A 45-year-old man presents to accident and emergency with a one-week history of progressive painless jaundice and fatigue. He consumes 40 units of alcohol per week, but otherwise there are no relevant features to his past medical, medication and family histories. At admission his temperature is 37.8 °C; he is icteric with a distended abdomen, spider naevi and caput medusa. Initial bloods: WCC 15, Ne 11, haemoglobin 14 g/dL, platelets 80 × 109/L, INR 1.9, Na 131 mmol/L, K 3.7 mmol/L, Cr 101 μmol/L, Ur 4.2, ALT < 5 IU/L, AST 39 IU/L, bilirubin 125 μmol/L, alkaline phosphatase 99 IU/L, albumin 26 g/dL and CRP 22.