** Your query can be expalined as following: 1. Since she is a chronic alcoholic thus probably one has to examine her very carefully to exclude hepato cellular failure and for cirrhosis of liver. 2. Chronic liver disease usually passes through a long period of non specific symptoms like fatigue,flatulent dyspepsia, anorexia (present) known as COMPENSATED Cirrhosis and appearance of ascites,jaundice,encephalopathy, G.I.bleeding and pre coma are known as DECOMPENSTED Cirrhosis thus: . Check with blood examination: Hb%,TLC,DLC,ESR . Stool for occult blood . Chest X-ray . Liver Function Test . Endoscopy of upper G.I. tract. 3. It could be chronic alcoholism with Tremors thus stop alcohol and give high protein nutritious diet. (But if there is impending coma-no protein diet) MANAGEMENT: . Abstinence from alcohol intake. .Rest: reduction of physical activitiy reduces metabolic demands of liver and increases the renal perfusion. . Diet: salt free high protein diet, if not taking orally then: Inj. Neurobion 2cc IM daily for 10 days I.V. 25% glucose (4 ampules) stat and then I.V. Dextrose 5% 1000ml with 1 ampule MVI Ryle s tube and stomach wash . When able to take by mouth: Tablet Liv. 52: 2 tab. thrice daily Syrup Jaundex: 2 tsf twice daily