5 Causes of Liver Disease In Children: Symptoms & Treatment

The liver is an organ of the digestive system and performs several essential functions. Therefore, any liver disease in children warrants immediate medical intervention.

The liver plays a key role in metabolism, detoxification, and immune system functions. It secretes bile juices containing digestive enzymes and serves as a storage organ for glucose, vitamins, and minerals (1) (2).

Therefore, timely diagnosis and early treatment are required for liver diseases to protect the liver’s functions. This post will help you know about liver disease in children, including its causes, symptoms, complications, and treatments.

Causes Of Liver Disease In Children

Liver diseases in children can be caused by various factors, including (3) (4)

1. Viruses: Chronic hepatitis (liver inflammation) is the primary type of liver disease caused by viruses. Hepatitis viruses are classified into A, B, C, D, and E. The type of virus determines the severity (5).

2. Medicine: Overdose of certain medications such as erythromycin, valproic acid, acetaminophen, can lead to liver diseases.

3. Toxins: Certain toxins or chemicals can damage the liver cells and cause inflammation.

4. Cancer: Although rare in children, liver cancer could occur due to an untreated underlying disease such as cirrhosis or hepatitis infection. It could also develop without any prior illness (6).

5. Genetic factors: A few inherited chronic liver diseases such as non-alcoholic fatty liver disease (NAFLD), Wilson’s disease, Alpha-1 antitrypsin deficiency, and hemochromatosis could also lead to liver disease in children (7) (8).

Conditions Of Liver Disease In Children

Liver disease is a common term used to refer to illnesses of the liver or gallbladder, those that simultaneously affect the liver (6) (8).

• Non-alcoholic fatty liver disease: Accumulation of fat in the liver can lead to NAFLD in children. It is a chronic disease, the risk of which increases in overweight children or those with metabolic syndrome and type-1-diabetes (7) (9) (10).

• Jaundice: It is a condition in which the number of bile pigments (bilirubin) in the blood increases. Jaundice usually indicates some other underlying issue in the liver, including blockage of bile ducts and damage or inflammation of the liver

• Portal hypertension: The portal vein supplies the liver with blood from the intestines and spleen. Increased blood pressure in these blood vessels causes a condition called portal hypertension, resulting in the formation of new blood vessels called collaterals.

The formation of collaterals results in the blood directly entering the circulation without being metabolized by the liver, giving rise to other complications such as ascites or varicose veins.

• Cholestasis: Pediatric cholestatic liver diseases occur when the components of bile moving from the liver to the intestines are obstructed in their path, or the liver fails to produce bile (11).

• Autoimmune liver diseases: In the case of an autoimmune disease, the body’s immune system attacks healthy cells. Autoimmune hepatitis and autoimmune cholangitis (inflammation in the bile ducts) are chronic diseases caused by unintentional immune attacks and require constant monitoring (12).

• Liver enlargement: Many factors can cause the liver to enlarge (hepatomegaly). Metabolic disorders, genetic disorders, cancers, Reye’s syndrome are a few factors (13).

• Ascites: It is the swelling of the abdomen either due to the accumulation of fluids and increased blood pressure in the abdominal cavity or an enlarged liver or spleen (14).

Symptoms Of Liver Disease In Children

A child with liver disease may show only one sign initially, and the other symptoms may manifest as the severity of the disease progresses. A few common symptoms of liver disease in children include (6) (15)

• Jaundice (the yellowing of the skin and eyes). Dark urine and pale stools also indicate jaundice.

• Abdominal pain (due to liver inflammation)

• Fatigue

• Nausea

• Pruritus—increased itching sensation due to increased circulation of bile acids

• Irregular sleeping patterns

• Bloody stool

• Vomiting of blood

Risks And Complications Of Liver Disease In Children

If not treated early, liver disease can lead to the following complications.

1. Acute liver failure: This could be sudden and can be due to any short-term liver illness (acute) or the progression of a long-term disease (chronic). Acute liver failure is often caused due to an overdose of any medication or some toxic substances or the progression of cirrhosis. Acute liver failure is a severe complication and requires immediate medical intervention (16) (17).

2. Cirrhosis: Progression of liver disease can lead to cirrhosis, which is characterized by the scarring of the liver. Cirrhosis indicates permanent damage to the liver tissue (18).

3. Hepatic encephalopathy: Severe liver disease can also affect the nervous system. When the liver fails to filter the toxins, the toxins can enter the bloodstream and affect brain function. Anxiety, impaired cognitive thinking, decreased attention span, slurred speech, irregular sleeping patterns, and muscle twitches (myoclonus) are a few symptoms of liver encephalopathy (19).

Treatment For Liver Disease In Children

Based on the results of the physical exam, liver function tests, scans, or liver biopsy and the type, stage, and severity of the disease, the healthcare providers may suggest any of the following treatments (3).

• Your healthcare provider would prescribe antiviral drugs for viral hepatitis.

• Lifestyle modifications are suggested for children with obesity. A dietitian would prescribe a diet that complements the child’s BMI, body fat, and electrolyte levels. Vitamin and mineral supplements would also be recommended.

• The child will be monitored and kept under observation if they have acute liver failure. IV fluids and medicines would be administered, and steroids may also be given to reduce inflammation.

• An anti-chemical would be injected to counteract the impact if the disease is a result of an overdose of medicines or toxin intake.

• Liver transplantation may be required if the liver has stopped functioning and end-stage liver disease is observed. Transplanting a liver requires a complex surgery and would be conducted if a suitable donor of the same blood group is found. Either a part of the liver or the entire liver would be transplanted. After successful transplantation, several anti-rejection drugs would be prescribed to prevent any complications.

Prognosis Of Liver Diseases In Children

The effectiveness of the treatment for liver disease is dependent on the type and severity of the disease. Timely intervention could reverse certain liver diseases. For example, hepatitis A, C, and E could be effectively treated. Similarly, acute liver failure caused by toxins or over-dosages could be treated effectively (5).

If the liver disease is hereditary, constant monitoring could help keep the complications at bay. However, if the disease has progressed or has been identified at later stages, liver transplantation may be ordered.

Liver disease in children could cause worry to the parents. Fortunately, the recovery rates among children with liver diseases are high. However, while medicines and supportive care may work their magic on restoring your child’s liver health, you need to ensure the disease is diagnosed early on for the best outcome and to avoid a liver transplant.

References

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Reviewer

Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha