More on Hepatic Hydrothorax

Proof enough for me:

Hepatic hydrothorax.

Milanez de Campos JR, Andrade Filho LO, de Campos Werebe E, Pandulo FL, Filomeno LT, Jatene FB.

Division of Thoracic Surgery, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil. jribas@usp.br

Hepatic hydrothorax (HH) is an uncommon manifestation of cirrhosis with ascites. Pleural effusions form when ascitic fluid moves through diaphragmatic defects that have been opened by increased peritoneal pressure. The diagnosis is established clinically by finding a serous transudate and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces. In end-stage liver disease, the management of hepatic hydrothorax is problematic and often does not respond to medical therapy. Therapeutic options for a refractory hepatic hydrothorax include therapeutic thoracentesis, talc slurry through a chest tube, peritoneovenous and pleurovenous shunting, thoracoscopic talc poudrage, transjugular intrahepatic portosystemic shunt (TIPS), thoracosopic diaphragmatic defect repair followed by talc poudrage, and lastly, liver transplant. TIPS can be used as a bridge for transplantation but is often complicated by encephalopathy. Video assisted thoracic surgery (VATS) with patching the defect and talc poudrage may provide symptomatic relief; however, the morbidity and mortality in these extremely ill patients is high. The only definitive treatment for refractory hepatic hydrothorax associated with end-stage cirrhosis is liver transplantation.

Hepatic Hydrothorax – An Uncommon Complication Of Cirrhosis

Author: M. Auron, M.D, Department of Hospital Medicine, Cleveland Clinic
Reviewer: V. Dimov, M.D., Department of Hospital Medicine, Cleveland Clinic

A 63-year-old female was admitted to the hospital with a progressive dyspnea of one-week duration. She also had orthopnea but denied chest pain, cough, palpitations, wheezing, fever or chills. Past medical history was significant for well-controlled hypertension. Social history was positive for smoking; the patient denied using drugs or alcohol. Family history was unremarkable.

Medications:
Amlodipine 10 mg daily and Propranolol 40 mg BID.

Physical examination:
Normal vital signs.
Anicteric.
Lung exam showed decreased air entry bilaterally, mostly on the right side with decreased vocal resonance and tactile fremitus, with dullness to percussion over the right infra-axillary and infra-scapular areas.
Abdominal and cardiac exam was unremarkable.
The patient had bilateral pitting edema of lower limbs.

What is the most likely diagnosis?
Pleural effusion.

What tests would you order?
- CXR (PA, lateral and decubitus).
- Complete blood count with differential (CBCD)
- Basic chemistry profile (BMP)
- Hepatic function panel (LFT) including coagulation profile (PT, INR and aPTT).
- Serum LDH
- Ascites fluid albumin, LDH, glucose, pH, cytology
- Thyroid function test
- BNP.
- Transthoracic echocardiogram to assess ejection fraction

Laboratory results
Chest roentgenogram revealed a large right sided pleural effusion.
LFTs shoewd hypoalbuminemia (2.5) and hyperbilirubinemia (Total 3.0, direct 2.5). INR was elevated (1.8) and PTT was normal. Transaminases were normal.
The remaining of the tests was normal.

What treatment would you start for this patient?
Patient was started on diuretics and a salt/fluid restricted diet. A CT of the chest and abdomen was requested for further evaluation of the effusion.

What happened?
The CT-scan of chest and abdomen showed liver appearance suggestive of cirrhosis without ascites.
Cirrhosis was confirmed via liver biopsy. Hepatitis serology was negative.
Work up for autoimmune hepatitis, alpha-1-antitrypsin deficiency, hemochromatosis and Wilson’s disease was negative. Alpha fetoprotein was normal. Lipid profile showed elevated total cholesterol (280 with elevated LDL 200), suggesting NASH (Non-alcoholic steatohepatitis) as the etiology of cirrhosis.



