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Cirrhosis

Nov 25, 2011 - 1 comments
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cirrhosis



Below is some information that Hector SF posted about Cirrhosis, which I found very helpful:

Stage 4, Cirrhosis of the liver is when the normal liver cells are replaced by scar tissue. The anatomy of the structure of the liver is changed and the livers surface becomes nodular replacing the smooth, shiny, nutmeg colored liver that you see in a super market of butcher shop.

End-Stage Liver Disease is decompensated cirrhosis.The difference between compensated and decompensated is the when decompensated the liver is no longer able to perform all of its function and so complications manifest themselves. The classic signs of ESLD are; ascites, hepatic encephalopathy, varices, jaundice (yellowing of eyes and skin).

The Child-Pugh score is usually used to measure the 3 stages of cirrhosis. Class A - compensated cirrhosis (can treatment Hep C with drugs):

Class B - decompensated cirrhosis (very few treat with Hep C drugs too ill)
Class C -

Class A is score 5 - 6
Class B is score 7 - 9
Class C is score >9

If you have experienced ascites, hepatic encephalopathy, or varices, then you are decompensated. If you haven't had any symptoms or complications other then fatigue than you a compensated Child-Pugh Class A. That does not mean you can't have less liver disease too. MELD score can go up and down over time. The same with Child-Pugh. But once you have a decompensation you are considered decompensated.

MELD is NOT a measure of the liver. It is a measure of the degree of liver disease.

The Model for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), used for liver transplant candidates age 12 and older. It gives each person a ‘score’ (number) based on how urgently he or she needs a liver transplant within the next three months. The number is calculated by a formula using three routine lab test results:
- bilirubin, which measures how effectively the liver excretes bile;
- INR (prothrombin time), which measures the liver’s ability to make blood clotting factors; and
- creatinine, which measures kidney function. (Impaired kidney function is often associated with severe liver disease.)

There are 4 stages on the metavir scale used to measure damage to the liver by hepatitis C. Cirrhosis is stage 4. Which is a measure of the extent of liver disease. It's characteristics are that the liver is scared throughout and nodules both micro and macro form on the surface of the liver.

Most decompensated patients will not be treated. The few that do need the full resources of a transplant center to treat as treatment can cause the liver to fail. Compensated cirrhotics can and do treat with hepatitis drugs and can clear the virus and stop the progression of their liver disease.



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by eureka254, Nov 25, 2011
Indeed, Hector is an excellent source of information about cirrhosis.
Help calculating MELD and estimating CPT classification can be found on the web:

To calculate MELD:
http://www.mayoclinic.org/meld/mayomodel6.html

To estimate Child-Pugh classification:
http://www.mdcalc.com/child-pugh-score-for-cirrhosis-mortality

And a great resource for those looking for in-depth reading on cirrhosis:
http://emedicine.medscape.com/article/185856-overview
Registration is free.

Good post, Advocate.

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