A Client with Portal Hypertension Has Bluish Veins Just Under

A client with portal hypertension has bluish veins just under the skin of the abdomen that radiate out across the umbilicus. Which pathophysiological factors does the nurse recognize causes this condition? Select all that apply.

A) Elevated bilirubin levels
B) Impaired clearance of ammonia
C) Increased fluid in the abdomen
D) Impaired metabolism of estrogens
E) Increased abdominal pressure