Pediatr Gastroenterol Hepatol Nutr.  2013 Dec;16(4):225-232.

Abnormality on Liver Function Test

• Kang KS

Abstract

Children with abnormal liver function can often be seen in outpatient clinics or inpatients wards. Most of them have respiratory disease, or gastroenteritis by virus infection, accompanying fever. Occasionally, hepatitis by the viruses causing systemic infection may occur, and screening tests are required. In patients with jaundice, the tests for differential diagnosis and appropriate treatment are important. In the case of a child with hepatitis B virus infection vertically from a hepatitis B surface antigen positive mother, the importance of the recognition of immune clearance can't be overstressed, for the decision of time to begin treatment. Early diagnosis changes the fate of a child with Wilson disease. So, screening test for the disease should not be omitted. Non-alcoholic fatty liver disease, which is mainly discovered in obese children, is a new strong candidate triggering abnormal liver function. Muscular dystrophy is a representative disease mimicking liver dysfunction. Although muscular dystrophy is a progressive disorder, and early diagnosis can't change the fate of patients, it will be better to avoid parent's blame for delayed diagnosis.

Keyword

Liver function tests; Child

MeSH Terms

Ambulatory Care Facilities
Child
Delayed Diagnosis
Diagnosis, Differential
Early Diagnosis
Fatty Liver
Fever
Gastroenteritis
Hepatitis
Hepatitis B Surface Antigens
Hepatitis B virus
Hepatolenticular Degeneration
Humans
Inpatients
Jaundice
Liver Diseases
Liver Function Tests*
Liver*
Mass Screening
Mothers
Muscular Dystrophies
Viruses
Hepatitis B Surface Antigens

Figure

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  Fig. 1 Suggesting diagnostic algorithm for the children with elevated AST and ALT. The first step is the measure of serum total bilirubin. When it is normal, serum HBsAg and anti-HCV can be checked. In case of the viral marker negative, the measurement of serum creatin kinase and ceruloplasmin may be performed. In addition, other viral markers can be tested. The markers are CMV IgM/Culture/PCR, EBV VCA IgM, and adenovirus PCR etc. When serum total bilirubin is elevated, serum anti-HAV IgM can be measured. In this way, we can differentiate variable diseases with hepatitis. AST: aspartate aminotransferase, ALT: alanine aminotransferase, HBsAg: hepatitis B surface antigen, HCV: hepatitis C virus, CMV IgM: cytomegalovirus immunoglobulin M, PCR: polymerase chain reaction, EBV VCA: Epstein bar virus viral capsid antigen, HAV: hepatitis A virus, NAFLD: non-alcoholic fatty liver disease, HSV: herpes simplex virus.

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