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 57 year old man with a long term alcohol consumption with the symptoms of yellowish discoloration of eyes, abdominal distention, bleeding manifestations along with hypoalbuminaemia, asterixis, constructional apraxia gives a picture of acute decompensation liver failure. In liver failure with  portal hypertension, the patient develops fluid and salt retention because of splanchnic vasodilation which leads to activation of sympathetic system activity, renin angiotensin aldosterone system activation leading to fluid and salt retention which lead to his ascites 2. With long standing fluid and salt retention which lead to his bilateral pedal edema would've lead to venous obstruction and lymphatic obstruction explaining his lymph edema. Venous stasis and lymphedema for a prolonged duration would've left to cellulitis along with recurrent blebs and ulcers, prone to recurrent infections 3. Asterexis and constructional apraxia are signs of hepatic encephalopathy due to accumulation of