Paediatric liver conditions Present with combinations of the following symptoms and signs. Jaundice Encephalopathy (altered consciousness or behaviour) Bleeding tendency Abdominal distension and ascites Hepatomegaly and/or hepatosplenomegaly. Paediatric Liver Conditions.
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Excess production of bilirubin
Liver disease/involvement in disease
Obstruction to bile flow
Onset day 1
Examine : Pale? splenomegaly? Heart failure? Other signs of illness
Tests : FBC, Coombs, Blood groups, TSB,
Onset after day 2
Jaundice of immaturity
Examine:GA?, well?, pallor?, splenomegaly?
Tests: FBC, TSB, Blood groups, Urine dipstix, possible cultures for infection
Onset after day 3 – 5
Infection (UTI, Sepsis)
Breast milk jaundice
Examination: careful search for infection, liver? Stool colour?
Tests: FBC, CRP, TSB/conjugated, Urine, B/C, TORCHeS, Urine Clinitest, TFT, Stool bile pigments, LFT’s
Jaundice persisting beyond 10 days
Breast milk jaundice
Examination:Well?, liver and spleen?, Stool appearance?
Tests: TSB/conjugated, FBC, CRP, LFT’s, TFT, Urine mcs and clinitest, TORCHeS and Hepatitis viruses, Stool for bile pigment
Early referral of obstructive jaundice
TORCHES, sepsis, UTI
Galactosaemia, 1Antitrypsin def.
Biliary atresia, choledochus cyst
Toxic and drug reactions
Septicaemia, HIV, granulomata
CCF, Constrictive pericarditis,
Hepatic vein/IVC obstruction
Leukaemia, lymphoma, hepatoma
Malnutrition, toxic damage
Glycogen, lipid, mucopolysaccharides
Reticulo-endothelial hyperplasia, sepsis
Haematological and RES disorders
Previous illnesses of all relevant organ systems and progress
Growth and nutritional state
Careful inspection, palpation, percussion
Organ sizes and appearance
Abdominal wall on a higher plane than the xiphisternum in patients lying on their back on a straight firm surface
4.5 – 5 cm at 1 week of age
7 – 8 cm at 12 years (boys)
6 – 6.5 cm at 12 years (girls)
Gut disease with secretion/absorption abnormalities
(May show shifting dullness, but not fluid thrill)
High protein content usually > 30g/l
Protein : serum protein ratio <0.5
Milky fluid, lymphocytes
TB, congenital, neoplastic