Hepatitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Hepatitis in children refers to inflammation of the liver caused by viral infections, autoimmune conditions, metabolic disorders, or toxic exposures, leading to impaired liver function.

Aetiology

  • Infectious causes:
    • Hepatitis A, B, C, D, and E viruses.
    • Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus.
    • Enteroviruses, parvovirus B19.
  • Autoimmune hepatitis: immune-mediated liver inflammation.
  • Metabolic causes: Wilson’s disease, alpha-1 antitrypsin deficiency.
  • Toxic causes: drug-induced liver injury (e.g., paracetamol overdose), environmental toxins.

Pathophysiology

  • Viral or immune-mediated destruction of hepatocytes leads to hepatic inflammation.
  • Inflammation disrupts normal liver function, affecting metabolism, coagulation, and detoxification.
  • Chronic hepatitis can lead to fibrosis, cirrhosis, and liver failure.

Risk Factors

  • Close contact with infected individuals (hepatitis A, B, E).
  • Mother to child transmission (hepatitis B, C).
  • Immunosuppression (e.g., chemotherapy, HIV).
  • Autoimmune conditions.
  • Exposure to hepatotoxic medications or toxins.

Signs and Symptoms

  • Jaundice (yellowing of skin and sclera).
  • Dark urine, pale stools.
  • Hepatomegaly, right upper quadrant pain.
  • Fatigue, malaise, nausea, vomiting.
  • Fever (more common in viral hepatitis).
  • Coagulopathy (easy bruising, bleeding tendencies in severe cases).

Investigations

  • Liver function tests (LFTs): raised ALT, AST, bilirubin, and abnormal clotting profile.
  • Viral serology: hepatitis A, B, C, EBV, CMV.
  • Autoimmune markers: ANA, SMA, LKM-1 for autoimmune hepatitis.
  • Metabolic screening: copper, ceruloplasmin (Wilson’s disease), alpha-1 antitrypsin.
  • Abdominal ultrasound: assesses liver size, echotexture, and biliary obstruction.
  • Liver biopsy: if cause remains unclear or to assess fibrosis.

Management

1. Supportive Care:

  • Maintain hydration and nutrition.
  • Avoid hepatotoxic drugs (e.g., paracetamol, NSAIDs).
  • Monitor liver function and coagulation parameters.

2. Specific Treatments:

  • Hepatitis A and E: supportive care, resolves spontaneously.
  • Hepatitis B: antivirals in chronic cases (tenofovir, entecavir).
  • Hepatitis C: direct acting antivirals (sofosbuvir, ledipasvir).
  • Autoimmune hepatitis: corticosteroids and immunosuppressants (azathioprine).
  • Wilson’s disease: chelation therapy (penicillamine, trientine).

3. Prevention:

  • Vaccination for hepatitis A and B.
  • Screening and early treatment for perinatal hepatitis B transmission.
  • Hygiene measures to prevent faecal-oral transmission (handwashing, safe food handling).

4. Referral:

  • Paediatrics: all suspected cases should be referred for assessment and monitoring.
  • Paediatric hepatology: if evidence of liver failure, chronic liver disease, or unclear aetiology.
  • Gastroenterology: if autoimmune hepatitis or metabolic liver disease is suspected.
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