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Diagnosis of liver cirrhosis in children
Last reviewed: 23.04.2024
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Physical examination
When collecting anamnesis, it is necessary to establish the timing of the emergence of the first clinical signs and patterns of disease development, the presence in the family history of cases of pathology of the hepatobiliary system.
At physical examination it is necessary to evaluate the physical development of the child, the severity of jaundice, the presence of an enhanced vascular pattern on the chest and abdomen, extrahepatic symptoms (telangiectasia, palmar erythema, "drumsticks", peripheral neuropathy, etc.), edematous syndrome. It is necessary to measure the size of the liver and spleen, abdominal circumference (with ascites), evaluate the color of the stool and urine.
Laboratory research
Biochemical blood test:
- a decrease in indicators reflecting the synthetic function of the liver (concentration of albumin, cholinesterase, cholesterol). The earliest sign of emerging biliary cirrhosis is the decrease in the activity of the cholinesterase enzyme, which in most cases precedes the appearance of other symptoms;
- cytolysis enzymes (ALT, ACT) and cholestasis markers (y-glutamyl-transpeptidase, alkaline phosphatase) can be increased either in norm (depending on the stage of the process). With the dynamic observation of the patient, a gradual decrease in the activity of these indicators is noted;
- mixed hyperbilirubinemia.
Coagulogram is characterized by a decrease in fibrinogen and protrobin index, which is caused by a violation of the synthetic function of the liver.
In the clinical analysis of blood, anemia, thrombocytopenia and leukopenia, caused by hypersplenism and liver-cell failure, can be detected.
Instrumental research
When ultrasound is determined that the size of the liver is increased or less than normal, the parenchyma acquires an increased echogenicity. The vascular pattern, as a rule, is impoverished. Signs of portal hypertension - increased blood flow through the portal system, hepatic and splenic veins, increased spleen size, accumulation of fluid in the abdominal cavity.
Fibroesophagogastroduodenoscopy can detect the expansion of the esophagus vein in portal hypertension.
Morphological study of liver biopsy is considered a "gold standard" for diagnosis of liver cirrhosis. Small tuberosity is characteristic of biliary cirrhosis, large nodes indicate post-hepatitis cirrhosis or other causes. Small-node cirrhosis is characterized by small, uniform sizes, parenchyma nodes up to 3-5 mm in diameter, surrounded by narrow interlayer connective tissue. These nodes usually include one lobule of the liver. When microscopic examination of liver biopsy specimens, a violation of the lobular structure of the liver is detected, regeneration sites or false lobules, fibrous layers or septums surrounding the false lobes, thickening of the hepatic trabeculae, changes in hepatocytes (large cells of regenerative type with polymorphic, hyperchromic nuclei) and fragmentation of liver tissue.
Differential diagnostics
Differential diagnostics is carried out with chronic diseases of the hepatobiliary system, extrahepatic portal hypertension.
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