Brief Answer:
please briefly mention your problem

Detailed Answer:
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Hi
Welcome back.
The clinical scenario and liver function tests are suggestive of alcoholic liver disease.
1. features suggestive of liver disease are raised bilirubin and deranged liver enzymes.
2.He is pretty sick, he is having irrelevent talking, drowsy, having problems in mobility,
distended abdomen, swelling at legs all these factors are suggestive of hepatic encephalopathy and this condition portends a
probable poor outcome if the condition does not resolve soon. He should be evaluated
by a liver specialist and should be treated as indoor patient.
3.The current medicines need to be updated. Syp lactulose needs to be increased.
Spironolactone and lasix need to be stopped.
Human albumin to be given by IV.
4.He should be evaluated rapidly and should be shifted in the ICU as soon as possible
because early treatment makes an impact on the ultimate outcome.
5.His GCS and vitals monitoring should be done. Ultrasound of the abdomen should be done,
if needed upper GI endoscopy should also be done.
I hope the advise will be helpful for you.

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Brief Answer:
some medicines need update

Detailed Answer:
Hi
Welcome back.
Alcoholic liver disease with encephalopathy indicates a very critical scenario. Such patients may have significantly swollen veins in the stomach and that may bleed badly and in unpredictable way.
Hence these patients should be managed in the ICU in consult with a gastroenterologist.
Daily hemoglobin and Alternate day LFT should be done apart from invasive hemodynamic monitoring.
Input of an intensivist would be valuable.
Some medicines need to be discontinued because they aggravate encephalopathy and lactulose helps in recovery so better be increased.
I hope that answers your query.

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