What happened next?
1L of pleural fluid was drained via thoracentesis (pleural tap) and sent for analysis.



The pleural effusion recurred despite conservative measures and frequent thoracocentesis. Hepatic hydrothorax was considered as the most likely diagnoses in the setting of recurrent transudative pleural effusion in a patient with cirrhosis. The patient underwent talc chemical pleurodesis and chest tube placement with clinical improvement and resolution of the effusion.

Final diagnosis:
Hepatic hydrothorax secondary to NASH-induced cirrhosis.

What did we learn from this case?
Hepatic hydrothorax is a recurrent transudative pleural effusion that occurs in patients with cirrhosis even in the absence of ascites or other manifestations of portal hypertension. Most commonly is associated with persistent diaphragmatic defects associated with relatively slow forming ascites; this results in pleural effusion as long as the rate of ascites formation does not exceed the volume capacity of the pleural space. The only definitive treatment is liver transplantation.

References:
1. von Bierbrauer A, Dilger M, Weissenbach P, Walle J. [Hepatic Hydrothorax - A Rare Cause of Pleural Effusion that is Difficult to Manage. Pneumologie. 2007 Nov 20.
2. Huffmyer JL, Nemergut EC. Respiratory dysfunction and pulmonary disease in cirrhosis and other hepatic disorders. Respir Care. 2007 Aug;52(8):1030-6.
3. Roussos A, Philippou N, Mantzaris GJ, Gourgouliannis KI. Hepatic hydrothorax: pathophysiology diagnosis and management. J Gastroenterol Hepatol. 2007 Sep;22(9):1388-93.
4. Cárdenas A, Arroyo V. Management of ascites and hepatic hydrothorax. Best Pract Res Clin Gastroenterol. 2007;21(1):55-75.
5. Garcia-Tsao G. Portal hypertension. Curr Opin Gastroenterol. 2002 May;18(3):351-9.
6. Gur C, Ilan Y, Shibolet O. Hepatic hydrothorax--pathophysiology, diagnosis and treatment--review of the literature. Liver Int. 2004 Aug;24(4):281-4.

Pleural Effusion and Cirrhosis

EUREKA!!

I had to post this everywhere. I had visited doctors for over a year, with the same symptom... extreme pain and the feeling like the wind had been knocked out of me on a daily basis.

What do I think the cause is? Plueral Effusion

Why?
Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation.

Signs and Symptoms of Plural Effusion

Pleuritic chest pain, chest pressure, dyspnea, and cough are the most common symptoms of pleural effusion. Pain may occur with little fluid formation as the symptom is related to the intense inflammation of the pleural surfaces. Chest pressure usually does not occur until the effusion is in the moderate (500-1500 ml) to large (>1500 ml) category. Dyspnea rarely occurs with small effusions unless significant pleurisy is present and often the patient will not complain of dyspnea until the effusion is massive with contralateral mediastinal shift on the chest x-ray. Cough is usually related to the associated atelectasis, which to some degree accompanies all pleural effusions. Classic physical findings associated with pleural effusions may occur when the volume begins to exceed 500 ml and include diminished breath sounds, dullness to percussion, reduced tactile and vocal fremitus, and occasionally a pleural friction rub. In contrast to pneumonia and atelectasis, crackles are not heard with an isolated pleural effusion.

More on Hepatitis C and Liver Transplants

Hepatitis C virus (HCV)-related liver disease is the leading indication for orthotopic liver transplantation (OLT) worldwide. Recurrent HCV infection-defined by viremia after transplantation-is nearly universal, with histologic evidence of recurrent hepatitis present in the majority of patients. Although short-term survival is similar for patients transplanted for other causes of liver failure, approximately 20 to 25% of HCV-positive patients develop allograft cirrhosis by 5 years. Currently, there are no proven antiviral therapies that prevent HCV recurrence or development of allograft cirrhosis. Therefore, retransplantation is often the only viable option for patients with recurrent HCV-related liver disease. However, the outcome after retransplantation for HCV recurrence is poor, and whether organs should be offered to patients whose first allograft is failing because of recurrent HCV disease remains highly controversial. This review will highlight recent information regarding the long-term results of liver transplantation for HCV-related liver disease, the role of antiviral therapy, and the outcome after retransplantation.


