26th April 2024

A 58-year-old man with a history of chronic alcohol use presents with a 4-week history of increasing jaundice, abdominal swelling, and confusion.

A 58-year-old man with a history of chronic alcohol use presents with a 4-week history of increasing jaundice, abdominal swelling, and confusion. He reports fatigue and a decreased appetite. He has a history of mild, intermittent epigastric pain. On examination, he has marked jaundice, an enlarged, tender liver, and ascites. His neurological examination reveals mild disorientation and asterixis.

Investigations:

Liver function tests show elevated bilirubin, ALT, and ALP.

Prothrombin time is prolonged.

Serum albumin is low.

Abdominal ultrasound shows a nodular liver and ascites.

Which is the most likely diagnosis?