The liver is essential and one of the busiest organs in the human body. It is considered as a vital organ for human survival because of its role in various metabolic and synthetic processes. The cells of the liver are known as hepatocytes and the hepatocytes are responsible for performing functions of the liver. Liver diseases either prevent the hepatocytes from performing their functions or damage them. Functions of the liver include:
Stores minerals, vitamins, and sugar.
Detoxify the body by removing harmful chemicals.
Synthesizes various proteins such as proteins required in blood clotting.
Convert food into energy.
Responsible for immunity.
Synthesizes bile which is required for fat digestion and helps in absorbing fat-soluble vitamins.
The signs and symptoms of liver disease in children are:
|Overall body||Fatigue, Unexplained weight loss, Fever and chills, irritability|
|Gastrointestinal||Loss of appetite, Abdominal Pain|
|Skin||Yellowing of skin, eyes, and nails (jaundice), Severe itching|
|Neurological||Light-headedness and confusion, Lack of concentration|
|Blood-Related||Abnormal bleeding, Anaemia, Portal hypertension and bleeding (Variceal Bleeding)|
The diagnosis of liver disease is done with similar techniques that are used in adults. However, the doctor diagnosing the disease should have an experience of emotionally handling the child. Following are some of the common techniques for diagnosis:
Physical Examination: A pediatric gastroenterologist may perform a comprehensive physical examination to determine if the symptoms are associated with liver disease. Once the doctor is convinced, he may advise further testing to confirm the diagnosis.
Imaging tests: Various imaging techniques such as CT scan and ultrasound may help in diagnosing liver disease.
Blood tests: Complete liver function tests or liver panel test is conducted by collecting and analyzing the blood sample of the patient. In addition to these routine tests, based on the results, further testing for liver-specific metabolic tests are conducted.
Urine tests: Urine tests may also be advised to determine the amount of bilirubin in the patient's urine.
Liver transplantation is considered the treatment of last resort. When other invasive and non-invasive treatment measures fail to provide adequate relief to the patient, the doctor may advise liver transplantation. Generally, liver transplantation is required in the following conditions:
Acute liver failure
Acute on chronic liver failure
Liver cancer (though rare in children)
Chronic hepatitis infection such as hepatitis B leading to cirrhosis
Primary Sclerosing Cholangitis
Non-Alcoholic fatty liver disease
Cholestatic liver disease
Metabolic diseases such as Wilson’s disease, tyrosinemia and galactosemia.
Once the child has been advised to undergo liver transplantation, the parents need to prepare the child physically and emotionally for the procedure. The parents should get comprehensive information from the doctor about the procedure. The child should be informed well in advance about the surgery and the recovery process. This will help in preparing him mentally and ally anxiety. The parents should extent care and support to the child and try to remain stress-free themselves. It is to be noted that although liver transplant is a complex surgery, the rate of success is excellent.
The liver transplant may be done by obtaining the liver from a dead or living donor. If the donor is brain dead, his liver should be transplanted immediately to the patient. Thus, surgery is done as soon as possible. This is not the case with living donor liver transplantation. Few days before liver transplantation, the child has to undergo comprehensive body check-ups to declare fit for the surgery. Before starting the surgical procedure, X-rays, blood tests, ultrasound, and cross-matching is done.
With advanced technology, it is now possible to transplant the liver of an adult to the child. Liver transplant surgery is done under general anaesthesia. The surgeon makes an incision in the abdominal area to get access to the diseased liver. Blood supply to the liver is interrupted and the surgeon will cut the bile ducts from the old liver. The old liver is then removed and replaced with a new healthy liver. The blood vessels and bile ducts are then connected with the new liver. The incision is closed through stitches and covered with bandages.
Recovery after liver transplant surgery will depend upon the care provided to your child. You may follow the below measures during post-transplant recovery:
Give your child the prescribed medications at the scheduled time.
Prevent sick people from meeting the child.
Do not take your child in public gatherings,
Take your child for a routine check-up
Give your child a healthy diet.
Support your child physically and emotionally.
Allow your child to take a good rest.
Consultant - Paediatric Gastroenterology and Hepatology
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