Department of Pediatric Gastroenterology, Institute of Gastrointestinal Sciences, Apollo BGS Hospitals, Kuvempunagar, Mysore, Karnataka, 570023, India.
Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Sakra World Hospital, Bengaluru, Karnataka, 560103, India.
Indian J Pediatr. 2024 Mar;91(3):262-269. doi: 10.1007/s12098-023-04751-1. Epub 2023 Sep 13.
Chronic liver disease (CLD) in children is more diverse compared to adults with respect to the etiology, progression and response to therapy. After history and clinical examination, the first step is to confirm the presence of CLD with basic blood investigations and ultrasonography. Markers of portal hypertension are splenomegaly, increased portal vein diameter, thrombocytopenia and presence of varices on endoscopy. The next step is to evaluate the etiology of CLD which will depend on the age of the child and needs targeted investigations as metabolic and inherited causes predominate in early childhood. CLD progression ought to be monitored regularly and several non-invasive markers are available but they have to be evaluated further in children. Since CLD progresses, complications have to be detected early not only to initiate appropriate treatment but also to prognosticate.
儿童慢性肝病（CLD）在病因、进展和对治疗的反应方面与成人相比更为多样化。在病史和临床检查后，第一步是通过基本的血液检查和超声检查来确认 CLD 的存在。门脉高压的标志物包括脾肿大、门静脉直径增加、血小板减少和内镜下静脉曲张。下一步是评估 CLD 的病因，这将取决于儿童的年龄，并需要有针对性的检查，因为代谢和遗传原因在幼儿中更为常见。CLD 的进展应定期监测，有几种非侵入性标志物可用，但需要在儿童中进一步评估。由于 CLD 会进展，因此不仅要尽早发现并发症以启动适当的治疗，还要进行预后评估。
