<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 52-year-old man comes to the physician because of progressive abdominal distention and weight gain over the last 2 months. He was diagnosed with alcoholic liver cirrhosis with large ascites 1 year ago. He has congestive heart failure with a depressed ejection fraction related to his alcohol use. For the last 6 months, he has abstained from alcohol and has followed a low-sodium diet. His current medications include propranolol, spironolactone, and furosemide. His temperature is 36.7C 98F, pulse is 90min, and blood pressure is 10956 mm Hg. Physical examination shows reddening of the palms, telangiectasias on the face and trunk, and prominent blood vessels around the umbilicus. The abdomen is tense and distended; there is no abdominal tenderness. On percussion of the abdomen, there is dullness that shifts when the patient moves from the supine to the right lateral decubitus position. When the patient stretches out his arms with the wrists extended, a jerky, flapping motion of the hands is seen. Mental status examination shows a decreased attention span. Serum studies show:Sodium 136 mEqLCreatinine 0.9 mgdLAlbumin 3.6 mgdLTotal bilirubin 1.9 mgdLINR 1.0Which of the following is the most appropriate next step in treatment?? A: Refer for transjugular intrahepatic portosystemic shunt, B: Refer for liver transplantation, C: Refer for peritoneovenous shunt, D: Change propranolol to carvedilol, E: Perform large-volume paracentesisn,  <response>: This is a question about a patient with alcoholic liver cirrhosis, ascites, and congestive heart failure who has been abstaining from alcohol and following a low-sodium diet but still has progressive abdominal distention. The key findings are signs of liver dysfunction like spider angiomata, ascites that shifts with position change, and asterixis. The lab values show low albumin and mild hyperbilirubinemia consistent with cirrhosis. The goal is to determine the next best step in managing his ascites. A peritoneovenous shunt could help drain the ascites but has risks of infection and thrombosis. Transjugular intrahepatic portosystemic shunt TIPS reduces portal pressures but his liver dysfunction makes him a poor candidate. Liver transplant would be definitive treatment but is premature at this stage. Carvedilol instead of propranolol is not likely to help. Paracentesis to drain the fluid is the next appropriate step.E: Perform large-volume paracentesis 