Table of Contents

evaluating hepatic function
Child-Pugh grading of hepatic dysfunction
alternative methods for assessing liver dysfunction
references and resources

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

jaundice (icterus)
spider naevi
palmar erythema
ascites
abdominal distension
hepatomegaly
hepatosplenomegaly
caput medusa

further investigations if clinical evidence of liver disease

liver function tests (LFTs)
- 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

Model for End-Stage Liver Disease (MELD)

references and resources

Australian Prescriber April 2009 - Prescribing in liver disease