Liver Disease Assessment ⚗️

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🎯 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.

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