A 43-year-old alcoholic man is referred with a 3-month history of abdominal distention, leg edema, and dyspnea. Physical examination is notable for mild jugular venous distention, distant heart sounds, marked ascites, and leg edema. Chest radiography shows mild cardiomegaly. Laboratory test results are as follows: total bilirubin 1.5 mg/dL, albumin 3.5 g/dL, and international normalized ratio 1.2. Liver Doppler ultrasonography shows ascites, a coarse echotexture of the liver, and patent hepatic and portal veins. In the abdominal fl uid, the protein level is 3.9 g/dL and the albumin level is 2.1 g/dL. Which of the following would you advise next? a. Hepatic venography b. Transjugular intrahepatic portosystemic shunt c. Liver biopsy d. Echocardiography e. Laparoscopy

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