mrcem2-0754

mrcem2-0754

A 62-year-old woman presents, confused and trembling. She has a strong smell of alcohol and her appearance is unkempt. She informs you that she typically consumes large amounts of alcohol (>1 L vodka per day) but has not had any since yesterday. Upon examination, you observe that she has jaundice and abdominal distension. There are numerous spider naevi on her abdomen. Her initial blood results are as follows:

AST: 492 IU/L (5-40)
ALT: 398 IU/L (5-40)
ALP: 320 IU/L (20-140)
Gamma GT: 712 IU/L (5-40)
Bilirubin: 104 mmol (3-20)

What is the SINGLE most likely diagnosis?