Liver transplants succeed in many hepatitis C patients.

Hepatitis C is a form of liver inflammation that causes primarily a long-lasting (chronic) disease. Acute (newly developed) hepatitis C is rarely observed as the early disease is generally quite mild. patients fare about as well over the decade following the procedure as do patients receiving liver transplants to ameliorate other conditions.

More than one-third of the livers transplanted in the United States go to hepatitis C patients.

Researchers tracked the progress of liver transplants in 135 people with hepatitis C It may never be fully completed or, depending on its its nature, it may be that it can never be completed. However, new and revised entries in the list are always welcome.

This is an alphabetical list of people who have or had the infectious disease hepatitis C. and 608 people with other liver diseases. After 10 years, 67 percent of the hepatitis C patients were still alive, compared with 59 percent of the others, scientists report in the September Liver Transplantation Liver Transplantation Definition

Liver transplantation is a surgery that removes a diseased liver and replace it with a healthy donor liver.
Purpose

The liver is the body's principle chemical factory. . People with liver cancer Liver Cancer Definition

Liver cancer is a relatively rare form of cancer but has a high mortality rate. Liver cancers can be classified into two types. or hepatitis B Hepatitis B Definition

Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic fared the worst.

Previous studies had suggested that liver transplants in hepatitis C patients were more likely to fall because the virus remains in the body even after a person's liver is replaced, says study coauthor Russel H. Wiesner, a hepatologist at the Mayo Clinic in Rochester, Minn. Indeed, the main cause of liver problems following a transplant in hepatitis C patients is the virus.

The new study shows that any life-threatening problem occurring in patients with hepatitis C generally came several years after transplant surgery. In the first 90 days after the operation, hepatitis C virus wasn't responsible for any of the severe health problems that occurred. They were usually caused by other infections or the failure of the transplanted organ to thrive.


What happens during transplant surgery?
Liver transplant surgery takes between six and 12 hours. During the operation, doctors remove the diseased liver and replace it with the donated liver. Most patients stay in the hospital for up to three weeks after surgery.
What are the side effects of a liver transplant?
The most common side effects are caused by the drugs that treat or prevent rejection. These side effects can include fluid retention, raised blood pressure, headaches, diarrhea and nausea. The severity of these side effects varies among patients.
What lifestyle changes are associated with liver transplants?
Most patients can return to a normal or near-normal lifestyle six months to a year after a successful liver transplant. When practical, transplant recipients should avoid exposure to people with infections. Maintaining a balanced diet, getting regular exercise and staying on prescribed medications are all important ways to stay healthy.
What is the outlook for liver transplant patients?
The outlook for patients is often expressed as a five-year survival rate. This refers to the percentage of liver transplant patients who are still alive five years after their transplant. The five-year survival rate for liver transplant patients is about 75 percent. Patients who receive livers from living donors have a slightly higher survival rate than patients whose livers came from deceased donors.

Hepatitis C and Liver Transplants

Hepatitis C and Liver Transplants
By Peter Jaret
CONSUMER HEALTH INTERACTIVE

Most people know him as the bad guy JR Ewing on the TV show "Dallas." But lately the actor who played the part, Larry Hagman, has adopted a different role: champion for the cause of organ transplants.

In 1995, Hagman, who had advanced cirrhosis, received a life-saving liver transplant. Since then he has gone on to become honorary chairman of the U.S. Transplant Games, an Olympics-style competition held for patients who have received donated organs. Hagman called the games "a true celebration of a second chance at life for transplant recipients from across the country."

