Cirrhosis classification

Jump to: navigation, search

Cirrhosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cirrhosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Cirrhosis classification On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cirrhosis classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cirrhosis classification

CDC on Cirrhosis classification

Cirrhosis classification in the news

Blogs on Cirrhosis classification

Directions to Hospitals Treating Cirrhosis

Risk calculators and risk factors for Cirrhosis classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]Sudarshana Datta, MD [3]

Overview

Cirrhosis of the liver may be classified using two classification methods based on etiology and morphology. Currently, classifying cirrhosis based on morphology is not recommended, as it requires an invasive procedure to examine the gross appearance of the liver, and provides little diagnostic value. Classifying cirrhosis according to etiology is a more acceptable form of classification, as it may be attained through non-invasive laboratory testing, and has a higher diagnostic value.

Classification Based On Etiology

Cirrhosis may be classified on the basis of etiology. This is the most widely accepted method of classification.

(a) Alcoholic cirrhosis

  • Most common cause of cirrhosis
  • Caused by continuous and prolonged alcohol abuse
  • According to American Academy of Family Physicians (AAFP), approximately 60-70 percent of all cases of cirrhosis are due to alcohol abuse

(b) Post-necrotic cirrhosis

(c) Biliary cirrhosis

(d) Cardiac cirrhosis

(e) Cirrhosis due to genetic disorders

(f) Cirrhosis due to malnutrition

Classification Based On Morphology

Cirrhosis has historically been classified based upon the nodular morphology that is seen on upon the gross appearance of the liver. Accurate assessment of the liver morphology can only be obtained through surgery, biopsy, or autopsy, therefore more recently, more non-invasive means of classifying and determining the causes of cirrhosis are used.

Micronodular Macronodular Mixed
Micronodular cirrhosis is characterized by nodules that are less than 3mm in diameter Macronodular cirrhosis is characterized by nodules that are more than 3mm in diameter Micronodular cirrhosis can often progress into macronodular cirrhosis. During this transformation, a mixed form of cirrhosis may be seen.[1]
Causes:

 Causes:

Mixed nodular cirrhosis is also seen in Indian childhood cirrhosis. [2]

Classification Based On Severity

  • Child-Pugh scoring system is used for predicting the risk of complications and severity of cirrhosis.
  • The Child-Pugh score employs five clinical measures of liver disease. Each measure is scored 1-3, with 3 indicating most severe derangement.
Measure 1 point 2 points 3 points units
Bilirubin (total) <34.2 (<2) 34.2-51.3 (2-3) >51.3 (>3) μmol/l (mg/dL)
Serum albumin >35 28-35 <28 g/L
INR <1.7 1.71-2.3 > 2.3 no unit
Ascites None Suppressed with medication Refractory no unit
Hepatic encephalopathy None Grade I-II (or suppressed with medication) Grade III-IV (or refractory) no unit
  • It should be noted that different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.
  • If the PT is <4 seconds than control, it is assigned 1 point.
  • If the PT is 4-6 seconds over control, then it scores 2 points and if PT is >6 seconds over control, it scores 3 points.
  • In primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels:
    • The upper limit for 1 point is 68 μmol/l (4 mg/dL) and the upper limit for 2 points is 170 μmol/l (10 mg/dL).

Interpretation

  • Chronic liver disease is classified into Child-Pugh class A to C:
Points Class One year survival Two year survival
5-6 A (Compensated cirrhosis) 100% 85%
7-9 B (Failing) 80% 60%
10-15 C (Decompensated cirrhosis) 45% 35%

References

  1. Fauerholdt L, Schlichting P, Christensen E, Poulsen H, Tygstrup N, Juhl E (1983). "Conversion of micronodular cirrhosis into macronodular cirrhosis.". Hepatology. 3 (6): 928–31. PMID 6629323. 
  2. Nayak NC, Ramalingaswami V (1975). "Indian childhood cirrhosis.". Clin Gastroenterol. 4 (2): 333–49. PMID 47794. 
  3. de Franchis R, Primignani M (1992). "Why do varices bleed?". Gastroenterology Clinics of North America. 21 (1): 85–101. PMID 1568779. 



Linked-in.jpg