A cachectic 65-year-old woman is brought in by paramedics. She is believed to be homeless and was found unresponsive

A cachectic 65-year-old woman is brought in by paramedics. She is believed to be homeless and was found unresponsive on the steps of the local public library. Her vital signs indicate a temperature of 100.0 °F, heart rate of 112 beats/min, and a blood pressure of 96/56 mmHg. On examination, scleral icterus and several spider angiomas on her chest are noted. Her jugular venous pressure is not detectable, and heart sounds are normal. Abdominal examination is notable for bulging flanks, a dull note to percussion of dependent areas of her abdomen, and a positive fluid wave. She has no masses noted on abdominal examination. Examination of her extremities reveals 2+ pitting edema to the midcalf. Which of the following is the most likely etiology of her physical examination findings? Nephrotic syndrome. Ovarian cancer. Heart failure. Cirrhosis of the liver. Malnutrition.

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