For patients with advanced hepatitis C liver disease, liver transplants can offer just such a second chance. Cirrhosis of the liver caused by HCV infection is the leading reason for liver transplants. The surgery is complicated and can be risky. Yet it saves lives. About 73 to 77 percent of adult patients survive the operation and resume normal lives. Some 90 percent of liver transplants in children are successful. And new advances in the surgery, including the use of combination anti-viral therapy and "live donor" liver transplants, are improving those odds.

Among those who beat the odds is David Crosby, formerly of the band Crosby, Stills, Nash, and Young. Learning from doctors at Johns Hopkins in the 1990s that chronic hepatitis C had "munched" his liver "to a truly amazing degree… so that I had very little function left," he received a long-awaited liver transplant in 1994. Today, the grateful musician says he is "having a ball" raising a 3-year-old, touring with one of his sons, and making a documentary about musician activism. In his spare time, Crosby has also found time to narrate public service announcements about hepatitis C. "A lot of people think that if they ignore the disease, it will go away," he told an interviewer recently. "It won't. It will come knock on your door."

Who qualifies for transplantation?

Because donated organs are in short supply, doctors carefully screen patients before putting them on the list to receive a liver.

In general, transplants are offered to patients who can't be treated using drugs or other therapies, and whose disease has become life-threatening. For HCV-infected patients, the most common reason for a transplant is severe cirrhosis, or scarring of the liver. Performing transplants on patients with liver cancer is less common and can be controversial. By the time cancer is detected, it has often spread too far to be cured by a liver transplant.

Transplants are usually not offered to people with ongoing drug or alcohol abuse problems, since the likelihood of success would be small. Crosby, for example, had experimented with needle drugs a few times and developed a serious drinking problem during his years on the road, but had been sober for 10 years before he learned he had hepatitis C. "I had already made the changes that I would recommend to anybody who discovers that they've got it, which are: Don't drink and don't use," he told Hep-C Alert. "I had decided that long before, or they wouldn't have done the treatment."

Timing is critical for patients who may need a liver transplant. Although transplantation is a last resort, it is important not to wait too long. If a patient's condition has seriously deteriorated, the chances of a successful liver transplant are lessened. Typically, a team from the liver transplant center determines, in consultation with the patient and family, whether a liver transplant is appropriate. Most centers have medical review boards that assess a patient's health information and make the final decision.

If a patient is approved, he or she is placed on the national waiting list for liver transplants. The wait can be a long one. It often takes more than a year to find a suitable donor.

Weighing the risks

Like all major surgeries, liver transplants carry risks of infection and bleeding. During the surgery, doctors sometimes have difficulty removing the diseased liver. Problems can also arise if the blood vessels connected to the new liver develop clots, reducing blood supply to the transplanted organ. Once the surgery is completed, there is risk that the immune system will reject the organ. This danger can usually be minimized with drugs that suppress the rejection mechanism.

The chances of surviving a liver transplant vary depending on the age and condition of a patient. On average, about three out of four transplant patients survive the first five years after transplantation. Those might not seem like very good odds. But among patients who are in good condition, the survival rate is as high as 90 percent. Among critically ill patients, the survival rate is about 50 percent.

Surgery and recovery

Liver transplants are performed only at major medical centers around the country, by expert teams of transplantation surgeons. In the past, donated organs came only from people who had died and agreed to donate their organs. Recently some centers have also begun performing "live donor" organ transplants, in which part of the liver from a matched donor is removed and transplanted. The surgery is possible because healthy livers can regenerate themselves. Within a year, the part of the liver removed from a donor has fully grown back.

Transplant patients typically spend a few days in an intensive care unit after surgery, where their condition can be carefully monitored. Then they are moved to a regular hospital room for a stay of two to three weeks, on average. Patients who are critically ill at the time of the transplant may need to remain in intensive care and in the hospital longer, up to three months. Once patients leave intensive care, they begin to resume normal diets and are encouraged to get out of bed and walk.

