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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
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Complication screening: endoscopic screen for esophageal varices q1-2 years
Hepatocellular carcinoma screening: alpha-fetoprotein q6months, liver u/s q6-12 months
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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
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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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