A 45-Year-Old Man with a History of Alcohol Use Disorder

A 45-year-old man with a history of alcohol use disorder, chronic hepatitis C, and HIV is brought to the emergency department due to altered mental status and abdominal distension.  He is disoriented and unable to provide an adequate history.  He is accompanied by a friend who reports that the patient has recently been drinking heavily.  The patient's breath has a sweet, sulfurous odor.  Physical examination shows gynecomastia, palmar erythema, and multiple spider angiomata.  The abdomen is severely distended, and dilated periumbilical veins are noted.  There is 3+ bilateral lower extremity edema.  Genital examination shows testicular atrophy.  Neurologic examination shows disorientation and asterixis.  Abdominal imaging reveals splenomegaly.  Development of this patient's gynecomastia most closely resembles the pathogenesis of which of the following additional findings in this patient?

A) Altered mental status
B) Dilated periumbilical veins
C) Lower extremity edema
D) Spider angiomata
E) Splenomegaly
F) Sweet, sulfurous breath odor

Correct Answer:

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