Worsening abdominal pain and distension

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A 42-year-old woman comes to the office due to worsening abdominal pain and distension. The vague upper abdominal discomfort began 4 weeks ago, and her abdomen has become progressively distended over the past week. The patient also notes several months of generalized pruritus, which is worsened by water contact and is not relieved by over-the-counter emollients. She has no other medical conditions and takes no medications. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 36.5 C (97.7 F), blood pressure is 152/80 mm Hg, pulse is 88/min, and respirations are 16/ min. Physical examination shows facial plethora and mild scleral icterus. The neck veins are flat, and heart and lung sounds are normal. The abdomen is distended with flank dullness to percussion, tender hepatomegaly, and splenomegaly. There is no extremity edema or skin rash. Laboratory results are as follows: Complete blood count: Hemoglobin: 20.8 g/dL, Hematocrit 62%, Platelets 440,000/mm3, Leukocytes 12,400/mm3, Liver function studies: Total bilirubin 4.3 mg/dL, Alkaline phosphatase 270 U/L, Aspartate aminotransferase (SGOT) 506 U/L, Alanine aminotransferase (SGPT) 614 U/L.

Reference no: EM133832316

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