A 52-year-old Chinese man with chronic hepatitis B presents with abdominal pain and new ascites. Ultrasound of the liver reveals enlarged liver, and portal vein thrombosis. The most likely diagnosis is

Correct Answer: B

Rationale: The correct answer is B: Hepatocellular carcinoma. In this case, the patient with chronic hepatitis B has developed new-onset ascites, enlarged liver, and portal vein thrombosis, which are classic findings of hepatocellular carcinoma. The presence of ascites and portal vein thrombosis suggests advanced liver disease, increasing the likelihood of hepatocellular carcinoma. Acute flare of hepatitis (choice A) typically presents with elevated liver enzymes without the specific findings mentioned. Outflow obstruction and congestion (choice C) would not explain the portal vein thrombosis. Superinfection with hepatitis D (choice D) is unlikely as it typically occurs in patients with concurrent hepatitis B infection. Therefore, hepatocellular carcinoma is the most likely diagnosis in this patient based on the clinical presentation and imaging findings.

Correct Answer: B

Rationale: The correct answer is B. Sucralfate forms a protective barrier over ulcers by binding to the ulcer site and creating a physical barrier against acid and pepsin. This protects the ulcer from further damage and allows it to heal. The other choices are incorrect because: A: Sucralfate does not neutralize stomach acid, it works by forming a barrier. C: Sucralfate does not eradicate H. pylori, which is typically treated with antibiotics. D: Sucralfate does not inhibit acid production, it works by creating a protective barrier.

Correct Answer: D

Rationale: The correct answer is D: High intake of dairy products. PUD (Peptic Ulcer Disease) is commonly caused by factors like chronic NSAID use, H. pylori infection, and excessive alcohol consumption. High dairy intake does not directly contribute to PUD. Dairy products usually do not irritate the stomach lining or lead to ulcer formation. Thus, it is not a typical cause of PUD.

Correct Answer: B

Rationale: Step 1: Effective PUD management involves eradicating H. pylori bacteria. Step 2: Absence of H. pylori on follow-up testing indicates successful treatment. Step 3: Therefore, the expected outcome of effective PUD management is the absence of H. pylori on follow-up testing, making choice B the correct answer. Summary: Choices A, C, and D are incorrect as they do not directly relate to the key aspect of PUD management, which is eradicating H. pylori.

Correct Answer: A

Rationale: The correct answer is A: Gastric outlet obstruction. Chronic PUD can lead to scarring and inflammation in the stomach lining, causing narrowing or blockage of the pyloric valve, leading to gastric outlet obstruction. This complication can manifest as persistent nausea, vomiting, and weight loss. The other choices, B, C, and D, are not typically associated with chronic PUD. Gallbladder disease is more commonly linked to gallstones, chronic kidney disease to conditions affecting the kidneys, and pulmonary embolism to blood clots in the lungs.