What Is Child Pugh Score And It’s Significance In Chronic Liver Disease

What is Child-Pugh Score?

Child-Pugh score which is also known as Child-Pugh-Turcotte score was introduced in 1973, for prognosis or prediction of chronic liver disease and Cirrhosis. This prognosis tool consists of five features which are further categorized in two categories i.e. synthetic liver function and clinical assessment. Synthetic liver functions includes Total bilirubin levels, Serum albumin and International normalized ratio (INR) while clinical assessment includes degree of Ascites and Degree of Hepatic Encephalopathy.

What Is The Significance Of Child-Pugh Score In Chronic Liver Diseases?

 About Liver

Liver which is considered as the largest gland in the body, weighing about 3 pounds lies mainly in the upper right portion of the abdominal activity under the diaphragm. Some of the important roles of liver are as follows-

• Helps in detoxifying blood by metabolizing and removing toxic substances.
• Helps in balancing cholesterol level in body.
• Produces bile, which is beneficial for absorption of lipids in small intestine.
• Stores glucose to maintain blood glucose concentration.
• Produces various structurally and functionally important proteins like albumins, fibrinogen etc. which are necessary for blood clotting.
• Helps in storing Iron and Vitamin A, Vitamin D, Vitamin E, Vitamin K and Vitamin B (fat-soluble vitamins).

Chronic Liver Conditions And Child-Pugh Scores

A diseased liver can cause various chronic and fatal liver diseases like Hepatitis, Cirrhosis, Liver cancer, Fascioliasis, PSC (Primary Sclerosing Cholangitis), Fatty liver diseases and gilbert’s syndrome. These disorders can be predicted by Child-Pugh Score tool and fatal level can be understood by measuring following features-

Synthetic Liver Functions 

1. Total Bilirubin Level

Bilirubin is a pigment varying from orange to yellow color which usually occurs when Red blood cells starts degenerating. Total Bilirubin level measures the amount of bilirubin and functioning of your liver. The standard range of total bilirubin level is 1.2 milligrams per deciliter (mg/dL). The condition in which bilirubin levels are high is called Hyperbilirubinemia. Although, levels may vary depending on age and gender likewise if an average adult is suffering from jaundice have bilirubin levels i.e. greater than 2.5 milligrams per deciliter (mg/dL) while in an newborn infant bilirubin level greater than 20-25 milligrams per deciliter (mg/dL) may cause serious damage.

2. Serum Albumin

Serum albumin is a water-soluble protein produced by liver that is beneficial in repairing tissues and a carrier of free fatty acids in blood. Serum albumin test measures the amount of albumin in your blood. The standard value of serum albumin ranges from 3.4-5.4 grams per deciliter (gm/dL). Lower Albumin levels signifies liver disorders hepatitis, Cirrhosis and Hepatocellular necrosis.

3.International Normalized Ratio (Inr)

INR is a system or parameter introduced by WHO for predicting Prothrombin Time (PT) and Blood clotting time. Their main purpose was to determine the effect of oral anticoagulants on clotting time. INR value greater than 4.5 increase the risk of hemorrhage while less than 2 causes thromboembolism. Normal value of INR is 1.0 and increase in standard value is either due to thinning of blood, if the person is suffering from cirrhosis or due to liver’s inability to produce proteins.

Clinical Assessment

1. Degree Of Ascites

Ascites or Hydro-peritoneum is a medical condition that occurs when there is accumulation of fluids within the abdomen. This is caused due to Cirrhosis, Hepatitis (alcoholic), cardio-vascular diseases, malignancy etc. Degree of ascites measures Total protein concentration which indirectly or directly signifies the functioning of liver.

2. Degree Of Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome which is caused by accumulation of neurotoxins and body’s disability to detoxify body. This syndrome results from acute or chronic liver disorders. Degree of Hepatic Encephalopathy determines the level of toxins in blood which are leading causes of fatal liver diseases.

