Cirrhosis

A 52-year-old man with a 15-year history of alcohol use disorder presents with jaundice, ascites, and spider angiomas. Clinical examination reveals hepatomegaly and splenomegaly. Serum bilirubin is 4.2 mg/dL, AST 120 U/L, ALT 65 U/L, and albumin 2.8 g/dL. Which investigation is most appropriate to confirm the diagnosis of cirrhosis and assess its etiology?

Which of the following histological features is pathognomonic for cirrhosis?

A 48-year-old woman with a 10-year history of hepatitis C virus (HCV) infection presents to the emergency department with hematemesis and melena. She is hemodynamically unstable (BP 85/50, HR 118). Upper endoscopy reveals actively bleeding esophageal varices. After stabilization and variceal ligation, the patient is admitted to the ICU. Laboratory tests show: platelet count 65,000/μL, INR 2.1, albumin 2.5 g/dL, total bilirubin 4.8 mg/dL, creatinine 1.8 mg/dL. Abdominal ultrasound with Doppler shows a nodular liver, patent portal vein with flow reversal, and splenomegaly. Which pathophysiological mechanism is MOST directly responsible for the development of esophageal varices in this patient?

A 52-year-old man from rural India presents with a 6-month history of progressive abdominal distension, early satiety, and weight loss. He reports a 15-year history of alcohol consumption (40–50 g/day). On examination, he has spider angiomas on the chest, palmar erythema, and a firm hepatomegaly. Abdominal examination reveals shifting dullness. Laboratory investigations show: AST 180 U/L, ALT 45 U/L, ALP 120 U/L, total bilirubin 3.2 mg/dL, albumin 2.8 g/dL, INR 1.8. Abdominal ultrasound shows a shrunken liver with coarse echotexture, splenomegaly, and free fluid. What is the most likely pathological finding on liver biopsy?

A 48-year-old woman with alcohol-induced cirrhosis (Child-Pugh Class C) is admitted with abdominal distension, fever (38.5°C), and abdominal pain. Diagnostic paracentesis shows ascitic fluid protein 1.2 g/dL, WBC 350/μL (85% neutrophils), and culture is pending. Serum creatinine is 1.8 mg/dL (baseline 0.9 mg/dL). What is the most appropriate immediate management?