The paradox of rejection

The most dangerous risk for transplantation patients is rejection. This occurs when the body's immune system attacks and destroys the transplanted organ.

Why does the immune system, which is there to protect us, try to reject the life-saving transplant? Rejection occurs because the immune system's job is to target and destroy foreign cells that pose a risk. Immune cells identify foreign cells by looking at unique molecular fingerprints on their surfaces and comparing them to the body's own unique molecular fingerprints. In this way, the immune system distinguishes between "self" and "non-self." A donor organ comes from someone whose cells have a different molecular fingerprint. Unfortunately, the immune system reacts as if the body has been invaded. It unleashes its destructive power to get rid of the foreign cells that it has mistakenly perceived as a threat. If not suppressed, the immune system can destroy a transplanted liver within days.

Several drugs have been developed that stop or slow the rejection process. Anti-rejection drugs may be given by injection during the first several weeks and later in pill form.

All anti-rejection drugs work by suppressing the immune system. As a result, they make patients more susceptible to infections. Other side effects include elevated blood pressure, fluid retention, puffiness, and bone loss. Over time, as the body begins to tolerate the new organ, patients require less anti-rejection medicine. Still, it's likely that all transplant patients will have to take the drugs for the rest of their lives. Because of the potentially serious side effects, doctors typically try to lower the dosage to the smallest amount required to prevent rejection. To prevent serious infections, transplant patients are often given antibiotics in pill form.

Liver transplantation doesn't always succeed. In some cases, the transplanted organ may fail to function. Clots forming in the blood vessels that supply the transplanted organ may cut off blood supply, starving the new liver. Sometimes doctors are unable to stop the rejection process. If the liver begins to fail, a second transplant may be necessary.

For most patients, however, liver transplants are nothing short of a miracle. People who were seriously ill, like Crosby, have been able to return to full, active lives. Some, like snowboarder Chris Klug, compete in the US Transplant Games as a way to inspire other patients facing transplants. In July 2000, Klug received a liver transplant because of a rare congenital liver condition. Five months after the surgery he won a World Cup in the parallel giant slalom. He took home a bronze medal in the 2002 Winter Olympics.

New advances ahead

For HCV-positive patients, a liver transplant doesn't offer a cure. Because HCV is circulating in the bloodstream, the transplanted liver inevitably becomes infected with the virus. Over time, the infection can begin to injure the new liver.

Fortunately, advances in treating hepatitis C promise to slow that process dramatically. The higher the viral load at the time of surgery, studies have shown, the more quickly symptoms of hepatitis C infection recur in transplant patients. That finding led scientists to wonder if anti-viral treatments given before surgery could lower viral levels and protect the new liver from damage. To find out, experts at Loyola University Medical Center in Illinois have begun aggressively treating HCV patients with high doses of alpha interferon. Early results suggest that the treatment may help delay recurrence of the disease.

The use of "live donor" liver transplants, meanwhile, could significantly increase the availability of donor organs. Because this technique poses some risk to the healthy donor, however, it remains controversial. In 2002, the National Institutes of Health launched a seven-year study to assess the technique and identify the safest ways to perform the procedure.

Another new advance could help buy time for patients awaiting donor livers. The Mayo Clinic laboratory is developing a bioartificial liver, which operates outside the body like hemodialysis but contains live, functioning liver cells. This new form of therapy is intended not only for patients prior to transplantation but also for those in need of chronic supportive therapy.

-- Peter Jaret is a contributing editor for Health magazine and a winner of the American Medical Association's award for medical reporting. His work has appeared in National Geographic, Newsweek, Hippocrates, and many other national magazines. He is also the author of In Self-Defense (Harcourt Brace Jovanovich), Active Living Every Day, and Heart Healthy for Life.

