Liver disease classification

To give an overview of the classification and types of liver disease. 

Table 4.5 Scoring for Child-Pugh classification of severity of liver disease...

TABLE 7.4 Pugh Modification of Child s Classification of Liver Disease Severity ... 

Any attempt at setting up a systematic approach to liver disease has to incorporate the correlation between morphological and functional changes. At the same time, such an approach has to take account of aetiological and pathogenic factors. However, any classification made is provisional by its very nature, since there is no uniform standpoint in this respect, and advances in medical knowledge can alter any such classification, see references 2, 4, 9, 20)... 

As early as 1947, H. Kalk strongly emphasized the need to systematize liver disease in line with morphological aspects. Initially, his approach was founded on laparoscopic criteria, i. e. size, colour and superficial structures of the liver. Pathohistological examination, however, is indispensable in the classification of most liver diseases. Liver diagnostics is based on four essential pillars, of which histology is still the most important and, in cases of doubt, the decisive factor in determining the diagnosis. (s. pp 75, 76)... 

Chronic liver diseases may show protracted (subchronic), persistent or aggressive courses. The new classification of chronic hepatitis emphasizes its respective aetiology while at the same time categorizing the degree of inflammatory and necrotic activity as well as any fibrosis and additional changes in the hepatic architecture. 

Drug therapy of liver diseases 853 6.3.2 Classification and indications 871... 

Detailed hepatic diagnosis with exact classification of the liver disease... 

The serum zinc level of the alcoholic subjects tends to be lower in comparison with the controls. An absolute increase in renal clearance of zinc in the alcoholics demonstrable at both normal level and low serum zinc concentration has been observed (32). Thus the measurement of renal clearance of zinc may be clinically used for etiological classification of chronic liver disease attributable to alcohol in diflFerent cases. 

Liver Disease — The oral Cl of LTG is 1/2 to 1/4 the Cl of inpatients with moderate to severe hepatic cirrhosis (Childs-Pugh classification of B or C, respectively) compared to healthy control subjects. 

In the case of chronic liver disease, episodic HE and persistent HE were defined and the term minimal hepatic encephalopathy (MHE) was coined to replace the hitherto inappropriate term subclinical encephalopathy . It is expected that this new system of classification will help to dispel the confusion frequently present in current textbook definitions and to facilitate multi-centre clinical trials in HE. 

Classification The classification of the hepatobiliary enzymes essential for enzyme diagnostics is based on their characteristic nature - i. e. excretory, secretory and indicator enzymes, (s. tab. 5.5) They are located predominantly within the liver cells and the biliary ducts as well as within the hepatic lobules. The speed of enzyme elimination does not depend on the blood enzyme levels, but follows an exponential curve. This allows the computation of the half-life of enzymes within the plasma, which is not influenced either by gender or age and is a typical enzyme characteristic. The velocity of enzyme elimination is largely constant, (s. tab. 5.5) However, in chronic diseases of the liver, it is known, for example, that GPT is usually eliminated faster than GOT despite its longer half-life. 

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