A 44-year-old woman complains of severe abdominal pain and a feeling of abdominal fullness. She has been vomiting off and on for the last week. First she got abdominal pain and then the abdominal distention after two days. She gets short of breath on exertion. She has been having normal bowel movements. Her stool frequency and stool color is normal. She takes vitamin tablets and a daily oral contraceptive. Her past medical history is significant for several admissions for alcohol-related complications and paroxysmal nocturnal hemoglobinuria. Her sister had developed a deep venous thrombosis at age 48 years. Her temperature is 99 °F (37.2 °C), heart rate is 112 beats/min, blood pressure is 87/57 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 96% on room air. On physical examination, she is afebrile. She has scleral icterus, otherwise eye examination is normal. She displayed shallow and rapid respirations. She has a protuberant abdomen with right upper quadrant tenderness and painful hepatic enlargement measuring 7 cm below the costal margin and a fluid wave. You can see visible dilated veins on her abdomen and back when standing. There is moderate ascites. She has 1+ pitting edema bilaterally. Rectal examination is normal. No occult blood was detected. Nervous system examination is normal. What is the most likely diagnosis in this patient?