References

Thomas, R.M. et al., Infection with chronic hepatitis C virus and liver transplantation: a role for interferon therapy before transplantation, Liver Transplantation, September 2003, pg. 905-915

Wiesner, R.H. et al., Recent advances in liver transplantation, Mayo Clinic Proceedings, February 2003, pg. 197-210

The Texas Liver Coalition, www.texasliver.org

HCV Advocate newsletter, An artificial liver device, July 2003

Hep-C Alert Interviews Crosby, www.hep-c.org

US Department of Health and Human Services. Chapter III: Pediatric Transplantation in the United States, 1996-2005. http://www.ustransplant.org/annual_reports/current/chapter_iii_AR_cd.htm

US Department of Health and Human Services. 2006 OPTN/SRTR Annual Report. http://www.ustransplant.org/annual_reports/current/chapter_i_AR_cd.htm

Mayo Clinic. Scott L. Nyberg (artificial liver and liver transplantation). http://mayoresearch.mayo.edu/mayo/research/nyberg_lab/

Mayo Clinic. Hepatitis C. September 2007. http://www.mayoclinic.com/health/hepatitis-c/DS00097

American Liver Foundation. Liver Transplant. September 2007. http://www.liverfoundation.org/education/info/transplant/

---

Reviewed by Alexander Monto, MD, a hepatologist at the Veterans Administration Medical Center in San Francisco.

Live Liver Donors

There are more then 17,500 patients waiting to receive a liver.
Over 6,000 patients are transplanted each year
Over 1,700 patients die each ear waiting for a liver.

BENEFITS OF A LIVING-DONOR LIVER TRANSPLANT:

• Transplant can be done before liver failure gets worse or becomes fatal

• Less time for a liver

• Quality of donated liver may be better due to medical evaluation of donor
  

RISKS OF DONATING:

• Most donors recover fully after the operation and can do normal activities within a few months after surgery. However as with any major surgery, there are risks!

• There is a 10 to 20% chance that the donor could have a complication (The most common is itching around the incision)

• The estimated risk of dying from the transplant surgery of about 1 in 500.

• Some of the complications involve bleeding, infection, bile leaks, or damage to the bile ducts.

• You could have a reaction to the anesthetic or get pneumonia or blood clots in the legs.

• Your liver recipiant will be wearing a cheesy shirt with a huge picture of you on it everyday after. hehe (this one isn't so bad)
  

DURING AND AFTER THE SURGERY:

• The donors liver is split into two parts. One part is removed for the transplant. The surgeon then closes the wound with sutures (which are later removed)

• The remaining part of the donors liver will begin to heal and grow new tissue.

• The donors liver will grow back to normal size within 6 to 8 weeks.

• The donor typically stays in the hospital 4 to 7 days after the surgery.

• For the most part it takes approx. 4 weeks to recover from surgery

• Most people return to work approx 8 weeks after surgery.

(The donors insurance will pay for all of pre and post transplant hospital costs)

There is so much more information and details available at the UNOS website. Check it out at http://www.unos.org/living_donation.asp

HEP C = Cirrhosis, Right? WRONG!

http://www.youtube.com/watch?v=tQIUV_cSll0


Only the minority of patients with hepatitis C infection progress to cirrhosis. Studies have shown that 20% to 25% of people with hepatitis C will develop cirrhosis ([1]). There are some individuals that are more likely to progress to cirrhosis than others ([2]). The current or past use of significant amounts of alcohol is the single most important factor in accelerating progression to cirrhosis ([3]). For this reason, we recommend that all patients with chronic hepatitis C abstain totally from alcohol.

Other factors that may increase the likelihood of progression to cirrhosis include co-infection with HIV (human immunodeficiency virus) and/or hepatitis B virus. Recent research suggests that excessive iron in the liver may also accelerate progression to cirrhosis ([4]). In some patients, progression to cirrhosis occurs despite none of these factors being present. Virus-specific factors or the type of immune response to the infection may be responsible for the progression to cirrhosis in these individuals.

