Child-Turcotte-Pugh (CTP) Calculator – Assessment of Liver Cirrhosis (Nursing)

00:01 We just looked at the progression of a healthy liver to a cirrhotic liver in the kind of radical changes that happen.

00:08 Now I want to look at five important liver functions and the lab tests we use to monitor those functions.

00:14 Now these are the labs these values are what we use to plug into the CTP calculator.

00:20 So function number one.

00:21 Produces Albumin.

00:23 What's the lab tests we use to monitor that? Serum albumin.

00:27 Function number two.

00:29 Livers recycles old red blood cells.

00:31 So we're going to look at red blood cell level and bilirubin.

00:36 Function number three.

00:37 A healthy liver produces fibrinogen.

00:40 So we're going to look at fibrinogen or pt/inr - Prothrombin time or INR.

00:48 Function number for transforms ammonia to water-soluble urea.

00:54 How do we monitor that? We're looking for the clinical symptoms of encephalopathy.

00:59 Now, can we do lab work? We sure can so we can look at a serum ammonia level.

01:04 We're also going to be watching for signs of encephalopathy to developed in our patient.

01:09 Now 5th function is protein fluid balance and portal pressure.

01:15 The clinical symptom you'll watch for is ascites.

01:18 Okay so I want to back up and review this with you one more time.

01:22 Now each one of these values when you be given a score on the CTP, I'll show you how that walks through.

01:29 You've got the lab test their and the function of the liver.

01:33 On this slide we talked about the functions of the liver and clinical symptoms that you as a nurse should be able to assess your patient for.

01:41 So I've given you a framework of the things that we're going to assess, now we're going to actually plug them into the CTP calculator.

01:48 Now look at the albumin level, remember that's a lab test we just talked about.

01:53 This measures the amount of albumin in the blood, now depending on the lab result.

01:58 You see greater than 3.5.

02:00 2.8 - 3.5 or less than 2 .8 the patient earns a score of 1, 2 or 3 points.

02:09 For bilirubin less than 2, 2 to 3 or greater than 3 again the patient ends earns a score of 1, 2 or 3 points.

02:20 Remember bilirubin is that yellow stuff since that's a part of bile.

02:23 It's formed when your red blood cells break down and too much bilirubin in the blood can cause jaundice.

02:29 There's also so a urine test for bilirubin but we're talking about serum bilirubin here.

02:35 Now prothrombin time, look at the values there.

02:38 Less than 1.7. they get 1, 1.7 - 2.3, two points greater than 2.3, they get 3 points.

02:47 So I want to make sure you're clear under each one of these categories albumin, bilirubin and prothrombin time that first column on the left is the value that will be reported on the patient's lab results.

03:01 The column on the right that is in green, One two or three is the number of points the patient will earn in the CTP calculator.

03:10 Now that prothrombin time I don't want to gloss over there, remember prothrombin time measures how long it takes for your blood to clot and prothrombin is made by the liver.

03:21 Now we talked about those other two factors, encephalopathy and ascites.

03:26 If the patient has no sign of encephalopathy, they're awake alert and oriented.

03:31 They know what's going on.

03:32 They just get a score of one.

03:34 Mild to moderate two, severe gets three points.

03:38 When it comes to a citis we're talking about that extra fluid in the abdomen.

03:42 There's no sign of ascites the patient gets one point, mild to moderate plus we have diuretic responsive meaning they have a mild to amount of fluid but when give them diuretics they tend to put off extra fluid, they get two points, or if it's severe and they don't respond to diuretics anymore.

04:01 They get three points.

04:03 So now we've scored lab work and assessment to get a score on this.

04:10 Now, here's the encephalopathy grades, I've got them here for your reference, but I don't want you to spend a lot of time in this besides looking at the fact, that normal consciousness awake and alert, their themselves, their personality, that's a grade of 0 all the way up to four whether an unstable coma, no personality, no behavior, they're not responding to you, there may even be disturbed by it posturing that earns a score of 4.

04:37 So why do we use these things? Well, these are not meant for you to memorize.

04:42 Okay, these will be available in a clinical setting but what you do want to know is that zero is normal and as the numbers get larger, the patient is experiencing significant change.

04:54 This is just a way that Healthcare Providers use to communicate with each other to quickly say, yeah, encephalopathy grade 3, and then everyone speaking the same language knows what we're talking about.

05:07 So this helps us see trends and monitor the patient's status over a period of time.

05:12 Now you see Class A Class B and Class C is all based on the number of your score.

05:19 So class A, you're going to have liver disease, this is the one you want.

05:24 It's the least severe liver disease, one to five year survival rate is usually 95% and that's a score of 5 to 6, but take a look at class B and Class C.

05:36 By the time your score is hitting 10 to 15.

05:39 We have a 1 to 5 years of farvel rate is 50%.

05:44 That's the most severe liver disease.

05:46 So the important takeaway points from this is not to memorize all these numbers.

05:51 Keep in mind what a clinical calculator is it helps us communicate with the team to know how severe the patient is what prior to they would be on a transplant list.

06:01 It also gives us consistent numbers that we can look at and Trend and see if the patient is making progress or if the patient is becoming more and more severe and therefore needs to be a higher priority on the transplant list.