hepatic_function
Table of Contents
assessment of hepatic function
see also:
evaluating hepatic function
- unfortunately, there is no single test that measures liver function.
index of suspicion of impaired function from clinical history
- history of ethanol (alcohol and alcohol withdrawal) and illicit substance use
- toxic industrial exposure
- medications including iron, vitamin A and herbal remedies
- FH alpha-1 antitrypsin deficiency, iron storage diseases (haemochromatosis), porphyrias and diabetes mellitus
clinical signs of liver disease
- spider naevi
- palmar erythema
- abdominal distension
- caput medusa
further investigations if clinical evidence of liver disease
-
- although not directly correlated with liver dysfunction, elevated liver enzymes may raise the suspicion of hepatic impairment
- abdominal ultrasound with portal vein Doppler study to assess portal hypertension
Child-Pugh grading of hepatic dysfunction
| parameter | Points assigned = 1 | Points assigned = 2 | Points assigned = 3 |
|---|---|---|---|
| ascites | absent | slight | moderate |
| bilirubin micromol/L | < 11 | 11-45 | >45 |
| albumin g/L | > 35 | 28-35 | < 28 |
| INR | <1.7 | 1.7-2.3 | > 2.3 |
| hepatic encephalopathy | none | grade 1-2 | grade 3-4 |
| Child-Pugh score | grade of dysfunction | 1 year survival | 2 year survival |
|---|---|---|---|
| 5-6 | grade A or well compensated | 100% | 85% |
| 7-9 | grade B or significant functional compromise | 80% | 60% |
| 10-15 | grade C or decompensated liver disease | 45% | 35% |
NB. survival rates are for patients with alcoholic cirrhosis
alternative methods for assessing liver dysfunction
references and resources
hepatic_function.txt · Last modified: 2023/11/20 12:59 by gary1