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THIS

THAT

Compensated

OR

Decompensated

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YES!

Histology Review

01

02

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European STAGING GUIDELINES

Patient Education

S

Fibrosis & Cirrhosis

STAGING & GRADING

03

04

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REFERENCES

Arjmand, A., Tsipouras, M. G., Tzallas, A. T., Forlano, R., Manousou, P., & Giannakeas, N. (2020). Quantification of liver fibrosis—a comparative study. Applied Sciences, 10(2), 447. https://doi.org/10.3390/app10020447 Fibrosis-4 (FIB-4) index for liver fibrosis. MDCalc. (n.d.). https://www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis#next-steps Fibrosis: Development. American Liver Foundation. (2023, September 6). https://liverfoundation.org/about-your-liver/how-liver-diseases-progress/fibrosis-scarring/ Gülcicegi, D. E., Goeser, T., & Kasper, P. (2023). Prognostic assessment of liver cirrhosis and its complications: Current concepts and future perspectives. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1268102 Pavlov, C. S., Casazza, G., Nikolova, D., Tsochatzis, E., Burroughs, A. K., Ivashkin, V. T., & Gluud, C. (2015). Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people with alcoholic liver disease. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd010542.pub2 Stages of cirrhosis. Cirrhosis Care. (n.d.). https://cirrhosiscare.ca/stages-of-cirrhosis/

Abbreviations

  • CC-Compensated cirrhosis
  • SDC- Stable Decomp Cirrhosis
  • UDC -Unstable decompensated cirrhosis
  • (Pre-ACLF)-Pre-acute-on chronic liver failure
  • (ACLF)-Acute-on chronic liver failure
.

"While the classification into a compensated and decompensated form has been established in everyday clinical practice for decades, recent data have shown that this dichotomous type of classification is an oversimplification. Since decompensated cirrhosis encompasses several different prognostic subgroups of patients with varying risk profiles, a more specific classification is needed" (Gülcicegi, Goeser, & Kasper, 2023)

Overtime scarring will continue to build and spread or "snake out". The scars begin to grow together creating bridges or septa (bands of tissue).

What are septa?

Review

Recall, that decompensation requires at least one of the symptoms below to be present.

  • Ascites
  • Jaundice
  • Hepatic Encephalopathy
  • Variceal Bleed

There are five stages

  • (F0: no scarring (no fibrosis);
  • F1: minimal scarring;
  • F2: scarring has occurred and extends outside the liver area (significant fibrosis);
  • F3: fibrosis spreading and forming bridges with other fibrotic liver areas (severe fibrosis);
  • F4: cirrhosis or advanced scarring).

Cochrane Review

There are five stages:

  • (F0: no scarring (no fibrosis);
  • F1: minimal scarring;
  • F2: scarring has occurred and extends outside the liver area (significant fibrosis);
  • F3: fibrosis spreading and forming bridges with other fibrotic liver areas (severe fibrosis);
  • F4: cirrhosis or advanced scarring).