Children chronic liver disease

Criteria and Scoring for the Child-Pugh Grading of Chronic Liver Disease... 

Some reports found an increase in liver zinc concentrations in chronic liver disease. An increase in copper and zinc liver concentrations was found in Canadian children with chronic cholestasis (Phillips et al., 1996). Another case report described the increase in zinc concentration in hepatic tissue of a child with hepatosplenomegaly and symptoms of zinc deficiency, and the authors speculated about the existence of a zinc metabolism disorder (Sampson et al, 1997). A study that investigated the concentration of metals in liver tissue of adults with hereditary hemochromatosis found an increase in zinc in the liver parenchyma. The authors suggested that the concurrent increase in iron and zinc might be explained by the greater intestinal absorption of these metals (Adams et al., 1991). 

A 52-year-old man presented with jaundice and pruritus over the last 10 days after taking the boiled Equisetum Arvense Herba juice (500 ml per day) for her renal colic complaints for the last 2 weeks. Liver function tests revealed alanine aminotransferase of 818 U/L, aspartate aminotransferase of 1117 U/L, and alkaline phosphatase of 298 U/L. It was found that the patient had Child-Pugh A chronic liver disease due to hepatitis B virus. There was a temporal relationship between drinking EA juice and severe hepatitis. Liver function tests data elevated dramatically 2 weeks after starting to drink EA juice. It was suspected that the presence of the underlying chronic liver disease secondary to hepatitits B infection may have predisposed the patient to EA-induced hepatotoxicity. His liver function tests data returned completely to the pre-admission levels 8 weeks after withdrawal of the E A juice. 

Chronic HCV- In combination with peginterferon alfa-2a for the treatment of adults with chronic HCV infection who have compensated liver disease and have not been previously treated with interferon alpha. Patients in whom efficacy was demonstrated included patients with compensated liver disease and histological evidence of cirrhosis (Child-Pugh class A). 

The main acute effect is inebriation, which in turn spawns violence, spousal and child abuse, crime, motor vehicle accidents, workplace and home accidents, drowning, suicide, and accidental death. The chronic effects include alcoholism, liver disease, various forms of cancer, brain disorders, cardiovascular disease and other organ system effects, absence from or loss of work, family dysfunction, and malnutrition. 

Folic acid is a nutritional supplement frequently used during periods of deficiency. Folic acid needs increase during chronic diseases, such as malabsorption liver disease, alcoholism, and anticonvulsant or oral contraceptive use. Folic acid supplementation during pregnancy is strongly recommended to prevent neural tube defects to the unborn child. The active form of folic acid, folinic acid, is used in the management of certain medical diseases (e.g., patients taking methotrexate, and 5-fluorouracil). 

Acid-base balance Of 16 patients with hepatic cirrhosis and chronic hepatitis B infection, five developed lactic acidosis after 4—240 days of treatment with entecavir all five had highly impaired liver function [13 ]. One patient died, but in the other four the lactic acidosis resolved after withdrawal of entecavir. The serum lactate concentrations were not increased in the other 11 patients, who all had less severe liver impairment. Child-Pugh scores did not correlate with the development of lactic acidosis, but MELD (Model for End-Stage Liver Disease) scores did, as did serum bilirubin, creatinine, and international normalized ratio (INR). The authors suggested that entecavir should be used cautiously in patients with severely impaired liver function. 

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