Final answer:
Preoperative risk in cirrhotic patients is determined using scores like the Child-Pugh score and the Model for End-Stage Liver Disease (MELD) score, which assess liver disease severity and predict operative mortality risk.
Step-by-step explanation:
To determine preoperative risk in cirrhotic patients, physicians use certain scores that evaluate the severity of liver disease and predict operative risk. A commonly used score is the Child-Pugh score, which categorizes cirrhosis based on five clinical measures: total bilirubin, serum albumin, prothrombin time, the presence of ascites, and encephalopathy. Each parameter is given a score, and the total score places the patient into one of three classes (A, B, or C), with Class C representing the most severe disease.
Another tool is the Model for End-Stage Liver Disease (MELD) score, which predicts mortality within three months of surgery in patients with end-stage liver disease. This score incorporates serum bilirubin, serum creatinine, and the international normalized ratio (INR) for prothrombin time. A higher MELD score indicates a higher risk of death.
These scores help to evaluate not only the liver’s synthetic function but also to assess extra-hepatic metabolism and can be used to strengthen the prediction of total body clearance, taking into consideration factors such as microsomes from various tissues. Such evaluations are essential given that cirrhotic patients often have a poor quality of life and increased risk of complications, with the eventual potential need for a liver transplant.