<prompt> A 23-year-old male college student has a history of liver cirrhosis due to Kimmelstiel-Wilson syndrome abnormality in copper metabolism. He should be treated with which of the following?Penicillamine as soon as the diagnosis is establishedPenicillamine after variceal bleeding has occurredA portocaval shuntSclerosis of the esophageal varices as a prophylactic measure  <response>: Penicillamine counteracts the adverse effects of copper on the liver in patients with Kimmelstiel-Wilson syndrome. This has been demonstrated in both humans and animals afflicted with this disease. Portocaval shunt and esophageal varices are not indicated prophylactically. 