A 52-Year-Old Man with a History of Alcoholic Liver Disease

A 52-year-old man with a history of alcoholic liver disease is admitted to the hospital due to fatigue and abdominal discomfort.  He has had no nausea, vomiting, constipation, or diarrhea.  The patient has chronic ascites treated with spironolactone and furosemide.  He had an inguinal hernia repaired 20 years ago.  His temperature is 37.9 C (100.2 F) , blood pressure is 102/68 mm Hg, and pulse is 106/min.  The patient is awake, alert, and oriented to time, place, and person but fails to perform a timed connect-the-numbers test.  Auscultation of the heart and lungs is normal.  Abdominal examination shows moderate ascites with diffuse discomfort to palpation.  There is no rigidity or rebound.  Bowel sounds are decreased.  The rectal examination is normal, with brown stool negative for occult blood.  Abdominal x-ray shows dilated loops of large bowel with air in the colon and rectum.  Which of the following is the most likely diagnosis in this patient?

A) Acute pancreatitis
B) Alcoholic hepatitis
C) Peptic ulcer perforation
D) Small bowel obstruction
E) Spontaneous bacterial peritonitis

Correct Answer:

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