00:01
We just looked at the
progression of a healthy liver
to a cirrhotic liver in the kind
of radical changes that happen.
00:08
Now I want to look at five
important liver functions
and the lab tests we use
to monitor those functions.
00:14
Now these are the
labs these values
are what we use to plug
into the CTP calculator.
00:20
So function number one.
00:21
Produces Albumin.
00:23
What's the lab tests
we use to monitor that?
Serum albumin.
00:27
Function number two.
00:29
Livers recycles old
red blood cells.
00:31
So we're going to look
at red blood cell level
and bilirubin.
00:36
Function number three.
00:37
A healthy liver
produces fibrinogen.
00:40
So we're going to
look at fibrinogen
or pt/inr - Prothrombin
time or INR.
00:48
Function number for transforms
ammonia to water-soluble urea.
00:54
How do we monitor that?
We're looking for the clinical
symptoms of encephalopathy.
00:59
Now, can we do lab work?
We sure can so we can look
at a serum ammonia level.
01:04
We're also going to be watching
for signs of encephalopathy
to developed in our patient.
01:09
Now 5th function is protein fluid
balance and portal pressure.
01:15
The clinical symptom you'll
watch for is ascites.
01:18
Okay so I want to back up and
review this with you one more time.
01:22
Now each one of these values when
you be given a score on the CTP,
I'll show you how
that walks through.
01:29
You've got the lab test their
and the function of the liver.
01:33
On this slide we talked about
the functions of the liver
and clinical symptoms
that you as a nurse
should be able to
assess your patient for.
01:41
So I've given you a framework of the
things that we're going to assess,
now we're going to actually plug
them into the CTP calculator.
01:48
Now look at the albumin level,
remember that's a lab
test we just talked about.
01:53
This measures the amount
of albumin in the blood,
now depending on the lab result.
01:58
You see greater than 3.5.
02:00
2.8 - 3.5 or less than 2 .8
the patient earns a score of
1, 2 or 3 points.
02:09
For bilirubin less than 2,
2 to 3 or greater than 3
again the patient ends earns a score of
1, 2 or 3 points.
02:20
Remember bilirubin is that yellow
stuff since that's a part of bile.
02:23
It's formed when your red
blood cells break down
and too much bilirubin in
the blood can cause jaundice.
02:29
There's also so a urine test for
bilirubin but we're talking about
serum bilirubin here.
02:35
Now prothrombin time,
look at the values there.
02:38
Less than 1.7. they get 1,
1.7 - 2.3, two points
greater than 2.3,
they get 3 points.
02:47
So I want to make sure you're clear
under each one of these categories
albumin,
bilirubin and prothrombin time
that first column on
the left is the value
that will be reported on
the patient's lab results.
03:01
The column on the
right that is in green,
One two or three is the number
of points the patient will earn
in the CTP calculator.
03:10
Now that prothrombin time I
don't want to gloss over there,
remember prothrombin time measures how
long it takes for your blood to clot
and prothrombin is
made by the liver.
03:21
Now we talked about
those other two factors,
encephalopathy and ascites.
03:26
If the patient has no
sign of encephalopathy,
they're awake
alert and oriented.
03:31
They know what's going on.
03:32
They just get a score of one.
03:34
Mild to moderate two,
severe gets three points.
03:38
When it comes to a citis we're talking
about that extra fluid in the abdomen.
03:42
There's no sign of ascites
the patient gets one point,
mild to moderate plus we
have diuretic responsive
meaning they have a
mild to amount of fluid
but when give them diuretics
they tend to put off extra fluid,
they get two points,
or if it's severe and they don't
respond to diuretics anymore.
04:01
They get three points.
04:03
So now we've scored lab work
and assessment to
get a score on this.
04:10
Now, here's the encephalopathy grades,
I've got them here for your reference,
but I don't want you to
spend a lot of time in this
besides looking at the fact,
that normal consciousness
awake and alert,
their themselves, their
personality, that's a grade of 0
all the way up to four
whether an unstable coma,
no personality, no behavior,
they're not responding to you,
there may even be disturbed by it posturing
that earns a score of 4.
04:37
So why do we use these things?
Well, these are not meant
for you to memorize.
04:42
Okay, these will be available
in a clinical setting
but what you do want to
know is that zero is normal
and as the numbers get larger,
the patient is experiencing
significant change.
04:54
This is just a way that Healthcare Providers
use to communicate with each other
to quickly say, yeah,
encephalopathy grade 3,
and then everyone
speaking the same
language knows what
we're talking about.
05:07
So this helps us see trends
and monitor the patient's
status over a period of time.
05:12
Now you see Class A
Class B and Class C
is all based on the
number of your score.
05:19
So class A,
you're going to have liver
disease, this is the one you want.
05:24
It's the least
severe liver disease,
one to five year survival
rate is usually 95%
and that's a score of 5 to 6,
but take a look at
class B and Class C.
05:36
By the time your score
is hitting 10 to 15.
05:39
We have a 1 to 5 years
of farvel rate is 50%.
05:44
That's the most
severe liver disease.
05:46
So the important
takeaway points from this
is not to memorize
all these numbers.
05:51
Keep in mind what a
clinical calculator is
it helps us communicate
with the team
to know how severe
the patient is
what prior to they would
be on a transplant list.
06:01
It also gives us consistent
numbers that we can look at
and Trend and see if the
patient is making progress
or if the patient is
becoming more and more severe
and therefore needs to be a higher
priority on the transplant list.