hepatology
zkadhem - 08-15-09 20:15

A 55-year-old African-American male is brought to your office by his concerned family
members because of "the bloody vomit he had about two days ago." He never had any
episodes of hematemesis in the past. He admits to being a chronic alcoholic for the past
twenty years; however, he stopped drinking two years ago, after being enrolled in a
rehabilitation program. His vital signs are stable. Pertinent physical findings on
examination are spider angiomata over the chest, 2+ peripheral edema, and mild
hepatomegaly. His chest and cardiovascular examination are normal. His laboratory test
results show the following:
total bilirubin: 2.6 mg/dl
AST: 40 IU/L
ALT: 50 IU/L
GGT: 39 IU/L
alkaline phosphatase: 170 IU/L
serum albumin 2.8 g/dl
PT: 16 seconds
viral serology: negative
An ultrasonogram of the abdomen shows minimal free fluid in the abdomen. A liver
biopsy is done, which shows findings suggestive of micronodular cirrhosis. Which of the
following is the most appropriate treatment for this patient?