Pediatrics · MU Sofia

12. Chronic hepatitis and cirrosis.

Covers chronic hepatitis, defined as inflammation lasting over six months, and how it can progress to fibrosis and cirrhosis in children. A table sets out causes such as hepatitis B and C, autoimmune hepatitis, Wilson disease, alpha-1 antitrypsin deficiency and fatty liver, with tests and treatments for each. It then moves to paediatric cirrhosis, listing causes, signs, a table of complications, severity scores, treatment, and a short section on dental and oral issues.

Inside: 3 sections · 2 tables · 16 flashcards · 4 min

Topic 12 of 30 in the MU Sofia syllabus for Pediatrics (Medicine, Year 5). The free AceMed note covers it in 3 sections, about 234 words (4 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Causes of chronic hepatitis in children
  3. Cirrhosis in children

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.

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