A 43 year old man was admitted with a history of high alcohol intake for 20 years. For six months prior to admission there had been an increase in weight, jaundice (yellow skin) and several episodes of melaena (black, tarry motions due to bleeding from the oesophagus, stomach or duodenum). Four days before admission, he developed pneumonia. On examination, he was jaundiced, with flapping tremor of the hands (a sign of brain injury due to acute liver failure), testicular shrinkage (resulting from chronic liver damage), enlarged liver and spleen, fluid in the abdominal cavity (ascites) and swelling of the legs. Despite treatment, he did not respond, and died 4 days after admission.