Classification of severity of liver cirrhosis by Child-Pugh

Cirrhosis of the liver is a proliferation of connectivetissues in the body due to prolonged inflammation. There is no single approach to the classification of this pathology, since there is no consensus on which of the available ones is most successful for diagnostic tasks and therapy of cirrhosis.

Classification of cirrhosis of the liver by Child-Pugh

This classification of hepatic cirrhosis is used to assess the severity of the disease in a patient.

Based on it, the survival of the patient with this pathology is evaluated and the percentage of mortality after a surgical operation is determined. It is determined how much liver transplant is needed.

The disease is divided into three classes. The parameters that these classes determine indicate the severity of cirrhosis, as well as the life expectancy of a sick person who has cirrhosis. According to Child-Pugh, the degree of compensation for the disease is defined as follows:

Class A includes compensated cirrhosis.
B - subcompensated.
C - decompensated cirrhosis.

How is this assessed?

Each Child-Pugh class is assignedcertain scores, which are calculated on the basis of the sum of several parameters. So, class A belongs to the range from 5 to 6 points, B, respectively, from 7 to 9 points. And the last class - the highest value from 10 to 15 points.

The minimum severity of cirrhosis belongs to A. In this case, the patient's life expectancy will be maximum - from 15 to 20 years. In the second it is about 10 years. Class C implies the shortest life expectancy of a patient with cirrhosis of the liver - only one, maximum three years.

classification of the severity of cirrhosis of the liver by drinking tea

After the surgical intervention, the highest percentage of lethality belongs to class C - it is 80%; 30% - respectively, B, but A - only 10%.

The need for liver transplantation at different degrees of severity is defined as follows:

high - C;
moderate - B;
low - A.

The parameters considered in the Child-Pugh classification

What parameters affect the distribution by class? First of all, the presence of:

bilirubin;
albumin;
ascites.

And also hepatic encephalopathy, RTI, PTV and INR.

The Child-Pugh system can not be considered a reference,because the assessment does not take into account all the parameters of the patient's condition. A sharp exacerbation of the disease, as well as its complication, change the picture, and this classification is no longer used.

In addition to the described system, cirrhosis also takes into account morphological and etiological features.

Classification by etiological signs

There are about twenty forms of cirrhosis. Depending on whether its cause is known or not, the disease is divided into three groups:

Cirrhosis with established (known) etiology.
A pathology in which etiology is controversial (sometimes they say "with a possible etiology").
Cirrhosis with vague (unknown) etiology.

Established etiology

The known, established causes of the occurrence of pathology are spoken in the following cases:

When alcoholic cirrhosis occurs with prolonged use of alcoholic beverages (40-60 grams of ethanol) for 15 years or more.
Viral, which in half the cases occurs due to viral chronic hepatitis B, C and G.
Medicinal or medicamentous, which is manifested due to the use of drugs of one type for a long time.
Primary and secondary biliary cirrhosis, in which the hepatic tissue is killed, and the rough scar tissue is formed to replace it.
Congenital or hereditary cirrhosis.
Stagnant - it differs from otherslisted forms and develops a sufficiently long period of time, when the blood supply to the liver is disturbed. It is observed in patients with a general circulatory disturbance.
In case of illness and Badda-Chiari syndrome - a disease associated with a violation of the outflow of blood from the liver (with thrombosis of the hepatic veins).
Obmenno-alimentary cirrhosis of the liver that occurs with severe diabetes mellitus, obesity, when the bypass is connected by the small intestine anastomosis.

Possible and unclear etiology

Possible and unclear, unknown etiology is manifested when:

infectious diseases;
parasitic diseases;
autoimmune pathologies;
malnutrition.

Unknown etiological factors are most often cryptogenic forms of cirrhosis. At primary biliarnom and the Indian children's cirrhosis too speak about an obscure etiology.

Morphological classification

Morphological classification of liver damage is the first proposed and approved, based on the biopsy data (a piece of organ taken in vivo). Allocate pathology of 4 forms:

small-nodular cirrhosis of the liver, characterized by small nodules in the organ, whose diameter is 1-3 mm;
coarse-nodular cirrhosis - diameter of nodules in the liver 3 mm or more;
forms of incomplete cirrhosis, in which interhepatic septa are predominantly affected;
mixed, characterized by a combination of all of the above features.

Treatment of cirrhosis

Exposed class of cirrhosis of the liver according to Child-Pugh provides an opportunity not only to make a diagnosis, to predict the survival rate of the patient, but also to select adequate treatment and maintenance therapy.

Thus, compensated liver damage (for class A) involves basic therapy,aimed at eliminating the root cause of the disease. In addition, it is necessary to select supporting medications. Their task is to eliminate dyspepsia. Of great importance in this case are enzymatic agents such as "Pancreatin", "Creon", "Mezima". Dosages are standard, taken three times a day, mainly before meals. Assigned courses, on average for 2-3 weeks, which are periodically repeated.

With subcompensated liver cirrhosis (with B class of Child-Pugh cirrhosis) requiredthe appointment of enhanced maintenance therapy. To this end, use a low salt diet (no more than 2 grams of salt per day), the protein is further restricted. From drugs prescribe "Furosemide" and "Spironolactone". The intake of diuretics restrains the developing portal hypertension and reduces ascites. The function of the gastrointestinal tract can be improved by "Lactulose" at 50-70 ml per day, but the reception should be constant.

In the case of decompensated liver damage(at grade C on the Child-Pugh scale) a life-threatening condition appears. Immediate intensive care is required. Paracentesis provides elimination of fluid from the peritoneum, intravenously injected albumin and crystalloids, replenishing the volume of circulating blood and protein in the body. Actively used diuretic drugs: the same "Spironolactone" and "Furosemide." Assign a diet low in salt. To a balanced parenteral nutrition come with hepatic encephalopathy and other severe conditions.

Conclusion

Prevention of this pathology is also based on the classification of severity of liver cirrhosis by Child-Pugh.

With compensated disease, notpreventive appointments are required. In classes B and C, anemia can develop in patients, which is why erythropoietin is often prescribed. In addition, beta-blockers (such as Metoprolol, Anaprilina) are often prescribed, which can prevent the rupture of the esophagus.