A 54-year-old woman has a long history of chronic hepatitis B infection and has had increasing malaise for the past year. She was hospitalized 1 year ago because of upper gastrointestinal hemorrhage. Physical examination now shows a firm nodular liver. Laboratory findings show a serum albumin level of 2.5 g/dL and a prothrombin time of 28 seconds. Which of the following additional physical examination findings is most likely to be present in this woman?

Cirrhosis with portal hypertension increases venous collateral flow in esophageal submucosal veins, producing varices, and in the abdominal wall, producing caput-medusae. Hyperreflexia, but not a diminution of deep tendon reflexes, can occur when hepatic encephalopathy develops from decompensated cirrhosis. Right-sided heart failure, in which the liver may be enlarged because of passive congestion, is associated with distended jugular veins. Liver failure with cirrhosis may lead to hepatic coma, but brain swelling with papilledema is not a major feature. The coagulopathy from decreased liver function may lead to purpuric hemorrhages, but splinter hemorrhages of the nails are the most characteristic of embolization from infective endocarditis.