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Cirrhosis Plan

CBC INR Albumin

ALT AST ALP Bilirubin GGT

Creatinine electrolytes Glucose

HBsAg HBs IgG HBc IgM HCV IgG HDV IgG

Fasting lipid panel Hemoglobin A1C Serum iron TIBC Ferritin

Antimitochondrial antibody Smooth Muscle Antibody ANA

Ceruloplasmin Alpha-1-Antitrypsin Alpha-fetoprotein

Abdominal U/S

Fibroscan

CT Scan or MRI of liver

Liver biopsy

Vaccination (hepatitis A-B, annual influenza, polyvalent pneumococcal)

Avoid exacerbating medications and substances (avoid alcohol, NSAIDs. Acetaminophen safe max 2g/day)

Maintain adequate nutrition

Review medications adjustment in Child-Pugh Class B and C



Complication screening: endoscopic screen for esophageal varices q1-2 years

Hepatocellular carcinoma screening: alpha-fetoprotein q6months, liver u/s q6-12 months



CHILD SCORE

Bilirubin <2 mg/dl: 1 point Bilirubin 2-3 mg/dl: 2 points Bilirubin >3 mg/dl: 3 points

Albumin >3.5 g/dl: 1 point Albumin 2.8 to 3.5 g/dl: 2 points Albumin <2.8 g/dl: 3 points

INR <1.70: 1 point INR 1.71 to 2.20: 2 points INR >2.20: 3 points

No Ascites: 1 point Ascites controlled medically: 2 points Ascites poorly controlled: 3 points

No Encephalopathy: 1 point Controlled medically: 2 points Poorly controlled: 3 points



Child Class A: 5 to 6 points

Child Class B: 7 to 9 points

Child Class C: 10 to 15 points

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