65-year-cid man comes to the physician !Of fatigue, poor appetite, and lower-leg swelling. Past medical history is significant for
hypertension, type 2 diabetes mellitus, chronic cough, chest infections, and lower-extremity peripheral artery disease. The patient has
a 40-pack-year smoking history He does not use alcohci or illicit drugs Physical examination shows a barrel-shaped chest, with
bilateral scattered wheezing on auscultation. The patient’s atxlomen is distended, and the liver edge is palpated 4 cm below the right
costal margin There is 2+ pitting edema and dilated, tortuous superficial veins over both lower extremities. Manual pressure on the
atxlomen causes persistent distension of the jugular veins. His serum sodium level is 135 mEqll, and creatinine is 1.2 mg/dL An
abnOfmality of which of the following is most likely the cause of this patient’s edema?
- Q A Portal venous resistance
- QB Pulmonary arterysystciic pressure
- Q C Pulmonary capillary wedge pressure
- Q D Serum albumin level
- Q E Urinary protein excretion
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