Move on to physical exam

On physical examination, her vital signs:

Afebrile, HR 95, BP 152/94, RR 12, sat 97%RA

She appears somewhat unstable and almost falls while changing. She is very thin but appears to have a bloated abdomen. She appears to have a lot of bruising of various ages on her arms and legs and is not able to explain how they occurred. Her liver is palpable 3 cm below the ribs and appears firm and irregular. A screening neurological exam demonstrates a constant tremor, instability and perhaps some decreased sensation peripherally. 

Her labs were ordered by the nurse in triage and have just come back: Her INR is slighlty elevated, albumin, Bilirubin, electrolyes & creatinine are all normal. Her EKG is normal to your eyes. Her glucose is elevated and she has a mild macrocytic anemia. Her her liver enzymes are three times normal values. Her blood alchol level is 95mg/dl.

Which are your top 3 diagnoses at this point?