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A 44-year-old man with a 20-year history of chronic liver disease presented with recurrent acute upper gastrointestinal bleeding and worsening mental status. He was emaciated, with marked abdominal distention due to ascites, and had prominent superficial veins over the anterior abdominal wall, with flow directed upward. Liver-function tests were elevated, with an aspartate aminotransferase level of 240 U per liter (normal range, 0 to 35), an alanine aminotransferase level of 367 U per liter (normal range, 0 to 35), a total bilirubin level of 4.6 mg per deciliter (78.7 µmol per liter) (normal range, 0.3 to 1.0 [5.1 to 17.1]), . . . [Full Text of this Article] |
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