Cirrhosis in children and adolescents: An overview
Raquel Borges Pinto1, Ana Claudia Reis Schneider1, Themis Reverbel da Silveira1
1Raquel Borges Pinto, Pediatric Gastroenterology Unit, Hospital da Criança Conceição, Porto Alegre 91340 480, Rio Grande do Sul, Brazil.
Insights
Pediatric cirrhosis, caused by various chronic liver diseases, presents similarly to adults but often with poor weight gain. Early diagnosis and management of nutritional deficits are crucial for children and adolescents with end-stage liver disease.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Internal Medicine
- Clinical Pediatrics
Background:
- Cirrhosis in children and adolescents stems from diverse chronic liver diseases.
- Etiologies vary by age, including biliary atresia in infants and autoimmune hepatitis or genetic disorders in older children.
- Symptoms and complications mirror adult cirrhosis but necessitate special attention to pediatric nutritional needs for growth.
Purpose of the Study:
- To review the diagnostic and differential diagnostic aspects of end-stage liver disease in pediatric patients.
- To outline the major treatment strategies for cirrhosis in children and adolescents.
- To highlight the importance of nutritional support in managing pediatric cirrhosis.
Main Methods:
- Review of existing literature on pediatric cirrhosis.
- Analysis of common etiologies and clinical presentations in pediatric populations.
- Discussion of diagnostic criteria and therapeutic approaches.
Main Results:
- Common causes include biliary atresia, genetic-metabolic diseases, autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency, and primary sclerosing cholangitis.
- Key signs include poor weight gain, with complications like gastroesophageal varices, ascites, and spontaneous bacterial peritonitis.
- Nutritional deficiencies and malnutrition pose significant risks, impacting both pre- and post-liver transplant outcomes.
Conclusions:
- Pediatric cirrhosis requires tailored diagnostic and management strategies, considering age-specific etiologies and nutritional demands.
- Early identification and intervention for nutritional alterations are critical for improving outcomes in children and adolescents with cirrhosis.
- Treatment protocols often adapt adult methods but must account for the unique physiological needs of pediatric patients.
Abstract:
Several conditions, especially chronic liver diseases, can lead to cirrhosis in children and adolescents. Most cases in clinical practice are caused by similar etiologies. In infants, cirrhosis is most often caused by biliary atresia and genetic-metabolic diseases, while in older children, it tends to result from autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency and primary sclerosing cholangitis. The symptoms of cirrhosis in children and adolescents are similar to those of adults. However, in pediatric patients, the first sign of cirrhosis is often poor weight gain. The complications of pediatric cirrhosis are similar to those observed in adult patients, and include gastrointestinal bleeding caused by gastroesophageal varices, ascites and spontaneous bacterial peritonitis. In pediatric patients, special attention should be paid to the nutritional alterations caused by cirrhosis, since children and adolescents have higher nutritional requirements for growth and development. Children and adolescents with chronic cholestasis are at risk for several nutritional deficiencies. Malnutrition can have severe consequences for both pre- and post-liver transplant patients. The treatment of cirrhosis-induced portal hypertension in children and adolescents is mostly based on methods developed for adults. The present article will review the diagnostic and differential diagnostic aspects of end-stage liver disease in children, as well as the major treatment options for this condition.
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