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ModerateGIDecompensated cirrhosisuk-plab-1

A 60-year-old man presents with a two-week history of jaundice, dark urine and right upper quadrant discomfort. He drinks heavily. On examination he is jaundiced with spider naevi and shifting dullness. Which of the following features would most strongly suggest decompensated cirrhosis rather than isolated obstructive jaundice?

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