A 63-year-old man with a long history of alcohol use presents to his new primary care physician with a 6-month history of increasing abdominal girth. He has also noted easy bruisability and worsening fatigue. He denies any history of GI bleeding. He continues to drink three or four cocktails a night but says he is trying to cut down. Physical examination reveals a cachectic man who appears older than his stated age. Blood pressure is 108/70 mm Hg. His scleras are anicteric. His neck veins are flat, and chest examination demonstrates gynecomastia and multiple spider angiomas. Abdominal examination is significant for a protuberant abdomen with a detectable fluid wave, shifting dullness, and an enlarged spleen. The liver edge is difficult to appreciate. He has trace pitting pedal edema. Laboratory evaluation shows anemia, mild thrombocytopenia, and an elevated prothrombin time. Abdominal ultrasonogram confirms a shrunken, significant ascites, and splenomegaly.
What anatomical structures are involved in the symptoms? Explain
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