Volume 88 - 2025 - Fasc.4 - Clinical images
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).