A 52-year-old man with a 20-year history of alcohol consumption presents with jaundice, hepatomegaly, and ascites. Laboratory investigations show elevated transaminases (AST > ALT), elevated bilirubin, and prolonged prothrombin time. What is the most common cause of jaundice in this clinical presentation?

Explanation

## Most Common Cause of Jaundice in Chronic Alcohol Use **Key Point:** Alcoholic cirrhosis is the most common cause of jaundice in patients with chronic alcohol consumption and clinical features of liver disease (hepatomegaly, ascites, coagulopathy). ### Clinical Features Supporting Alcoholic Cirrhosis | Feature | Alcoholic Cirrhosis | Autoimmune Hepatitis | Viral Hepatitis B | |---------|-------------------|----------------------|-------------------| | AST vs ALT | AST > ALT (characteristic) | ALT > AST | ALT > AST | | Hepatomegaly | Common | Possible | Common | | Ascites | Yes (advanced disease) | Rare | If cirrhotic | | History | Chronic alcohol use | No alcohol history | Exposure history | | Prothrombin time | Prolonged (synthetic dysfunction) | Prolonged | Prolonged if advanced | **High-Yield:** The AST > ALT pattern is a hallmark of alcoholic liver disease and helps distinguish it from viral and autoimmune causes, where ALT typically exceeds AST. ### Pathophysiology 1. Chronic alcohol metabolism → acetaldehyde accumulation 2. Hepatocyte necrosis and inflammation 3. Fibrosis and cirrhosis development 4. Portal hypertension → ascites, varices 5. Hepatic synthetic dysfunction → coagulopathy, jaundice **Clinical Pearl:** The combination of hepatomegaly, ascites, prolonged PT, and jaundice in a chronic alcoholic indicates decompensated cirrhosis with hepatic encephalopathy risk — urgent management needed. **Mnemonic: HALT** — Hepatomegaly, Alcohol history, Liver dysfunction (elevated transaminases), Thrombocytopenia (portal hypertension). [cite:Harrison 21e Ch 297]