Introduction
Chronic hepatitis is inflammation of the liver lasting more than 6 months. It may be silent for years, but it can lead to fibrosis and cirrhosis: diffuse scarring with regenerating nodules, which disturbs blood flow (portal hypertension) and liver function.
Cirrhosis in children
Causes
Biliary atresia (the leading cause), alpha-1 antitrypsin deficiency, Wilson disease, autoimmune hepatitis, progressive familial intrahepatic cholestasis, cystic fibrosis, chronic hepatitis B and C, glycogen storage disease, tyrosinaemia.
Signs
- Poor growth and muscle wasting, jaundice, itching (cholestasis), a hard liver (may be small), splenomegaly.
- Spider naevi, palmar erythema, clubbing, prominent abdominal veins, ascites, bruising.
Complications
Severity and treatment
- Severity: PELD score (under 12 years) or MELD, Child–Pugh; they guide transplant listing.
- Treat the cause where possible (antivirals, immunosuppression, chelation).
- Nutrition: high-energy feeds with medium-chain triglycerides (absorbed without bile), fat-soluble vitamins A, D, E, K; extra protein unless encephalopathy is severe.
- Itching: ursodeoxycholic acid, cholestyramine, rifampicin; newer IBAT inhibitors (odevixibat, maralixibat).
- Ascites: salt restriction, spironolactone. Varices: endoscopic band ligation or sclerotherapy for bleeding.
- Liver transplantation for end-stage disease; survival over 85–90% at 5 years.
A child with chronic liver disease should have all vaccines (hepatitis A and B especially) before transplant, while live vaccines are still possible.
Mouth and teeth: poor clotting and low platelets cause gum bleeding (check INR and platelets before extractions); bilirubin can stain teeth green; chronic cholestasis delays tooth eruption and causes enamel hypoplasia; after transplant, ciclosporin can cause gingival overgrowth.