Cirrhosis Quiz: Ace Your Exams

A 44-year-old man comes to the emergency department after multiple episodes of painless hematemesis. He was at home eating dinner when he felt nauseous and vomited bright red blood. The patient has multiple prior admissions for alcohol intoxication. He has been drinking a pint of vodka daily for the last 15 years. He does not smoke cigarettes. The patient tried heroin several years ago, but has not used it since. Past medical history is otherwise not significant for any abnormal bleeding episodes. His temperature is 37.0°C (98.6°F), pulse is 105/min, and blood pressure is 104/74 mm Hg. Physical examination reveals scleral icterus and engorged paraumbilical veins. There is 2+ pitting edema of the lower extremities. Despite appropriate management, the patient is told there is a high likelihood of his symptoms recurring. Which of the following best explains why this patient is likely to experience a similar episode in the future?