A 56-year-old male with a history of chronic alcohol use and liver cirrhosis, presents to the clinic with worsening abdominal swelling and bilateral lower limb edema over the past two weeks. He also reports mild shortness of breath and reduced urine output. Mark denies any fever, chest pain, or gastrointestinal bleeding. Mark’s medical history includes liver cirrhosis, diagnosed two years ago due to chronic alcohol use. He stopped consuming alcohol six months ago and has no other significant health issues. On examination, Mark’s vital signs reveal mild hypotension with a blood pressure of 100/65 mmHg and a heart rate of 92 bpm. Abdominal examination shows gross ascites with a positive fluid wave, and pitting edema extends to the mid-thighs bilaterally. Signs of chronic liver disease, such as jaundice and spider angiomas, are also noted. Which diuretic is considered first-line therapy for ascites management in chronic liver cirrhosis?