More recently it has been observed that progression to fibrosis (scar tissue) and cirrhosis appears to accelerate after age 45. The reasons for this are not clear, but it is suspected that changes in the immune response to the hepatitis C infection may cause increased fibrosis after age 45 ([5]). This is another reason why we are becoming more aggressive in treating hepatitis C in young people, even if fibrosis has not yet developed.

Factors that are associated with a lower likelihood of progression to cirrhosis include young age at time of infection, female gender, no history of alcohol use and past treatment with interferon. It should be noted that the genotype of the virus and the viral load have no relationship whatsoever to the development of cirrhosis.

What are the symptoms of cirrhosis?

In early cases of cirrhosis, there are no specific symptoms that would make the physician suspect cirrhosis. At an early stage, even laboratory tests may not show evidence of cirrhosis. Currently we do not have an accurate way of diagnosing cirrhosis by doing a blood test. Even though there is a commercially-available blood test for detecting advanced fibrosis in the liver, the accuracy of this test in patients with hepatitis C is still unknown, and currently it is unable to differentiate cirrhosis from less-advanced stages of fibrosis.

As the cirrhosis becomes more advanced, symptoms from the complications of cirrhosis may develop. By this time, laboratory test abnormalities suggestive of decreased liver function (abnormal levels of bilirubin and albumin; and abnormal coagulation parameters) also develop. Complications from cirrhosis include ascites, variceal bleeding, encephalopathy and liver cancer.

The severity of the cirrhosis is determined based on laboratory test results and findings on physical exam. The liver biopsy plays no role in determining the severity of the cirrhosis. Factors that are taken into account to determine the severity of cirrhosis include the serum albumin (albumin is a protein produced by the liver), the PT or INR (measures the ability of the blood to clot) and the level of serum bilirubin (bilirubin is a substance excreted by the liver, which, when it accumulates, causes jaundice). In addition, the presence or absence of ascites (fluid accumulation in the abdomen) and encephalopathy (confusion caused by toxins not filtered by the liver) are also used to grade the severity of cirrhosis.

A point system known as the Child’s-Pugh-Turcotte score (CPT score) has been devised to determine the severity of the cirrhosis. Depending on the total score, a patient is classified as Class A (early cirrhosis) through Class C (advanced cirrhosis).

Child-Pugh-Turcotte Criteria
	1 Point	2 Points	3 Points
Albumin (g/dl)	>3.5	2.8-3.5	<2.8
Bilirubin (mg/dL)	<2	2-3	>3
Ascites	None	Minimal	Moderate
Encephalo-pathy	None	Grade 1-2	Grade 3-4
PT (sec prolonged) INR	<4>	4-6 <1.7-2.3	>6 >2.3

Class A: 5-6 points; Class B: 7-9 points; Class C: 10-15 points
As of 9/1/09 Ricki stands at 12 points. (Class C - advanced)

Prognosis of cirrhosis

Patients with early cirrhosis (CPT Class A) from hepatitis C infection who have no complications from cirrhosis have an excellent prognosis. Even without treating the hepatitis C infection, 10 years after diagnosing cirrhosis the majority (>75%) continue to do well with no liver-related complications ([6]). It is believed that treatment of the hepatitis C with interferon will provide an even better prognosis.

The diagnosis of early cirrhosis should not be considered a fatal diagnosis. Most patients will continue to do well for decades. There is no reason to refer a person with cirrhosis to a liver transplant center unless the cirrhosis is advanced (CPT class C) or complications from cirrhosis have developed.

(C) 2003. Hepatitis C Support Project

** Hep C is not a death sentence, get the facts, become your own advocate, and fight! No one else is going to do it for you. ** Ricki

http://www.telegraph.co.uk/health/healthnews/5778426/It-girl-Jazzy-de-Lisser-17-breaks-taboos-on-hepatitis-C.html

http://www.telegraph.co.uk/health/healthnews/5778426/It-girl-Jazzy-de-Lisser-17-breaks-taboos-on-hepatitis-C.html