Cirrhosis

Background

  • A generally irreversible fibrotic scarring of the liver parenchyma resulting in liver failure
  • The twelfth leading cause of death in men and women in 2013[1]

Clinical Features

Child-Pugh Score[2]

+1 +2 +3
Bilirubin <2mg/dL 2-3mg/dL >3 Mg/dL
Albumin >3.5mg/dL 2.8-3.5mg/dL <2.8mg/dL
INR <1.7 1.7-2.2 >2.2
Ascites No ascites Ascites, medically controlled Ascites, poorly controlled
Encephalopathy No encephalopathy Encephalopathy, medically controlled Encephalopathy, poorly controlled
  • Score ≤ 7 = Class A = 100% and 85% one and two-year patient survival
  • Score 7 - 9 = Class B = 80% and 60% one and two-year patient survival
  • Score ≥ 10 = Class c = 45% and 35% one and two-year patient survival


MELD Score[3]

MELD-Na Score 3-month mortality
40 71.3%
30-39 52.6%
20-29 19.6%
10-19 6.0%
<9 1.9%

Differential Diagnosis

Management

Complications of cirrhosis

Pain management in cirrhotic patients

Disposition

  • Often complex and should be based on presence/absence of acute complications
  • If no complications present, discussion with patient's primary care provider or gastroenterologist recommended

See Also

External Links

References

  1. Heron M. Deaths: Leading Causes for 2013. Natl Vital Stat Rep 2016: 16;65(2):1-95.
  2. Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64
  3. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70.
Last modified on 28 March 2017, at 18:33