Patient History: A 49-year-old woman presents to the emergency room complaining of a 4-week history of progressive abdominal swelling and discomfort. She has no other gastrointestinal symptoms, and she has a normal appetite and normal bowel habits. Her medical history is significant only for three pregnancies, one of which was complicated by excessive blood loss, requiring a blood transfusion. She is happily married for 20 years, does not smoke, and drinks only occasionally. On pointed questioning, however, she does admit that she was “wild” in her youth, and she had snorted cocaine once or twice at parties many years ago.
She does not use drugs now. She was HIV negative at the time of the birth of her last child. Physical Examination: Her temperature is 100.3°F, heart rate 88 bpm, and blood pressure 94/60 mm Hg. She is thin, her complexion is sallow, her sclerae are icteric, her chest…
