USMLE Step 1 Question 292

Question:

A 50-year-old man with a long history of alcohol abuse and chronic hepatitis B infection presents with a protuberant abdomen and scleral icterus for 3 weeks duration. The patient is in no acute distress; however, physical exam reveals a constellation of signs suggestive of liver cirrhosis and portal hypertension. Which of the following signs is a result of decreased hepatic oncotic function in cirrhotic patients?

Correct Answer: E.  Lower limb swelling

Lower limb swelling (choice E) in cirrhotic patients is caused by a combination of portal hypertension and low oncotic pressure secondary to hypoalbuminemia resulting in fluid accumulating in the extracellular space. The liver is the major site of albumin production.

Spider nevi (choice A), gynecomastia (choice B), redistribution of pubic hair (choice C), and testicular atrophy (choice D) are all signs of hyperestrogenism in a man with cirrhosis. Hyperestrogenism occurs in men with cirrhosis because the liver cannot degrade estrogen and 17-ketosteriods such as androstenedione. Androstenediones are subsequently aromatized into estrogen in adipose tissue.