Liver Disease Assessment ⚗️
Clinical guide for liver disease assessment. Child-Pugh and MELD calculators, cirrhosis staging, prognosis, and hepatology management for NCHDs.
🎯 Liver Disease Assessment Overview
- Child-Pugh Score: Assesses severity of cirrhosis and prognosis
- UK-MELD Score: UK Model for End-stage Liver Disease - prioritizes liver transplant
- UK-MELD-Na: UK-MELD with sodium correction for better accuracy
- CTP Class: Child-Turcotte-Pugh classification (A, B, C)
- Key Indications: Cirrhosis, portal hypertension, liver failure
- Clinical Use: Prognosis, transplant priority, treatment planning
🔍 Clinical Assessment
- History: Alcohol use, viral hepatitis, medications, family history
- Physical Examination:
- - Jaundice: Scleral icterus, skin yellowing
- - Ascites: Abdominal distension, shifting dullness
- - Hepatic encephalopathy: Altered mental status, asterixis
- - Spider naevi, palmar erythema, clubbing
- - Hepatosplenomegaly, caput medusae
- Vital Signs: BP, HR, temperature, respiratory rate
- Neurological: GCS, asterixis, orientation, cognitive function
📊 Laboratory Investigations
- Essential: FBC, U&E, LFTs, INR, albumin, bilirubin
- LFTs: ALT, AST, ALP, GGT, total bilirubin, direct bilirubin
- Synthetic Function: INR, albumin, total protein
- Renal Function: Urea, creatinine, electrolytes
- Hepatitis Serology: HBsAg, anti-HCV, anti-HAV IgM
- Additional: Alpha-fetoprotein, copper studies if indicated
- Imaging: USS liver, CT/MRI if indicated
📋 Child-Pugh Score Components
- Bilirubin: <2mg/dL (1), 2-3mg/dL (2), >3mg/dL (3)
- Albumin: >3.5g/dL (1), 2.8-3.5g/dL (2), <2.8g/dL (3)
- INR: <1.7 (1), 1.7-2.3 (2), >2.3 (3)
- Ascites: None (1), Mild (2), Moderate-Severe (3)
- Encephalopathy: None (1), Grade 1-2 (2), Grade 3-4 (3)
- Total Score: 5-15 points
- Class A: 5-6 points, Class B: 7-9 points, Class C: 10-15 points
📋 UK-MELD Score Calculation
- Components: Bilirubin, INR, Creatinine, Sodium (UK-MELD-Na)
- Formula: 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43
- UK-MELD-Na: Includes sodium correction for better accuracy
- Range: 6-40 points (higher = worse prognosis)
- Transplant Priority: UK-MELD >15 for liver transplant consideration
- Updates: UK-MELD recalculated every 3-6 months
- Limitations: Not valid for acute liver failure
⚠️ Clinical Implications
- Child-Pugh Class A: 1-year survival 100%, 2-year 85%
- Child-Pugh Class B: 1-year survival 80%, 2-year 60%
- Child-Pugh Class C: 1-year survival 45%, 2-year 35%
- UK-MELD <10: Low mortality risk, conservative management
- UK-MELD 10-19: Moderate risk, consider transplant evaluation
- UK-MELD 20-29: High risk, urgent transplant evaluation
- UK-MELD ≥30: Very high risk, highest transplant priority
🚨 Complications to Monitor
- Portal Hypertension: Varices, ascites, splenomegaly
- Hepatic Encephalopathy: Altered mental status, asterixis
- Hepatorenal Syndrome: AKI in setting of liver disease
- Hepatopulmonary Syndrome: Hypoxemia, platypnea
- Spontaneous Bacterial Peritonitis: Fever, abdominal pain
- Hepatocellular Carcinoma: Surveillance with AFP and imaging
- Variceal Bleeding: Upper GI bleeding, hematemesis
💊 Management Principles
- Etiology-Specific: Treat underlying cause (alcohol, viral, etc.)
- Portal Hypertension: Beta-blockers, variceal banding
- Ascites: Salt restriction, diuretics, paracentesis
- Encephalopathy: Lactulose, rifaximin, protein restriction
- Surveillance: HCC screening every 6 months
- Transplant Evaluation: Consider when UK-MELD >15 or complications
- Palliative Care: For advanced disease not suitable for transplant
📞 Escalation Criteria
- Acute Decompensation: New ascites, encephalopathy, jaundice
- Variceal Bleeding: Hematemesis, melena, hemodynamic instability
- Hepatorenal Syndrome: Rising creatinine, oliguria
- Spontaneous Bacterial Peritonitis: Fever, abdominal pain, ascites
- Hepatic Encephalopathy: Grade 3-4, altered consciousness
- Contact: Gastroenterology, hepatology, ICU if indicated
- Emergency: Variceal bleeding, severe encephalopathy
✅ Documentation Requirements
- Clinical Assessment: Physical examination findings, mental status
- Laboratory Results: LFTs, INR, albumin, bilirubin, creatinine
- Scores: Child-Pugh score and class, UK-MELD score
- Complications: Ascites, encephalopathy, varices, HCC
- Management Plan: Etiology-specific treatment, surveillance
- Follow-up: Frequency of monitoring, specialist referrals
- Prognosis: Discussion with patient and family
Liver Disease Assessment
Child-Pugh and MELD Score Calculator
Instructions
Enter laboratory values and clinical findings to calculate Child-Pugh and MELD scores for liver disease assessment and prognosis.
Child-Pugh Score Components
UK-MELD Score Components
Note: Bilirubin and INR values automatically sync with Child-Pugh score above. You can edit either set of values.