November 13, 2014

Pediatric Liver Disease: Silence Can Be Sinister

Early recognition, intervention can avert complications

690×380-Fatty-Liver

Pediatric liver diseases typically produce no symptoms in their early stages, making timely diagnosis a challenge.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“These diseases can be silent for years before causing serious complications,” says pediatric hepatologist Naim Alkhouri, MD, who directs Cleveland Clinic Children’s Metabolic Liver Disease Clinic.

The specialized clinic offers a comprehensive approach to help expedite recognition and management of these silent but sinister conditions, be they acquired disorders — including nonalcoholic fatty liver disease (NAFLD) and hepatitis B and C — or genetic diseases, such as Wilson disease, alpha-1 antitrypsin deficiency or hemochromatosis.

When to be suspicious

Suspicion should be based on the presence of obesity or associated comorbidities, such as insulin resistance, type 2 diabetes, polycystic ovary syndrome or a family history of liver disease.

Additionally, elevated ALT and AST, hepatomegaly, splenomegaly, jaundice or failure to thrive should prompt referral to a specialized program like the Metabolic Liver Disease Clinic for a thorough examination and complete biochemical profile.

Confirmation of the diagnosis may require liver enzyme testing, liver ultrasound or biopsy.

Advertisement

Evaluation and treatment: What families can expect

Families typically spend less than two hours in the initial evaluation. Follow-up visits are scheduled every month or two during the first year, then as needed.

At every visit, the patient sees a pediatric hepatologist and a registered dietitian. An appointment may be made for the child to also see an exercise physiologist or pediatric psychologist. Whenever possible, the visits are accomplished on the same day.

When an associated medical condition is present, the child may be referred to pediatric endocrinology, nephrology, cardiology or sleep medicine — or even for liver transplant evaluation.

Treatment of the liver disease may involve medications, lifestyle changes or both.

“Our dietitian plays a key role, because NAFLD is the result of obesity,” says Dr. Alkhouri. “Other liver diseases can cause malnourishment or vitamin deficiency.” The dietitian also helps families plan healthy meals and snacks.

Advertisement

“By intervening early, we can often reverse the course and help the patient avoid consequences — which, in the case of NAFLD, may include liver transplantation,” Dr. Alkhouri adds.

Making diagnosis more child-friendly

The concentration of pediatric liver disease patients in a single multidisciplinary program has enabled the team to investigate ways to make the diagnostic process more child-friendly.

Recent research has focused on finding potential biomarkers for NAFLD and its severe form, nonalcoholic steatohepatitis. “Identifying a biomarker that successfully predicts the degree of liver damage will help us avoid the need for biopsy,” says Dr. Alkhouri.

The team is also looking at markers of liver disease in the breath, with the hope that changes in volatile organic compounds as measured by mass spectrometry may replace the need for blood work and liver biopsy.

Related Articles

650×450-Mediterranean-diet-adherence-and-metabolic-syndrome-in-US-adolescents
January 7, 2021
Study Finds that US Adolescents Have Low Adherence to the Mediterranean Diet

Pediatricians can play valuable role in recommending substitutions for unhealthy foods

690×380-Childhood-Wellness
September 9, 2015
Going on the Offensive for Childhood Wellness: Profiles of 3 Initiatives

From integrative med to school-based care, inventive approaches promise progress

690×380-Integrative-Med
January 14, 2015
Cleveland Clinic Children’s Addresses Growing Demand for Integrative Medicine

New center focuses on treating the whole child — body, mind and spirit

Teen patient sitting in exam room with gastroenterologist
March 29, 2024
EoE Transition Clinic Drives Continuity of Care

Pediatric and adult gastroenterologists offer team care for patients with eosinophilic esophagitis

Patient in hospital getting bone marrow transplant
March 26, 2024
Updated Recommendations for Long-Term Survivors of Bone Marrow Transplant

New guidelines expand on psychosocial, sexual health, cognitive and other issues

Closeup of bone marrow
March 25, 2024
Bridging the Gap Between Bone Marrow Transplant and cGvHD

Consensus conference begins work on new recommendations for clinical care and research

Woman in chair breastfeeding an infant
March 15, 2024
Breastfeeding Duration in U.S. Closely Linked With Length of Maternity Leave

Systemic change needed to improve health outcomes for parents and children, say researchers

Illustration of a liver
March 13, 2024
Case Study: Late Diagnosis of Glycogen Storage Disease

Rare genetic variant protected siblings against seizures and severe hypoglycemia

Ad