A 20-year-old man with Dandy-Walker syndrome, cerebral palsy, epilepsy, and congenital hydrocephalus with ventriculoperitoneal (VP) shunt presents with 4 months of progressive abdominal distention and 1 day of lower-extremity swelling. Treatment for constipation was tried before his presentation, with no improvement. He is uncomfortable when supine, which his mother attributes to the abdominal fullness. Otherwise, he has been asymptomatic.

Physical examination is notable for a distended abdomen and pitting edema up to his ankles. There is no dyspnea and no stigmata of chronic liver disease.

Laboratory evaluation is notable for a hemoglobin level of 10.5 g/dL (105.0 g/L), an albumin level of 2.0 g/dL (20.0 g/L), a total protein level of 5.2 g/dL (52.0 g/L), and an erythrocyte sedimentation rate of 39 mm/hour. Results of additional studies, including serum electrolytes, liver function, kidney function, thyroid hormones, coagulation profile, urinalysis, pancreatic enzymes, serum uric acid, serum lactate dehydrogenase, serum ceruloplasmin, and...

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