61歳の男性。自営業。旅客機内で耐え難い全身倦怠感を訴えた。2週間の仕事を終えて東アジアのある国から帰国するところである。たまたま同乗していた医師が機内アナウンスに呼応した。男性が現地の医療機関を昨日受診した際に渡された紹介状の一部を示す。

The patient is a 61-year-old man with a complaint of general malaise. Distended abdomen has been developed in these two days. He has a long history of drinking. However, he has never been treatedon alcoholic problems. On physical examination, his consciousness was clear. He had no fever. Icterus on his conjunctiva, several vascular spiders in his anterior chest and bilateral pretibial edema were observed. Moderate amount of ascites was detected by ultrasonography. Therefore, I strongly recommended him to consult aphysician in his home country as soon as possible.

機内での現症:体温36.5 ℃。脈拍88/分、整。呼吸数12/分。腹部に圧痛を認めない。

この情報から最も疑うべき疾患はどれか。

a. 肝硬変

b. 心不全

c. 深部静脈血栓症

d. 甲状腺機能低下症

e. ネフローゼ症候群

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