James Alvarez, a 52-year-old recently divorced, Latino male is a new patient who

James Alvarez, a 52-year-old recently divorced, Latino male is a new patient who arrives at the community health clinic for an appointment with a primary care Nurse Practitioner. His chief complaint includes abdominal pain and vomiting, fatigue, and weight loss. He notes that, although he has experienced overall weight loss, his stomach “looks huge.” As his history is taken, he notes no alcohol use. In speaking with him, the Nurse Practitioner notices a yellow tinge to the whites of his eyes. During the examination, the Nurse Practitioner notes organomegaly in the right upper quadrant.