<prompt> According to Pughs classification moderate to severe hepatic insufficiency is managed by ?SclerotherapyConservativeOhotopic liver transplantationShunt surgery  <response>: Ans. is c ie. Ohoptic liver transplantation Child-Pughs classification is used to assess the status of pt. of liver cirrhosis. A liver cirrhotic pt. having variceal bleeding or ascites can be controlled by shunt surgery only if he falls in ChildPughs A class or some pts. of B class. Moderate to severe grade liver insufficiency can only be managed by liver transplantation. 