A 56-year-old woman is diagnosed with stage IV cholangiocarcinoma
, for which she is receiving chemotherapy. Periodically, the patient develops ascites
, for which abdominal paracentesis is performed. However, the patient was lost to follow-up. The patient is brought to the emergency department by her daughter with diffuse abdominal pain
, nausea, vomiting, and altered mental status. On admission, temperature is 38.6°C (101.5°F), pulse
is 100/min, respirations are 22/min, and blood pressure
is 120/66 mm Hg. On physical examination, the abdomen is distended and shifting dullness and a fluid wave are present. There is diffuse guarding
with abdominal palpation
. Which of the following is the most likely cause of this patient’s symptoms?