30th April 2024

A 55-year-old male with a history of chronic alcohol abuse presents to the emergency department with confusion, jaundice, and abdominal distension.

A 55-year-old male with a history of chronic alcohol abuse presents to the emergency department with confusion, jaundice, and abdominal distension. He reports a recent increase in alcohol consumption. On examination, he is disoriented, with a distended abdomen and ascites. He has spider nevi on his chest and palmar erythema.

Which investigation is most appropriate to confirm the diagnosis of acute liver failure?