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Diagnosis of liver cirrhosis in children
Last reviewed: 06.07.2025
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Physical examination
When collecting anamnesis, it is necessary to establish the timing of the onset of the first clinical signs and patterns of disease development, the presence of cases of hepatobiliary system pathology in the family history.
During a physical examination, it is necessary to assess the child's physical development, the severity of jaundice, the presence of increased vascular pattern on the chest and abdomen, extrahepatic symptoms (telangiectasia, palmar erythema, "drumsticks", peripheral neuropathy, etc.), edema syndrome. It is necessary to measure the size of the liver and spleen, abdominal circumference (in case of ascites), assess the color of stool and urine.
Laboratory research
Biochemical blood test:
- a decrease in the indicators reflecting the synthetic function of the liver (the concentration of albumin, cholinesterase, cholesterol). The earliest sign of developing biliary cirrhosis is a decrease in the activity of the cholinesterase enzyme, which in most cases precedes the occurrence of other signs;
- cytolysis enzymes (ALT, AST) and cholestasis markers (γ-glutamyl transpeptidase, alkaline phosphatase) may be elevated or normal (depending on the stage of the process). During dynamic monitoring of the patient, a gradual decrease in the activity of these indicators is noted;
- mixed hyperbilirubinemia.
The coagulogram is characterized by a decrease in fibrinogen and prothrobin index, which is due to a violation of the synthetic function of the liver.
A clinical blood test may reveal anemia, thrombocytopenia and leukopenia due to hypersplenism and hepatocellular insufficiency.
Instrumental research
Ultrasound shows that the liver is enlarged or smaller than normal, the parenchyma acquires increased echogenicity. The vascular pattern is usually depleted. Signs of portal hypertension are expressed - increased blood flow velocity in the portal system, hepatic and splenic veins, an increase in the size of the spleen, and fluid accumulation in the abdominal cavity.
Fibroesophagogastroduodenoscopy allows detection of esophageal vein dilation in portal hypertension.
Morphological examination of liver biopsy is considered the "gold standard" for diagnosing liver cirrhosis. Small tuberosities are characteristic of biliary cirrhosis, large nodes indicate posthepatitis cirrhosis or other causes. Small nodular cirrhosis is characterized by small, uniformly sized parenchymal nodes up to 3-5 mm in diameter, surrounded by narrow layers of connective tissue. These nodes usually include one liver lobule. Microscopic examination of liver biopsy reveals disruption of the lobular structure of the liver, regeneration nodes or false lobules, fibrous layers or septa surrounding false lobules, thickening of liver trabeculae, changes in hepatocytes (large regenerative cells with polymorphic, hyperchromic nuclei) and fragmentation of liver tissue.
Differential diagnostics
Differential diagnostics are carried out with chronic diseases of the hepatobiliary system and extrahepatic portal hypertension.
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