WHAT IS LIVER FAILURE IN CHILDREN?

The liver is an important organ in the human body as it filters out toxic or harmful chemicals from the blood, helps digest food, stores & releases energy, makes proteins to build the body’s cells & tissues and allows the blood to clot.

Liver failure happens when the liver becomes sick and/ or damaged. This hampers the functioning of the liver, either partly or completely. While it is rare, this can happen even in children. Most of the children are able to recover well, but some children become extremely sick and some children might need a liver transplant to survive.

There are two types of liver failure that can happen in children:

Acute Liver Failure: This type of liver failure happens suddenly and it occurs even in children who do not have a history of liver disease.
Chronic Liver Failure: This type of liver failure happens when a long-lasting liver disease worsens, either slowly or suddenly.

WHAT CAUSES LIVER FAILURE IN CHILDREN?

Live failure, although rare, is possible in children of any age. The reasons for liver failure vary and can be due to different types of injury and/ or disease.

CAUSES OF ACUTE LIVER FAILURE:

In many cases, the exact cause of liver failure cannot be found, however, some known causes of acute or sudden liver failure are:

Viruses such as herpes (HSV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) or hepatitis A, B & E.
Certain inherited metabolic disorders, such as
- Galactosemia – a disorder that affects how the body processes a simple type of sugar called galactose and that leads to the inability to use galactose to produce energy.
- Tyrosinemia – a genetic disorder that is characterized by disruptions in the process that breaks down the amino acid tyrosine, a building block of most proteins.
- Hereditary Fructose Intolerance (HFT) – a disorder in which a child lacks the protein that is needed to break down fructose.
- Wilson Disease – an extremely rare inherited disorder that prevents the body from getting rid of extra copper. A small amount of copper is necessary to remain healthy, however too much copper can be poisonous.
- Mitochondrial Diseases: Mintochondria are known as the body’s energy factory. Mitochondrial diseases are long-term, genetic, often inherited disorders that happen when the mitochondira fail to produce enough energy for the body to function properly.
Toxins, such as some cleaners, rat poison, insect killers, wild mushrooms etc.
Problems of the body’s immune system, such as autoimmune hepatitis.
Low blood flow to the liver – during heart failure, shock or when a blood vessel is blocked.

CAUSES OF CHRONIC LIVER FAILURE:

Chronic liver failure or slowly developing long-term liver failure happens most often when a child has developed cirrhosis i.e. severe scarring of the liver. This cirrhosis could be a result of some of the conditions listed above, other possible causes of chronic liver failure include:

Chronic hepatitis, such as hepatitis C, autoimmune hepatitis or non-alcoholic steatohepatitis (a severe form of fatty liver disease).
Inherited conditions, such as hemochromatosis – a condition in which extra iron is built up in the body and could lead to harmful levels – or cystic fibrosis (a disease that affects the lungs)
Heart issues that reduce the supply of blood to the liver or that lead to a backup of blood flow in the liver.
Diseases of the bile ducts, such as biliary atresia – blocked or incompletely formed bile ducts in babies or sclerosing cholangitis – chronic inflammation of the bile ducts.

WHAT ARE THE SYMPTOMS OF LIVER FAILURE IN CHILDREN?

The symptoms of liver failure, at first, can be mistaken for any other common childhood illnesses, such as the flu. The early symptoms of liver failure are fatigue (a feeling of being tired all the time), nausea or vomiting, loss of appetite, and abdominal pain.

As the condition progresses and the liver failure gets worse, the symptoms may include:

Dark urine
Jaundice
Itching all over the body
Bruising easily or bleeding for a long time
Swollen abdomen from fluid build-up
Brain issues, such as confusion, irritability, unusual sleepiness during the day and/ or sleeplessness at night

HOW IS LIVER FAILURE DIAGNOSED IN CHILDREN?

In the early stages, liver failure can be difficult to diagnose because the symptoms are similar to many other illnesses, and as the symptoms appear, the gastroenterologist will action some tests to confirm the diagnosis. These tests are done to check for the following:

Levels of bilirubin – high bilirubin levels could lead to jaundice
Levels of liver enzyme levels
Problems with blood clotting
Signs of damage to the brain (encephalopathy)

OUR APPROACH TO TREATMENT:

The right approach to treatment of liver failure in children largely depends on the cause of the liver failure, and basis that, the gastroenterologist chooses from the following options:

Wait & Watch:
While a child with acute liver failure will have to be admitted to the hospital where the doctors can closely observe and provide supportive treatment, such as IV fluids and medicines for nausea and abdominal pain, this condition might get better on its own. This happens when the cause of the liver failure are certain viruses.
Medicines:
If the acute liver failure is caused by some heart issues or toxins, it can be treated with medicines. Chronic liver failure always requires long-term care by a liver specialist who may prescribe various medications that help treat or prevent related complications, such as vitamins, antibodies, diuretics (water pills), drugs to help reduce blood pressure and/ or medicines to help against sleepiness or confusion.
Liver Transplant:
Unfortunately, about half of all the children with acute liver failure and many children with chronic liver failure, eventually, have to get a liver transplant to survive. A liver transplant is a complicated procedure. In younger children, it is sometimes possible to use part of a liver from a compatible living donor who is old and big enough, generally healthy and has the same blood group.

After a liver transplant several precautions need to be taken along with special medicines that include some anti-rejection drugs that help the body adjust to the new organ and some that help prevent complications, such as infections, blood clots, high BP and stomach problems.

Liver Transplantation is highly regulated, and can only be performed at designated transplant medical centres, like ours, by highly trained transplant physicians and supporting medical team. In case you have any questions, do feel free to contact Dr. Deepak Goyal, who would be most happy to put all your doubts to rest.

WHAT ARE THE COMPLICATIONS OF LIVER FAILURE IN A CHILD?

Liver failure in a child may lead to the following complications:

Enlarged liver or spleen
Build-up of fluid in the abdomen (Ascites)
Blood not being able to clot normally
Jaundice
Bleeding in the oesophagus (food pipe), stomach or intestine
Brain issues, such as confusion or disorientation
Kidney issues causing the body to not make enough urine
infections

WHAT SHOULD YOU, AS A MOTHER DO WHEN YOUR CHILD IS DIAGNOSED WITH LIVER FAILURE?

When and unfortunately if your child has been diagnosed with liver failure, your best source of information is your child’s paediatrician, who will work with you to give your child the best possible chance of recovery. However, you, as a mother can do the following:

Understand everything you possible can about recommended treatments – know about the benefits and downsides
Ensure that your child takes all the medicines as prescribed
Keep an eye out for any side effects of the medicines on your child
Do not, we repeat, DO NOT give any medications or drugs, home remedies, herbs or supplements that haven’t been specifically prescribed for your child without speaking to your child’s doctor.
Ask and follow specific diets that are recommended for your child.
Ask about what forms of exercises are safe for your child and also about what activities should strictly be avoided.
Contact your child’s doctor IMMEDIATELY if you notice some concerning changes in how your child looks, feels or behaves.