MRCP2-2106
An 80-year-old woman presents to the hospital with shortness of breath and a distended abdomen. She has been living alone for the past 3 years since her husband passed away. Over the last 6 months, she has been experiencing fatigue, nausea, and progressive breathlessness. Despite a reduced appetite and eating less than normal, she has noticed that her clothing feels tighter. She is a non-smoker and drinks 1-2 bottles of wine per week.
The patient has a history of ischaemic heart disease following an acute myocardial infarction two years ago. An echocardiogram 6 months after the acute event showed a mildly dilated left ventricle with good overall function (ejection fraction 45-55%) and mild aortic stenosis. She also had a left mastectomy 17 years ago for a small breast carcinoma.
On examination, there is dullness to percussion at both bases of her chest, and her abdomen appears distended with large volume ascites. Blood tests show low hemoglobin, low albumin, and elevated CRP. Ascitic fluid analysis reveals low albumin and glucose levels, with a negative gram stain.
What is the most likely cause of the patient’s ascites?