Q. A 53-year-old male has presented to the Emergency Department complaining of gradually increasing abdominal distension over the last three months. He also mentioned associated symptoms of loss of appetite, weight loss, and general weakness. His wife noticed a yellowish discoloration of his eyes and dark urine. He has a history of moderate alcohol consumption and was diagnosed with fatty liver disease five years ago.
On examination, he appears jaundiced, with prominent spider angiomata on his chest wall. The abdomen is significantly distended with a positive fluid thrill. The liver edge is not palpable, but the spleen tip is felt on deep inspiration. On percussion, the liver span seems reduced. His blood pressure is 105/60 mmHg, his pulse rate is 92 beats per minute, and he is afebrile.
Laboratory investigations show Hemoglobin: 12.0 g/dl, Platelet count: 75,000 cells/mm³, Total bilirubin: 3.5 mg/dl, Direct bilirubin: 2.8 mg/dl, Aspartate aminotransferase (AST): 70 U/L, Alanine aminotransferase (ALT): 52 U/L, Alkaline phosphatase (ALP): 145 U/L, Serum albumin: 2.5 g/dl, INR: 1.5.
Which of the following is the best next step in managing this patient?