Paediatric liver conditions present with combinations of the following symptoms and signs
1 / 22

Paediatric liver conditions Present with combinations of the following symptoms and signs - PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

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.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

Paediatric liver conditions Present with combinations of the following symptoms and signs

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Paediatric liver conditionsPresent 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

  • Persistent Neonatal Jaundice

  • Hepatomegaly and hepatosplenomegaly

  • Acute onset jaundice

  • Acute liver failure

  • Ascites

  • Chronic liver disease

    Chronic hepatitis

    Hepatic schistosomiasis

    Veno-occlusive disease


  • Portal hypertension

Neonatal jaundice

  • Failure to clear bilirubin

    Excess production of bilirubin

    Liver immaturity

    Liver disease/involvement in disease

    Obstruction to bile flow

  • Persistence beyond 10 days to 2 weeks

Onset day 1

Haemolytic disease

Intrauterine infection



Examine : Pale? splenomegaly? Heart failure? Other signs of illness

Tests : FBC, Coombs, Blood groups, TSB,

Cultures, TORCHeS

Approach to neonatal jaundice

Onset after day 2

Physiological jaundice


Jaundice of immaturity



Examine:GA?, well?, pallor?, splenomegaly?

Tests: FBC, TSB, Blood groups, Urine dipstix, possible cultures for infection

Approach to neonatal jaundice

Onset after day 3 – 5

Infection (UTI, Sepsis)

Neonatal hepatitis

Metabolic disease

Biliary atresia

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

Approach to neonatal jaundice

Jaundice persisting beyond 10 days

Neonatal hepatitis

Biliary obstruction/atresia

Metabolic disease

Breast milk jaundice

Infection (congenital/acquired)


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

Approach to neonatal jaundice

Persistent neonatal jaundice

  • Failure to conjugate : Unconjugated




  • Conjugated hyperbilirubinaemia (20%)

    Liver disorder

    Bile obstruction

Conjugated Hyperbilirubinaemia

  • Identifiable infections

    TORCHES, sepsis, UTI

  • Metabolic conditions

    Galactosaemia, 1Antitrypsin def.

  • Neonatal hepatitis syndrome

  • Idiopathic neonatal cholestasis

  • Intrahepatic biliary obstruction

  • Extrahepatic biliary obstruction

    Biliary atresia, choledochus cyst


  • Inflammation

    Infection, Auto-immune,

    Toxic and drug reactions

  • Reticulo-endothelial hyperplasia

    Septicaemia, HIV, granulomata

  • Venous congestion

    CCF, Constrictive pericarditis,

    Hepatic vein/IVC obstruction


  • Infiltrations and neoplasia

    Extramedullary haemopoiesis

    Leukaemia, lymphoma, hepatoma

  • Fat accumulation

    Malnutrition, toxic damage

  • Storage disorders

    Glycogen, lipid, mucopolysaccharides


  • Same cause for both organs to be enlarged

    Reticulo-endothelial hyperplasia, sepsis

  • Spleen enlarged secondary to liver

    Portal hypertension

  • Spleen enlargement more significant than liver

    Parasitic disease

    Haematological and RES disorders

Investigation of liver disease

  • History



    Abdominal pain

    Previous illnesses of all relevant organ systems and progress

  • Examination

    Growth and nutritional state

    Careful inspection, palpation, percussion

    Stool examination

Investigation II

  • Ultrasonography

    Organ sizes and appearance

    Free fluid


  • Specialized investigations for specific indications

Abdominal distension

  • Definition

    Abdominal wall on a higher plane than the xiphisternum in patients lying on their back on a straight firm surface

  • Normal lordotic posture giving appearance of pot-belly when standing up

Abdominal Distension

  • Fluid

  • Gaseous distension

  • Faeces retention

  • Organ enlargement including bladder

  • Inflammatory masses

  • Tumours

  • Pregnancy

Abdominal Distension

  • Gut distensibility

    • Food

    • Air/gas

    • Unabsorbed fluid contents

  • Omentum

    • Fat

    • Lymph nodes

    • Ascites fluid

  • Abdominal Distension

    • Liver

      • Normal size measurements

        • Edge below the costal margin

        • Span of dullness to percussion in midclavicular line

      • Normal span varies with age

      • Relatively bigger liver in young children relative to body size

  • Span at different ages

    4.5 – 5 cm at 1 week of age

    7 – 8 cm at 12 years (boys)

    6 – 6.5 cm at 12 years (girls)

  • Fluid in the abdomen

    • Fluid in the bowel


      Gut disease with secretion/absorption abnormalities

      (May show shifting dullness, but not fluid thrill)

    • Fluid in the peritoneal cavity (ascites)


    • Exudate

      High protein content usually > 30g/l

      Inflammatory cells

    • Transudate

      Protein : serum protein ratio <0.5

    • Blood

    • Chyle

      Milky fluid, lymphocytes


    • Lymphatic obstruction

      TB, congenital, neoplastic

    • Raised intravascular hydrostatic pressure

      portal hypertension

    • Decreased intravascular oncotic pressure


    • Inflammation and increased permeability


    Abdominal Distension

    • Organomegaly

      • Liver

      • Spleen

      • Kidneys

      • Bladder

  • Masses and Tumours

    • Kidney

    • Adrenal

    • Liver

    • Lymphoma

    • Retroperitoneal

  • ad
  • Login