Liver Disease

End Stage Liver Disease

The patient has:

  • Prothrombin time (PT) more than 5 seconds over control, or International Normalized Ratio (INR) >1.5
  • Serum albumin <2.5 gm/dL and
    • One or more of the following conditions:
      • Ascites, refractory to treatment or patient non-compliant
      • Spontaneous bacterial peritonitis
      • Hepatorenal syndrome; elevated creatinine and BUN; oliguria {< 400 ml/day}; urine sodium concentration < 10 mEq/l; cirrhosis and ascites
      • Hepatic encephalopathy, refractory to treatment or patient non-compliant
      • Recurrent variceal bleeding, despite intensive therapy.
  • Supporting documentation:
    • Progressive malnutrition
    • Muscle wasting with reduced strength and endurance
    • Continued active alcoholism (>80 gm ethanol/day)
    • Hepatocellular carcinoma
    • HBsAg (Hepatitis B) positivity.
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