Natural Remedies For Chronic Liver Disorders By Planet Ayurveda

Planet Ayurveda is formulating 100% pure and natural products which are free from chemicals, preservatives, additives, colors and binders. They are offering amazing Liver pack which includes Echinacea capsules, Liver detox formula, Bhumi Amla and Yakrit- Plihantak churna. Properties of the products and herbs used in the formulation are as follows-

1. Echinacea Capsules

Echinacea capsules have been formulated using best quality of Indian Echinacea (Andrographis paniculata) which is also known as Kalmegh. This herbal supplement is beneficial in treating liver disorders and helps in removing toxins from blood. Kalmegh possess echinacein which provide it antibacterial and antifungal properties. These capsules works effectively in treating Hepatitis-B, HIV, Bowel syndrome and helps in stimulating immune system due to presence of phenolic compounds.

Dosage– 2 capsules twice daily after meals with plain water.

2. Liver Detox Formula

This perfect herbal supplement for liver detoxification is formulated with the goodness of many Indian traditional herbs like Kutki (Picrorhiza kurrao), Punarnava (Boerrhavia diffusa), Kalmegh (Andrographis paniculata), Makoy (Solanum nigrum), Kasni (Chicorium intybus), and Biranjasipha (Achilea millefolium), Jhavuka (Tamarix galluca), Himsra (Capparis spinosa) and Haritaki (Terminalia chebula). Benefits of the herbs used in this formulation are discussed below-

• Kutki (Picrorhiza kurrao) – According to Ayurveda, Kutki is considered as an amazing tonic for liver which protects liver from mechanical or physical stress and toxins. This herb acts as a beneficial cholagogue that manages the bile flow from the liver into the intestines.
• Punarnava (Boerrhavia diffusa) – Punarnava helps in inducing bile secretions from liver which helps in proper functioning of liver. This is one of the beneficial herbs which tends to reduce bilirubin level effectively.
• Kalmegh (Andrographis paniculata)- Kalmegh which is considered as an wonder Ayurvedic herb which is very useful in treating various liver disorders like jaundice, enlarged liver and viral hepatitis.
• Kasni (Chicorium intybus) – Kasni is commonly known as chicory is known for its benefits in treating liver disorders. This is also beneficial in flushing out toxins which being accumulated in body.
• Jhavuka (Tamarix gallica) – Jhavuka is considered as a great laxative which is beneficial in treating constipation and various bleeding disorders like menorrhagia and rectal bleeding.

Dosage– 1-2 capsules two times a day with plain water after meals.

3. Yakrit Plihantak Churna

Yakritplihantak churna has been formulated by many herbal ingredients which includes Bhumi Amla (Phyllanthus niruri), Kutki (Picorrhiza kurrao), Makoy (Solanum indicum), Punarnava (Boherrhavia diffusa), Kalmegh (Andrographis paniculata), Kaasni (Cichorium intybus), Sharpunkha (Tephrosia purpurea) and Bhringraj (Eclipta alba) that promotes liver health and spleen. Some of the important roles of the herbs are as follows-

• Bhringraj (Eclipta alba) – Bhringraj is known as ‘Rasayana’ in Indian scriptures which tends to show incredible effect on hairs and skin. Moreover, this is an amazing appetizer, detoxifying agent, nerve-tonic and carminative agent which alleviates the symptoms of liver disorders.
• Sharpunkha (Tephrosia purpurea) – Sharpunkha is known to maintain equilibrium between Kapha and Vata dosha. It promotes healthy functioning of digestive system.

Dosage- 1 teaspoonful two times a day after meals with plain water.

4. Bhumi Amla (Phyllanthus Niruri) Capsules 

Phyllanthus niruri is also known as Bhumiamla or Bhumiamalki. This is an amazing traditional herb which is beneficial in treating various chronic liver disorders like Acute Hepatitis B (HBV), Cirrhosis etc. It possess various tremendous properties like anti-oxidants, anti-microbial and anti-inflammatory properties. This proves to treat Non-alcoholic fatty liver disease (NAFLD) and atherosclerosis effectively.

Dosage- 1-2 capsules two times a day with plain water after meals or as per Ayurvedic consultation.