Ee Looi C
Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2020 Nov;56(11):1702-1707. doi: 10.1111/jpc.14708.
Liver disease in children tends to present either as: (i) an acute hepatitis with or without jaundice; (ii) incidental finding of abnormal liver function tests; or (iii) from a complication of portal hypertension with either haematemesis and/or incidental splenomegaly. Acute hepatitis may result from acute infection, prescribed or other drugs, ischaemia or vascular causes, autoimmune hepatitis, or idiopathic liver failure. Non-alcoholic fatty liver disease is now the most likely reason for abnormal liver function tests but medications, metabolic disease, cholangiopathy and non-liver causes should be considered. Autoimmune hepatitis and alpha-1-antitrypsin deficiency are the most likely causes of insidious liver disease. An international normalised ratio uncorrected by vitamin K reflects the severity of liver synthetic dysfunction, but not propensity to bleed. Creatine kinase helps to differentiate muscle from liver disease in patients with raised transaminases. Doppler ultrasound of hepatic vasculature is useful when assessing splenomegaly to differentiate extra-hepatic portal hypertension from inherent liver disease.
(i) 伴有或不伴有黄疸的急性肝炎；(ii) 肝功能检查异常的偶然发现；或(iii) 门静脉高压并发症，伴有呕血和/或偶然发现脾肿大。急性肝炎可能由急性感染、处方药或其他药物、缺血或血管原因、自身免疫性肝炎或特发性肝衰竭引起。非酒精性脂肪性肝病现在是肝功能检查异常最常见的原因，但也应考虑药物、代谢性疾病、胆管病和非肝脏原因。自身免疫性肝炎和α-1抗胰蛋白酶缺乏症是隐匿性肝病最可能的原因。未用维生素K校正的国际标准化比值反映了肝脏合成功能障碍的严重程度，但不能反映出血倾向。肌酸激酶有助于在转氨酶升高的患者中区分肌肉疾病和肝脏疾病。在评估脾肿大以区分肝外门静脉高压和内在肝脏疾病时，肝脏血管的多普勒超声检查很有用。
