Long Heavy Alcohol Use in Medicine / Internal Medicine — 47yo Man | Hepatology | SMLE Q#7936

A 47-year-old man with a long history of heavy alcohol use presents to the clinic with a 6-week history of unintentional weight loss, low-grade fevers, and dull right upper quadrant abdominal pain. He also reports progressive abdominal distension and early satiety. On examination, he appears mildly cachectic with scleral icterus and a distended abdomen with shifting dullness consistent with ascites. There is a firm, nodular hepatomegaly without signs of peritonitis. Laboratory studies reveal mildly elevated transaminases and an alpha-fetoprotein level of 120 ng/mL (normal: 0–40 ng/mL). Abdominal ultrasound demonstrates a cirrhotic liver with ascites and a solitary focal liver lesion. Which of the following is the most likely diagnosis?