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Pediatric Liver Disease in Children: Symptoms, Causes and Treatment

Pediatric Liver Disease in Children: Symptoms, Causes and Treatment

Pediatric Liver Disease

“Pediatric liver diseases are common and debilitating. However, if detected at the right time they could be completely reversible and can save extreme complications like the need for liver transplant, and death.” 

What are Pediatric Liver Diseases? 

Pediatric Liver Disease

Just as in adults, children can have diseases of the liver too. A long list of reasons can lead to liver diseases in children. Some liver diseases can be acute and some chronic, and together they could be caused by reasons including infections, autoimmune or metabolic disorders, genetic reasons, etc. The course and fate of each type of liver disease varies as per the cause. While some can be mild, others can be fatal. Thus, in case of any sign of liver disease an immediate consultation with an expert should be sought because in pediatric liver diseases, early diagnosis is the key. 

Types of Pediatric Liver Disease

Here is a broad classification to understand the pediatric liver diseases: 

Depending on the course of the disease-

Symptoms of liver disease

  • Acute liver diseases: These are sudden-onset liver conditions in children, often triggered by infections, toxins, or metabolic disorders, and can lead to rapid liver dysfunction, requiring urgent medical attention to prevent severe complications.
  • Chronic liver diseases: Chronic liver diseases in children are long-lasting conditions that progressively impair liver function over time, often due to genetic, autoimmune, or metabolic factors, requiring ongoing management to prevent liver damage and maintain health.

Depending on the cause of the disease-

  • Genetic and Metabolic Disorders: These occur due to some inherited genetic mutations affecting liver metabolism, often leading to abnormal protein or enzyme function. Examples include: Wilson’s disease, Alpha-1 antitrypsin deficiency, and Glycogen storage diseases. In Wilson’s disease, copper accumulates in several areas, including the liver and brain, this could lead to neurological symptoms as well.
  • Diseases due to Congenital Structural Abnormalities: These liver diseases can be due to developmental abnormalities of the liver or bile duct. They obstruct normal bile flow and liver function, thus leading to damage.
    Examples of this include, Biliary atresia a fatal liver disease. Urgent attention should be sought if jaundice in newborns extends beyond two weeks after birth. A corrective surgical procedure done at the right time can be life-saving and can prevent the need for a liver transplant.
  • Infectious Causes: Infections of the liver can lead to inflammation and damage to the liver. This includes well-known infections due to hepatitis virus, like Hepatitis A, B, C, and E.
  • Autoimmune Liver Diseases: In this type body’s immune system mistakenly attacks liver cells or bile ducts, leading to chronic inflammation and liver damage.
    Examples include: Autoimmune hepatitis, Primary sclerosing cholangitis (PSC)
  • Toxic or Drug-Induced Liver Diseases: The liver is an important point in the metabolism of products. Some toxic substances or medications can lead to liver damage.
    Example includes: Acetaminophen overdose.
  • Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH)
    This is the most common form of liver disease in adolescents in children and occurs due to fat accumulation in the liver due to causes such as obesity, inactivity, diabetes, or some metabolic syndrome.
  • Vascular and Hemodynamic Disorders: These conditions affect the blood flow in the liver, leading to congestion, ischemia, or liver cell death.
    Examples include Budd-Chiari syndrome and portal vein thrombosis.

Identification of Pediatric Liver Diseases

Though there may be some differences in the presentation of individual liver conditions, some common symptoms that indicate an underlying liver disease should alert the parents and caretakers of children. 

-Jaundice: A yellowing of the skin or eyes is the most common and significant symptom that points to an underlying liver disease.

-Dark urine: Urine that is dark in color (mustard color) 

-Pale Stools: Ivory-colored stools

-Nausea or vomiting: An occasional episode of nausea and vomiting could be due to gastrointestinal infections, but if the child has been vomiting often and complains of nausea then it could indicate liver disease.

-Itching: Itching all over the body, especially without any mark of insect bite

-Anorexia: Loss of appetite 

-Swollen abdomen: Swelling of the abdomen 

Other general symptoms can include excessive tiredness and painful abdomen. 

In case any of the above symptoms are noticed in a child, an immediate consultation should be sought. Pediatric gastroenterologists and hepatologists are specialists in the child’s liver diseases and gastrointestinal tract who can help diagnose and treat pediatric liver diseases.

How are Liver Diseases in Children Diagnosed? 

Apart from a detailed history and physical examination, some tests that can be prescribed by your doctor include: 

  • Blood Tests: Liver function tests (LFTs), viral hepatitis markers, and autoimmune markers 
  • Imaging: Ultrasound, MRI, or CT scans for assessment of the size and structure of liver and bile ducts.
  • Liver Biopsy: A small liver tissue sample can be taken from the liver for microscopic examination. 
  • Genetic Testing: For some hereditary liver diseases like Wilson’s disease or Alagille syndrome, genetic testing can confirm the diagnosis.

What are the treatment options for liver disease in children?

Treatment for pediatric liver diseases varies based on the type and severity of the condition. Some treatment aspects that can be expected: 

  • Medical Management: Your doctor may prescribe medications to reduce liver inflammation, manage symptoms, and slow the disease progression.
  • Nutritional Support: This is especially essential for children who may struggle with malnutrition and poor growth.
  • Surgical Intervention: Procedures like the Kasai procedure for biliary atresia or shunt surgeries for complications related to portal hypertension.
  • Liver Transplantation: A liver transplant may be required in severe cases of liver disease or liver failure, where other treatments are ineffective.

Lifestyle Recommendations

  • Balanced Diet: A nutrient-rich, low-fat diet is often recommended for children with liver disease. Dieticians work hand in hand with the pediatric hepatologist to plan diets tailored to the specific needs of children. 
  • Avoidance of Certain Medications: Certain drugs can exacerbate liver disease, thus, a doctor should always be consulted before administering medications.

Indigenous medicines should be avoided as they could lead to further liver damage.

  • Vaccinations: Children with liver disease are at higher risk for infections; therefore, vaccinations, especially against hepatitis A and B, are essential and may be prescribed.

When should a parent visit the doctor?

If a child displays prolonged jaundice, abdominal pain, poor weight gain, or any signs of liver disease, prompt evaluation by a pediatric gastroenterologist or hepatologist is essential. Early diagnosis and intervention can improve outcomes and quality of life for children with liver diseases.

Pediatric liver diseases present unique challenges and require specialized care. With advancements in diagnosis, management, and treatment, many children with liver diseases can lead healthier lives. Education and early intervention play a pivotal role in managing these conditions and supporting the well-being of affected children.

Dr. Parijat Ram Tripathi
Author: Dr. Parijat Ram Tripathi

Consultant Pediatric Gastroenterologist and Hepatologist

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