liver enzyme

Child Pugh Score, is the best indicator in cirrhosis. Child Turcotte classification of patients with cirrhosis

Child-Pugh classification of severity of cirrhosis

Child Pugh classification

Parameter	Points assigned
	1	2	3
Ascites	Absent	Slight	Moderate
Bilirubin	<2 mg/dL (<34.2 micromol/liter)	2 to 3 mg/dL (34.2 to 51.3 micromol/liter)	>3 mg/dL (>51.3 micromol/liter)
Albumin	>3.5 g/dL (35 g/liter)	2.8 to 3.5 g/dL (28 to 35 g/liter)	<2.8 g/dL (<28 g/liter)
Prothrombin time
Seconds over control	<4	4 to 6	>6
INR	<1.7	1.7 to 2.3	>2.3
Encephalopathy	None	Grade 1 to 2	Grade 3 to 4

Modified Child-Pugh classification of the severity of liver disease according to the degree of ascites, the serum concentrations of bilirubin and albumin, the prothrombin time, and the degree of encephalopathy. A total Child-Turcotte-Pugh score of 5 to 6 is considered class A (well-compensated disease); 7 to 9 is class B (significant functional compromise); and 10 to 15 is class C (decompensated disease). These classes correlate with one- and two-year patient survival: class A: 100 and 85 percent; class B: 80 and 60 percent; and class C: 45 and 35 percent.


remember, MI can has elevated AST+LDH, although it is non-specific.
When you see both elevated, beware of MI.

AST/ALT ratio 2:1 indicate alcoholic, because AST exists in both cytoplasm and mitochondrial, and ALT only exists in cytoplasm. Alcohol will damage mitochondrial, that is the reason why AST can be higher. 

Elevated GGT can help hepatic/non-hepatic for elevation of ALP.

If patient has chronic ALT, AST elevation, work up include:
ANA(autoimmune hepatitis),
iron study(hematochromatosis),
alpha 1 anti-trypsin,
and hepatitis B and C

when you see the isolated elevation of ALP, suspect PBC, check the antimitochondrial, and ultrasound

if liver enzyme is 10 times higher >400, 400-800, >1000 (think about ischemic injury, drug toxin, viral hepatitis augmentin(amoxicillin/clavulanate potassium) and unasyn(ampicillin sodium/sulbactam sodium) are MCC medication for cholestasis.

MELD score (Model for End-stage Liver Disease) MELD = 3.8[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.6[Ln serum creatinine (mg/dL)] + 6.4