Progressive Abdominal Distention in Medicine / Internal Medicine — 60yo Woman | Hepatology | SMLE Q#18732
SMLE Question #18732
Medicine / Internal Medicine
Hepatology
Objective: OBJ-HEP-ASCITES-INITIAL
Last updated: March 2026
A 60-year-old woman with hypertension, dyslipidemia, and type 2 diabetes presents with progressive abdominal distention for 4 weeks. She denies alcohol use and reports mildly elevated liver enzymes for years. Examination shows shifting dullness consistent with ascites, with no peripheral edema, raised JVP, hepatosplenomegaly, or stigmata of chronic liver disease. What is the most appropriate next step in evaluation?
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