A 52-year-old woman was admitted to the hospital because of
Sriya Tallapragada
A 52-year-old woman was admitted to the hospital because of increased abdominal girth. About two months prior to admission she noted unexpected weight gain of 10 lbs. This was followed by ankle swelling when she stood up for long periods, and progressed to the point that her clothes became too tight. She said it felt like she was pregnant.

Over the course of the last two weeks she noted increased fatigue, more difficulty sleeping and dyspnea on exertion. Today she claimed that her abdomen and shoulders hurt so she sought medical attention. She has a history of alcohol abuse over the past 20 years, and was hospitalized once for pancreatitis related to alcohol, but had no history of liver disease. She denied any chest pain, cough, change in bowel habits, jaundice, vaginal or rectal bleeding. She lives with her husband and has three healthy children. She has no family history of similar problems; her parents both died of heart disease.

P.E. reveals a thin woman with protuberant abdomen in mild respiratory distress. T 99oF; P 100; R 30; BP 120/80. SKIN - normal but with scattered spider angiomata. LN - none palpable. HEENT - conjuctivae normal; FUNDI - normal; oropharynx dry without lesions. CHEST - clear with decreased breath sounds at both bases about 1/4 way up; percussion note is dull over the same area and there is an absence of tactile fremitus at both bases. COR - JVP is 6 cm; RRR with no murmurs, gallops or rubs audible. ABD - protuberant but symmetrical on inspection; there are no palpable masses; liver and spleen are not palpable; there is mild tenderness throughout but no rebound pain; flank dullness and fluid wave are evident.

What could be her diagnosis?

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