Portal hypertension is the haemodynamic abnormality associated with the most severe complications of cirrhosis, including ascites, hepatic encephalopathy and bleeding from gastroesophageal varices. Variceal bleeding is a medical emergency associated with a mortality that, in spite of recent progress, is still in the order of 10–20% at 6 weeks. The evaluation of diagnostic tools and the design and conduct of good clinical trials for the treatment of portal hypertension have always been difficult.
Liver
Fibrosis-4 (FIB4) Scoring System for Liver Fibrosis
The FIB4 index was developed in 2006 by Sterling as a non-invasive method to diagnose liver fibrosis and combines aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, platelet count, and age.
Diagnosis of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new concept proposed in 2020. Unlike non-alcoholic fatter liver disease (NAFLD), the diagnosis of MAFLD requires the presence any of the following 3 metabolic risks, including overweight/obesity, presence of diabetes mellitus, and evidence of metabolic dysregulation.
Liver Imaging Reporting and Data System (LI-RADS)
The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC.
Histologic Scoring Systems for Chronic Liver Disease
Grading and staging refers to a semiquantitative assessment of the necroinflammatory activity (grade) and degree of fibrosis (stage) in relation to chronic hepatitis.
Typical Laboratory Abnormalities in Alcoholic Liver Disease (ALD)
Alcoholic liver disease (ALD) encompasses a spectrum of injury, ranging from simple steatosis to frank cirrhosis.
Indications and Contraindications for Liver Transplantation
Survival rates after liver transplantation have improved steadily because of earlier referral and timely evaluation, judicious patient selection, improved surgical techniques, superior immunosuppressive regimens, and effective prevention of perioperative opportunistic infections. Indications and contraindications for liver transplantation are undergoing constant modifications with the goal of improving survival and functional status of patients who have end-stage liver disease or acute liver failure. Potential candidates for liver transplantation should meet minimal listing criteria and not have contraindications to liver transplantation.
King´s College Hospital Criteria for Liver Transplantation in Fulminant Hepatic Failure
In acetaminophen-induced fulminant hepatic failure, survival correlated with arterial blood pH, peak prothrombin time, and serum creatinine–a pH less than 7.30, prothrombin time greater than 100 s, and creatinine greater than 300 mumol/L indicating a poor prognosis.
Histological Scoring System for Nonalcoholic Fatty Liver Disease (NAFLD)
Components of NAFLD Activity Score (NAS) and Fibrosis Staging
Child-Pugh Classification of Severity of Liver Disease
Modified Child-Pugh classification of severity of liver disease according to the degree of ascites, the plasma concentrations of bilirrubin and albumin, the prothrombin time, and the degree of encephalopathy.