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End Stage Liver Disease

  1. The Model for End-Stage Liver Disease (MELD) score.
  2. The MELD score is based upon a mathematical model that includes
    1. Bilirubin
    2. Creatinine
    3. Prothrombin time expressed as international normalized ratio (INR).
PELD score (Pediatric End-Stage Liver Disease) (Younger than 12)
  1. Age
  2. Serum Bilirubin
  3. Albumin
  4. INR
Table 304-1 Indications for Liver Transplantation (Ref. Hari. 18th ed., Table-310.1, Pg - 2607)
Children Adults
Biliary atresia Primary biliary cirrhosis
Neonatal hepatitis Secondary biliary cirrhosis
Congenital hepatic fibrosis Primary sclerosing cholangitis
Alagille's disease Autoimmune hepatitis (Recurrence common)
Byler's disease Caroli's disease
alpha 1-Antitrypsin deficiency Cryptogenic cirrhosis
Inherited disorders of metabolism Chronic hepatitis with cirrhosis
  Wilson's disease Hepatic vein thrombosis
  Tyrosinemia Fulminant hepatitis
  Glycogen storage diseases Alcoholic cirrhosis
  Lysosomal storage diseases Chronic viral hepatitis
  Protoporphyria Primary hepatocellular malignancies
  Crigler-Najjar disease type I Hepatic adenomas
  Familial hypercholesterolemia Nonalcoholic steatohepatitis
  Primary hyperoxaluria type I Familial amyloid polyneuropathy


Important Point

Rapamycin, an inhibitor of later events in T cell activation, is approved for use in kidney transplantation but is not used for use in liver transplant recipients because of the association with an increased frequency of hepatic artery thrombosis in the first month posttransplantation.

  1. Focal nodular hyperplasia
    1. Occurs at all ages and is not caused by oral contraceptives. (Ref. Hari. 18th ed., Pg - 2565)
    2. It is often asymptomatic and appears as a hypervascular mass, often with a central hypodense “stellate” scar on CT scan or MRI.
    3. It is not a true neoplasm but a nonspecific reaction to altered blood flow is associated with an elevated angio poietin 1/angiopoietin 2 mRNA ratio and may also occur in patients with cirrhosis, with exposure to certain drugs such as azathioprine, and in antiphospholipid syndrome.
  2. Hepatic adenoma occurs most commonly in the third and fourth decades of life and is usually caused by oral contraceptives.
Causes of hepatomegaly –
  1. Infective
    1. Hepatitis
    2. Liver abscess
    3. Malaria
    4. Hydatid cyst
    5. Leptospirosis
    6. Actinomycosis
  2. Neoplastic
    1. Metastatic tumours
    2. Hemangiomas
    3. Hepatocellular carcinoma
    4. Myeloma
    5. Leukemia
    6. Lymphoma
  3. Cirrhotic:
    1. Haemochromatosis
  4. Metabolic
    1. Fatty infiltration
    2. Amyloidosis
    3. Gaucher's disease
    4. Niemann Pick disease
    5. Von Gierke disease
  5. Drugs and Toxins:
    1. Alcoholism
  6. Congenital:
    1. Hemolytic anemia
  7. Others:
    1. Right ventricular failure

Extra Edge Porphyria is not a cause of hepatomegaly

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