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Cirrhosis Essay

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Introduction and Background: Cirrhosis named by Laennec in 1826 means orange or twany in Greek. Cirrhosis is defined by the World Health Organization (WHO) as a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. (Anthony PP) Patients with cirrhosis are susceptible to a variety of complications, and their life expectancy is markedly reduced. Global liver cirrhosis deaths increased from around 676,000 in 1980 to over 1 million in 2010. Similarly in India also cirrhosis related deaths increased from around 77,741 in 1980 to over 188,575 in 2010. This accounts for almost one-fifth (18.3%) of the global liver cirrhosis death toll. Cirrhosis mortality has been steadily …show more content…

Predictive scoring systems derive a severity score from a variety of clinical variables, to quantify the severity of illness and to predict clinical outcome, usually mortality. Several scoring systems have been developed, like Acute Physiologic and Chronic Health Evaluation (APACHE) system, Simplified Acute Physiologic Score (SAPS), Mortality Prediction Model (MPM), and Sequential Organ Failure Assessment score (SOFA). The APACHE II scoring system is widely used and to be calculated within 24 hours of hospital admission. Child-Turcotte-Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) score are the disease specific scores commonly used for prognosis in cirrhotic …show more content…

It is calculated according to the following formula: MELD = 3.8[Ln serum bilirubin (mg/dl)] + 11.2[Ln INR] + 9.6[Ln serum creatinine (mg/dl)] + 6.4, where Ln is the natural logarithm. The main use of the MELD score is in prioritizing patients on the waitlist for deceased donor liver transplantation based on liver disease severity and short-term mortality risk. MELD score does have its own limitations. The MELD score is subject to variability of laboratory measurements (such as bilirubin and creatinine levels), certain clinically important prognostic information, such as complications of portal hypertension, hepatoma, hepatopulmonary syndrome, and presence of select systemic metabolic disorders such as hyponatremia are not accounted for in the MELD score. Also, the MELD score was developed in a homogeneous cohort of patients waiting for liver transplantation and thus may not be applicable to a cohort of patients who are not being considered for liver transplantation because of either medical or socioeconomic reasons. The group that originally described MELD in a recent review did acknowledge that “MELD is by no means a perfect system”. (Ghoshal

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