Etiologies of liver disease in children

Objective: To review the etiology & clinical spectrum of chronic liver disease in children in various hospitals of Faisalabad.
Methods: Prospective study in children aged 10 months to 15years with suspected chronic liver disease. Complete blood count, prothrombin time, LFT's, serum albumin and ultrasound of abdomen were done in all patients. Liver biopsy was done in majority of the cases. Viral markers included HBsAg, anti HCV and ANA to determine etiology. Those who were negative for hepatitis B, C and autoimmune disease, were subjected to slit lamp examination of eyes and 24 hours urinary copper estimation for Wilson's disease. Alpha-1-antitrypsin levels were done in selected patients.
Results: A total of 55 cases were studied. The common presenting features were ascites (42 patients) edema, jaundice (23), variceal bleeding (27) and fever (24). On examination anemia was present in 52 patients, edema in 36, jaundice in 33, splenomegaly in 42 and hepatomegaly in 35 patients. 52 patients had hypoalbuminemia (<2.5 gm%), 45 raised ALT (>80 IU/L) and 49 prolonged PT (>4 sec of control). Ultrasonography showed a dilated portal vein in 38 patients and esophageal varices were seen in 48 patients on endoscopy. Thirteen (24%) had chronic hepatitis B, 9(16%) autoimmune disease, 9 (16%) Wilson's disease and all were anti HCV negative. Etiology remained uncertain in 24 (44%) cases. Conclusion: Hepatitis B was the leading cause of chronic liver disease in children followed by Wilson's disease and autoimmune liver disease. None of the patients had hepatitis C in this study.