Liver cirrhosis is the proliferation of connective tissue in the organ 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 is most successful for diagnostic tasks and the treatment of cirrhosis.
Child-Pugh classification of liver cirrhosis
This classification of liver cirrhosis is used to assess the severity of the disease in a patient.
Based on it, the survival rate of a patient with this pathology is assessed and the percentage of mortality after surgery is determined. It is determined how much a 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 what will be 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 evaluated?
Each Child-Pugh class is assigned specific points, which are calculated based on the sum of several parameters. So, class A has a 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. Moreover, the patient's lifespan 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.
After the surgery, the highest mortality rate belongs to class C - it is 80%; 30% - respectively, B, but A - only 10%.
The need for a liver transplant with different degrees of severity is defined as follows:
- high - C;
- moderate - B;
- low - A.
Child-Pugh classification parameters
What parameters affect class distribution? First of all, the presence of:
- bilirubin;
- albumin;
- ascites.
As well as hepatic encephalopathy, IPT, PTV and INR.
The Child-Pugh system cannot be considered a reference, since 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, with cirrhosis, morphological and etiological signs are also taken into account.
Etiological classification
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 the etiology is controversial (sometimes they say "with a possible etiology").
- Cirrhosis with an unclear (unknown) etiology.
Established etiology
The known, established causes of the pathology are indicated in the following cases:
- With alcoholic cirrhosis that 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 medical, which manifests itself as a result of the use of drugs of the same type for a long time.
- Primary and secondary biliary cirrhosis of the liver, in which death of the liver tissue occurs, and coarse scar tissue is formed to replace it.
- Congenital or hereditary cirrhosis.
- Stagnant - it has differences from the other listed forms and develops for a rather long period of time when the blood supply to the liver is disturbed. It is observed in patients with general circulatory disorders.
- With the disease and Budd-Chiari syndrome, a disease associated with a violation of the outflow of blood from the liver (with hepatic vein thrombosis).
- Exchange-alimentary cirrhosis of the liver that occurs with severe diabetes mellitus, obesity, when a bypass small intestinal anastomosis is attached.
Possible and unclear etiology
Possible and unclear, unknown etiology manifests itself in the presence of:
- infectious diseases;
- parasitic diseases;
- autoimmune pathologies;
- malnutrition.
Unknown etiological factors are most often cryptogenic forms of cirrhosis. With primary biliary and Indian childhood cirrhosis, they also speak of an unclear etiology.
Morphological classification
The morphological classification of liver damage is the first proposed and approved, based on biopsy data (a piece of an organ taken in vivo). There are pathology of 4 forms:
- small cirrhosis of the liver, characterized by small nodules in the organ, the diameter of which is 1-3 mm;
- coarse cirrhosis - the diameter of the nodules in the liver is 3 mm or more;
- forms of incomplete cirrhosis, in which interhepatic septa are mainly affected;
- mixed, characterized by a combination of all of the above features.
Cirrhosis treatment
The exposed Child-Pugh cirrhosis class of the liver makes it possible not only to make a diagnosis, to predict the survival of the patient, but also to choose an adequate treatment and supportive therapy.
So, compensated liver damage (in class A) involves basic therapy aimed at eliminating the underlying cause of the disease. In addition, supportive drugs must be selected. Their task is to eliminate dyspepsia. At the same time, enzyme agents such as Pancreatin, Creon, Mezima are of great importance. Dosages are standard, taken three times a day, mainly before meals. They are appointed by courses, on average for 2-3 weeks, which are repeated with a certain frequency.
With subcompensated liver cirrhosis (in case of Child-Pugh grade B cirrhosis), enhanced maintenance therapy is required. For this purpose, use a low-salt diet (not more than 2 g of salt per day), protein is additionally limited. Of the drugs prescribed "Furosemide" and "Spironolactone." Taking diuretics inhibits 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 intake should be constant.
In the case of decompensated liver damage (with class C on the Child-Pugh scale), a life-threatening condition manifests itself. Immediate intensive care is required . Paracentesis provides the removal of fluid from the peritoneum, albumin and crystalloids are introduced intravenously, replenishing the volume of circulating blood and protein in the body. Actively used diuretics: the same "Spironolactone" and "Furosemide." A low-salt diet is prescribed. A balanced parenteral nutrition comes with hepatic encephalopathy and other serious conditions.
Conclusion
Prevention of this pathology is also based on the classification of the severity of cirrhosis of the liver according to Child-Pugh.
With a compensated course of the disease, preventive purposes are not required. In classes B and C, patients may develop anemia, which is why erythropoietin is often prescribed. In addition, beta-blockers (such as "Metoprolol", "Anaprilin") are often prescribed, which can prevent esophageal vein rupture.