And respiratory rate are within normal limits. Moderate

And respiratory rate are within normal limits. Moderate

And respiratory rate are within normal limits. Moderate scleral icterus is noted. The abdomen is soft and not distended. The liver is enlarged, nontender, and smooth with an edge palpable 5 cm below the costal margin and a span of 15 cm. The spleen is palpable. The cardiac, pulmonary, neurologic, and extremity examinations all are within normal limits. C.R.’s laboratory evaluation is significant for the following: Hct, 39% Hgb, 11 g/dL WBC count, 8.8 cells/?L Platelets, 75,000/?L PT, 15.4 seconds INR, 2.1 AST, 326 units/L ALT, 382 units/L Alkaline phosphatase, 142 units/mL Total bilirubin, 4.2 mg/dL Albumin, 2.8 g/dL Hepatitis serologic tests are positive for HBsAg, HBeAg, and anti-HBc and negative for IgM anti-HBc, IgM antiHAV, and anti-HCV. HBV DNA is reported as greater than 200 pg/mL. A liver biopsy reveals periportal inflammation as well as piecemeal and bridging necrosis. What clinical findings does C.R. have that support the diagnosis of chronic HBV infection?

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