Cirrhosis in children and adolescents: An overview

Table 3 Evaluation of children and adolescents with cirrhosis

Clinical history

Age, sex, ethnicity

Pregnancy and birth data: Adverse events during pregnancy, maternal serologies, birthweight, neonatal cholestasis, surgery, TPN

Signs and symptoms of systemic disease: anorexia, fatigue, muscle weakness, failure to thrive

Nausea, vomiting, abdominal pain, diarrhea, dyspepsia

Jaundice, pruritus, discoloration of urine and feces

Abdominal distension

Peripheral edema

Bleeding - nose, gums, skin, gastrointestinal tract

Bone pain, fractures

Adolescence: Menstrual history

Previous medical history: Jaundice, hepatitis, drug use, blood transfusions, inflammatory bowel disease

Social behaviors (adolescence): Use of alcohol or other drugs, tattoos, piercings

Family history: Consanguinity, liver disease, autoimmune disease

Physical examination:

General: Anthropometric data (malnutrition or obesity), fever

Skin and extremities: jaundice, flushing or pallor, spider nevi, telangiectasias, palmar erythema, clubbing of the nails, xanthoma, Terry’s nails

Abdomen: Distension, prominent blood vessels, liver and spleen alterations (reduced liver size, splenomegaly)

Neurological alterations: Academic performance, sleep, asterixis, positive Babinski sign, mental status changes

Miscellaneous: Pubertal delay, gynecomastia, testicular atrophy, feminization

Adapted from: McCormick[57], 2011; Högler et al[35], 2012; Hsu[31], 2014. TPN: Total parenteral nutrition.