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Wednesday, June 29, 2022

Common Liver Conditions in Children

Prevention and early detection of liver disorders is important rather than treatment of complications. 

April 21, 2022 5:19:25 pm
Common Liver Conditions

Liver is one of the most vital organs in the body and largest solid organ. It serves many important functions including facilitation of digestion, absorption of nutrients, maintenance of blood sugar, blood cholesterol and the energy balance. It is a very resilient organ and plays an important role in fighting infection and illness. Its role in breaking down many drugs and removing various toxic substances from the body is absolutely essential. Liver is a very friendly, tolerant organ with a good regenerating capacity. As much as the liver protects and helps us to achieve a healthy living we should also do our best to protect the liver. Prevention and early detection of liver disorders is important rather than treatment of complications. Hence world liver day is observed on April 19th every year to create awareness about liver disorders and maintain a good liver health.

Symptoms of liver disease –

Liver conditions can manifest as jaundice which means yellowish discolouration of the eyes and skin, this is due to increased retention in the blood and staining by the bile pigment called bilirubin. Other symptoms that one might develop include dark coloured urine, pale stools, generalised itching, bleeding manifestations in the form of vomiting of blood, black coloured stools or fresh blood in the stools. Abdominal distention and swelling of the legs, face can happen in advanced liver disease. Tiredness and easy fatigability can also be present. Sometimes individuals can also present with acute liver failure having been healthy previously. Acute liver failure leads to multi-organ damage and death unless treated appropriately at the right time.  

Conditions in children –

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Liver diseases can be inherited or genetic conditions but many conditions are acquired due to infections or unhealthy eating habits and lifestyle. Infants and children can present with jaundice due to various conditions. One of the commonest such conditions is viral hepatitis due to hepatitis A and hepatitis E viruses. They spread through contaminated food or water and children can be asymptomatic or present with acute hepatitis. Most of them can be treated at home and recovery is usually good. During recovery there is no need to restrict their food intake or avoid oil, non-vegetarian food.

Newborn babies presenting with prolonged jaundice can be due to increased breakdown of red cells called haemolytic jaundice, thyroid dysfunctions or liver disorders. Jaundice due to liver disorders is called neonatal cholestasis, where they present with conjugated jaundice or direct hyperbilirubinemia. Stool colour should be reviewed by a doctor in such cases and babies who have pale coloured stools should be investigated immediately and thoroughly. Babies who have the condition called biliary atresia will require timely surgical intervention. 

Another emerging threat to children’s liver health is non-alcoholic fatty liver disease(NAFLD). Fatty liver is basically fat deposition in the liver and can be due to infections, certain medications, wilson’s disease or other metabolic conditions. However the entity called non-alcoholic fatty liver disease (NAFLD) is related to obesity and unhealthy lifestyle. It is considered the hepatic manifestation of metabolic syndrome and incidence is increasing in children. This is of huge concern as the condition can progress to non-alcoholic steatohepatitis (NASH), cirrhosis and liver failure, if not intervened early.

Prevention of liver disease –

Many liver conditions are preventable. Healthy lifestyle including healthy eating habits, avoiding intake of unnecessary drugs and self medications helps to maintain liver health and it’s important these lifestyle changes happen in childhood. 

While celebrating World Liver Day this week, I recommend the following in order to maintain your liver health and promote a healthier and happier future –

First, choose a healthy and balanced diet that is rich in fruits, vegetables, whole grains and healthy fats. Avoid saturated fats and refined carbohydrates, reduce or avoid consumption of processed foods. 

Second, maintain a healthy weight by consuming a healthy diet combined with regular exercise. This is important in the context of the recent pandemic, current social situation and unhealthy change in lifestyle.

Third, say no to alcohol, smoking and drugs. 

Fourth, avoid unnecessary medications and self medications as even paracetamol overdose can cause acute liver failure

Fifth, be sure to vaccinate your children against hepatitis A and B. Hepatitis B vaccine is given to newborns and hepatitis A vaccine is given to children after their first birthday. Hepatitis B, C and D infections can also be prevented by avoiding high risk practices such as use of unscreened blood, sharing needles for injections, unhygienic tattooing or ear piercing, needle stick injury in health workers and high risk sexual practices.

And finally, seek help early if you are worried about your or your child’s liver health. Conditions like chronic hepatitis C infection are completely curable with appropriate medications. Early detection and treatment of liver disorders will delay progression to chronic liver disease, cirrhosis and liver failure. Various newer and advanced modalities of treatment including liver transplant are widely available in the current scenario.

Dr. Lavenya R Padmanaban, MBBS, MD Pediatrics, MRCPCH (UK), Training in Pediatric Gastroenterology and Hepatology, King’s College Hospital, UK, Consultant – Pediatric Gastroenterology and Hepatology, Rainbow Children’s Hospital, Marathahalli, Bengaluru

Dr Lavenya Padmanabhan

Pediatric Gastroenterology and Hepatology

Rainbow Children’s Hospital, Marathahalli, Bengaluru

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