Assessment of Liver Cirrhosis: Introduction to Clinical Calculators (Nursing)

00:00 Hi! Welcome to our video series on the liver now.

00:04 We're talking about hepatitis and liver disease.

00:07 In this one I'm going to give you an example of a calculator that we use as clinicians to assess the severity of cirrhosis.

00:15 Now clinical calculators are used for all different types of systems.

00:20 These are just tools and we use them to assess the severity of the illness in the risk of poor outcomes.

00:27 So these tools are used to decide things like which clinical interventions would be best for the patient help us determine how sick they are or term that you've heard as far as acuity.

00:37 The higher the acuity, the sicker the patient is the more resources they need and possibly even the more nurses they need to care for them on a shift.

00:47 Now clinical calculators can even use to make decisions regarding transplant priorities.

00:52 Patients with livers that are damaged or destroyed are candidates for a liver transplant.

00:59 The sicker the patient becomes the more of a priority they become on the transplant list.

01:05 Now I'm going to give you talk about a couple examples of calculators, but I'm going to walk you through the CTP specifically.

01:12 Now when a liver is damaged, It's decompensated cirrhosis has gotten to the point where they're now in liver failure.

01:19 The patient is at a high risk for death or what we call mortality.

01:24 So that's why I clinical calculator seems kind of a cop doesn't it, a little bizarre, but it's actually a very helpful clinical tool.

01:33 We're not putting a value on the patient's life.

01:36 We're trying to quantify how sick they are.

01:39 Now there's a CTP score and there's also a MELD.

01:44 Which is a model for end-stage liver disease.

01:47 These are two examples of tools that the health care team can use for patients with liver damage.

01:52 Now, you may notice that you're seeing the MELD more often, but either way whether you're seeing the CTP or the MELD that's going a decision made by the physician team in the facility of which one they prefer to use.

02:06 The sad news is that cirrhosis is progressive unless the patient can take extreme measure, recognizes the problem early on, the disease is going to progress to a point that becomes life-threatening.

02:19 On the left, I've got a picture of healthy hepatocytes for you.

02:22 It's looks good, everything's in order, things can flow through that as they were intended in the liver, but look to the cirrhosis side, look you can see the blow-up picture that we have for you there, look the cells are not in order.

02:36 You've got remnants of dead cells.

02:38 It's fibrotic just doesn't function as well.

02:41 So how do we go from healthy to cirrhotic? Well, as those liver cells are destroyed whatever was the original cause of the patient cirrhosis of the liver tries to repair itself fight back, but it doesn't build it back in as efficient of a manner when cells are rebuilt, they're never as efficient as the original ones of the liver.

03:04 The damaged cells are fibrotic have cirrhosis and scarring and they've got these nodules so it works but it's definitely not like the original liver healthy hepatocytes.

03:18 So cirrhosis is progressive.

03:20 You don't go from healthy one day to wildly cirrhotic the next, it's a process.

03:27 So we have some time to intervene if we can work with the patient during the time of initial diagnosis.