Aisha Mehnaz ( Department of Paediatrics, Civil Hospital and PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
A. Gbaffar Billo ( Department of Paediatrics, Civil Hospital and PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
Sarwar J. Zuberi ( Department of Paediatrics, Civil Hospital and PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
Retrospective analysis of 300 children with various liver diseases, seen at two major teaching hospitals of Karachi indicates that acute viral hepatitis and its sequelae are the commonest of all hepatic ailments. Their frequency, clinical presentation, biochemical findings and outcome are presented (JPMA 40 : 62, 1990).
Among the paediatric health hazards liver disorders bear a considerable magnitude and have a high morbidity and mortality. Scarcity of published data on liver diseases in children prompted us to retrospectively review the cases seen in our departments to determine their pattern, frequency, presentation and outcome.
PATIENTS AND METHODS
Three hundred children were included in this study, 152 from the department of Paediatrics Civil Hospital and 148 from PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. Their ages varied from one month to 14 years. History and physical findings of each case were entered on a proforma. Complete blood picture, prothrombin time, serum bilirubin, alkaline phosphatase, ALT and urinalysis were done. Serum proteins, Electrolytes, liver biopsy, ultrasonography, upper G.I. endoscopy, alphafoetoprotein, Casoni’s test, microscopy and culture of pus from liver abscess were done where indicated. Hepatitis B surface antigen was done in 25% cases.
Pooled data from the two centres was analysed. Acute viral hepatitis together with acute fulminant hepatitis accounted for 42% of the total cases, 29% had cirrhosis, 8% liver abscess and 5% suspected storage disorders (Table I).
Fever (76%), jaundice (75%) and hepatosplenomegaly(72%) were the most frequent presentations of infective liver disorders. Fulminant hepatic failure and hepatic encephalopathy was seen in 18% cases. Patients with non-infective disorders presented with jaundice (42%), hepatosplenomegaly (56%), nausea, vomiting, diarrhoea, and abdominal pain. Mental retardation was noted in 16% cases (Table II).
Malnutrition was not a pre-disposing factor in the acute and chronic liver disease (Table III).
Biochemical profile in various disorders is shown in Table IV.
All cases of acute viral hepatitis admitted in Civil Hospital improved while 78% cases of acute fulminant hepatitis died. Twenty four per cent cases of cirrhosis developed hepatic encephalopathy and died. Liver abscesses were mostly amoebic and recovered after appropriate therapy. The overall mortality in Civil Hospital from liver disease was 26% (Table V).
Neoplasms had the worst prognosis.
Acute viral hepatitis was the most common liver disorder in children. Of various types, hepatitis A and Non A - Non B were seen in 54% and 30% of cases respectively. A similar incidence has been reported in Indian children2. Most of the epidemics of viral hepatitis in the third world are due to contamination of water. Similar mode of transmission is suggested in Pakistan1,3. In this study a history suggestive of parenteral transmission or a close contact with hepatitis patients or carries was obtained in only 19.3% of the cases suggesting orofaecal transmission in the remaining cases. Age and sex distribution in this study was similar but liver function derangement was less marked in the study reported from Rawalpindi. HBsAg positivity was 37% in the present series and 6.6% in other series1 (Table VI).
Amoebic liver abscesses were also frequent in children. Metabolic and storage disorders were suspected in 4.6% of cases which may be due to a high incidence of consanguinous marriages in this country. Overall mortality from liver disease at the department of Paediatrics, Civil Hospital, Karachi was 26% as compared to 6.6% in United States4. To determine the actual pattern of liver disease in children a more detailed prospective, clinico epidemiological study with complete serology, biopsy and special tests for metabolic and storage disorders is needed in our country.
1. Malik, I.A., Anwar, C.M., Luqman, M., Ahmed, A., Sarfraz, T. and Qamar, M.A. The pattern of acute viral hepatitis in children. A study based on seroepidemiology and biochemical profile. JPMA., 1987: 37: 314.
2. Tandon, B.N., Gandhi, B.M. and Joshi, Y.K. Etiological spectrum of viral hepatitis and prevalence of markers of hepatitis A and B virus infection in North India. Bull. WHO., 1984; 62: 67.
3. DeCock, K. M., Bradley, D.W. Sanford, N.L., Oovindarajans, S., Maynard, J.E. and Redeker, A.O. Epidemic non-A, non-B hepatitis in patients from Pakistan. Ann. Intern. Med., 1987; 106:227.
4. Lloyd-Still, J.D. Mortality from liver diseases in children. implications for hepatic transplantation programs. Am. J. Dis. Child., 1985; 139:381.