A 44-Year-Old Construction Worker Comes to the Emergency Department with Nausea

A 44-year-old construction worker comes to the emergency department with nausea and fatigue over the last 2 days.  He strained his back at work 7 days ago.  He could not move for several days and took over-the-counter painkillers and applied hot packs.  The patient still has significant back pain and limited mobility.  He smokes 1 pack of cigarettes a day.  He drinks alcohol daily and heavily on weekends.  In addition, he also admits to using intravenous heroin on occasion.
He was hospitalized for pneumonia 6 months ago and treated with intravenous antibiotics.  The echocardiogram during that admission showed normal left ventricular systolic function, mildly dilated right ventricle, and mild pulmonary hypertension.
His temperature is 37.2° C (99° F) , blood pressure is 94/50 mm Hg, and pulse is 112/min.  There is mild scleral icterus.  Several needle tracks are seen on both forearms.  No heart murmurs are present.  The lungs are clear.  There is no abdominal distention.  Moderate right upper-quadrant tenderness is present.  The spleen is not palpable.  There is no peripheral edema.
Laboratory results are as follows:

Which of the following is the most likely cause of this patient's current condition?

A) Alcoholic hepatitis
B) Bacteremia with liver abscess
C) Hepatitis C infection
D) Medication toxicity
E) Pulmonary hypertension

Correct Answer:

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