Let’s take a look at drinks, but also at solid foods

A 62-year-old Caucasian patient was admitted to the hospital for the management of alcohol dependence (approximately 280g of ethanol per day for the past 10 years). He had no other relevant medical history. He reported asthenia, physical deconditioning and severe inappetence with a marked decrease of food intake in the past months, eating a maximum of one meal per day. On clinical examination, there were significant oedema of the lower limbs, marked conjunctival jaundice and low brachial perimeter compatible with myopenia (26 cm). The results of the blood test were as follows: total bilirubin 7.2 mg/dL (direct 6.4 mg/dL), INR 1.31, CRP 25.2 mg/dL, albumin 31 g/L, prealbumin 0.13 g/L, ASAT 251 U/L, ALAT 77 U/L, gamma-GT 3718 U/L, alkaline phosphatases 374 U/L, ferritin 3777 μg/L (transferrin saturation 85%), triglycerides 344 mg/dL. IgG, IgA, IgM were normal. Platelets and neutrophils were normal. Viral serologies B and C were negative. Ultrasonography showed a hyperechoic liver without bile duct dilatation. Liver elasticity was high (32.2 kPa), as well as controlled attenuation parameter or CAP (342 dB/m). Due to significant cholestasis, hepatocellular insufficiency and high liver elasticity, we measured the hepatic venous pressure gradient (9 mmHg) and performed a transvenous liver biopsy (Fig 1A-D).