, sweating, and hypotension post-gastrectomy suggest hemorrhage or shock, requiring immediate physician notification.