The gentleman on the left presents with hepatic encephalopathy, and abdominal swelling. Your exam reveals a positive fluid wave and markedly distended abdominal veins in which the flow of venous blood is cephalad above and below the umbilicus. He has a negative "ruler test". The x-ray on the right is of a 45 year-old woman who has noted gradual painless swelling of her abdomen over a period of one year. Your abdominal exam shows a fluid wave and a positive "ruler test". What is the cause of the fluid wave in these two patients?
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