Patient Question: "What percentage of my liver is working?”
Hard to answer. Don’t measure % like the kidneys. But can estimate causes of liver disease, operative risks, and life-expectancies/survival estimates
Two major causes of liver disease: hepatocellular injury and cholestatic injury
What are some general complications of Liver Disease?
•Cholestasis – impairment of bile flow anywhere in the flow
•Decreased clearance (like with ammonia- high ammonia is toxic!)
•Portal hypertension – portal blood is shunted around the liver and not processed by the liver
What do elevated aminotransferases suggest?
What does elevated alk phosphate suggest?
more biliary damage (or bone)
What are some liver tests that measure clearance?
bilirubin and ammonia
What are some liver tests that measure synthetic capacity?
cholesterol (late complication of severe dysfunction)
What are the aminotransferases?
•Aspartate aminotransferase (AST)
•Alanine aminotransferase (ALT)
•Increase associated with liver cell injury or death (release these after injury/death)
AST is also elevated in _____
muscle injury (marathon runner). ALT is more specific for liver injury
•Marked elevations of both associated with primary hepatocellular injury
Where does alk P come from?
bile ducts. Correlates with intrahepatic and extrahepatic injury or obstruction
What pts normally have elevated Alk P?
What are the 3 main isozymes of Alk P?
gut, liver, and bone
What bilirubin level leads to juandice usually?
This pt. was given an IM injection in a person with high INR, and bleeding resulted
Femoral a. stick for BAG leading to bleeding in a person with high INR
What is the half-life of albumin?
the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) is used to assess the prognosis of chronic liver disease, mainly cirrhosis. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation.
What is MELD?
The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict mortality within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure, and was subsequently found to be useful in determining prognosis and prioritizing for receipt of a liver transplant.This score is now used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants instead of the older Child-Pugh score
What are the components of MELD?
•International Normalized Ratio (INR) – standardized measure of Prothrombin time, hepatic synthetic function
•Creatinine. Often low in pts. With liver disease, and when high you’re likely to die
•Added Na+ recently. When Na+ is low in cirrhosis pts, they don’t live as long
MELD = 3.8 [Ln Bilirubin (mg/dl)]+11.2 [Ln INR] + 9.6 [Ln Creatinine (mg/dl)] + 6.4