Physical examination of a 45 year old man who looks much older than his stated age demonstrates thin arms and legs, a swollen abdomen, red tongue, dry, thin, and slightly yellow skin, gynecomastia, testicular atrophy, multiple spider angiomas, tremor, yellow discoloration of sclera, and sho term memory loss. Which of the following conditions is most strongly suggested by these findings?

The physical examination is typical for an advanced alcoholic with hepatic cirrhosis. It is impoant to recognize these symptoms, as these patients are notorious for "underestimating" and even denying their alcohol use. Bronchogenic carcinoma typically presents with cough and/or respiratory changes, but can present with mass effects in the chest or involvement of mediastinal nerves or vessels. Colon cancer typically presents with changes in the stool or bowel habits. Congestive hea failure is typically heralded by shoness of breath or peripheral edema, or both. Ref: Khalili M., Liao C.E., Nquyen T. (2010). Chapter 14. Liver Disease. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e.