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Child-Pugh classification of cirrhosis

The results of surgery for portal hypertension & variceal bleeding depend upon the patient's preoperative Child's classification. Child's criteria are used to assess the extent of liver disease. 1) jaundice (serum bilirubin) 2) ascites 3) coagulopathy (prothrombin time) 4) hypoalbuminemia (serum albumin) 5) orientation (encephalopathy) Point system: ascites 1: absent 2: slight-moderate 3: tense encephalopathy 1: none 2: grades I-II 3: grades III-IV serum albumin (g/dL) 1: > 3.5 2: 3.0-3.5 3: < 3.0 total bilirubin (mg/dL) 1: < 2.0 2: 2.0-3.0 3: > 3.0 prothrombin time (seconds > control) 1: < 4.0 (INR < 1.7) 2: 4.0-6.0 (INR 1.7-2.3) 3: > 6.0 (INR > 2.3) Class Score 1 year mortality A 5-6 0% B 7-9 20% C 10-15 55%

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References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 352
  2. Cecil Textbook of Medicine, 20th ed, Bennett JC & Plum F eds, WB Saunders, Philadelphia, 1996, pg 789
  3. Infante-Rivard et al, Hepatology 7:660-64, 1987
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018