A 55-Year-Old Man Comes to the Office Reporting "A Swollen

A 55-year-old man comes to the office reporting "a swollen belly and puffy feet" that began several months ago.  He has not seen a physician for several years but says that he was previously diagnosed with depression.  The patient takes no medications.  He currently lives alone and is unemployed.  He admits to drinking 6-12 beers a night, depending on what he can afford.  He has a remote history of cigarette smoking.  Physical examination reveals bilateral gynecomastia, spider angiomas on the chest, Dupuytren contracture of both hands, and palmar erythema.  Dilated periumbilical veins are also visible.  Percussion of the abdomen demonstrates shifting dullness.  Splenomegaly is present.  There is no evidence of asterixis.  There is pitting edema of the lower extremities.  Laboratory studies reveal increased prothrombin time and thrombocytopenia.  Which of the following findings has the same pathogenesis as spider angiomas?

A) Dilated abdominal veins
B) Dupuytren contracture
C) Palmar erythema
D) Pedal edema
E) Splenomegaly

Correct Answer:

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