Parameter 1 point 2 points 3 points

each each each CHILDS

S. Bilirubin <34 34-50 >50
mol/L
S. Albumin >35 25-35 <25
Gm/L
Ascites None Controlled Tense
(poorly controlled)
Encephalopath None Controlled (G I-II) Severe (G III-IV)
y
Nutritional Normal Adequate Cachectic
state

Op. Mortality 5% 10% 50%

Classification

Childs A 5-6

Childs B 7-9

Childs C 10 15

In the modified ChildTurcottePugh (CTP) classification INR replaces nutritional

state.

1 point INR <1.7

2 points INR 1.7 2.2

3 points INR >2.2

MELD Score (Model for end stage liver disease)

is based on 1. Bilirubin 4 categories 25

2. INR 24 - 29

3. Creatinine 10

Average MELD score of a patient undergoing liver transplant is 20 nationally in

the States.

Peritoneo-venous shunts to treat ascites

- Le Veen Shunt
- Denver Shunt

Complications DIC, consumptive coagulopathy continue on

next page

Breakdown of protein by transamination and oxidative deamination leads to

formation of ketoacids, ammonia and glutamine within the liver.

The KREBS HENSELEIT UREA CYCLE converts the ammonia and most of
nitrogenous excretory products into UREA.

Surgical trauma increases protein degradation and urea production &

excretion and decreases protein synthesis, ultimately producing a
CATABOLIC STATE with negative nitrogen balance.