Cirrhosis in children and adolescents: An overview

Table 4 Investigation of chronic liver disease and cirrhosis in childhood and adolescence

Hematology

Hemoglobin, leukocyte and platelet count, prothrombin time (INR)

Coombs test, blood type, Rh factor

Biochemistry

Bilirubins

Transaminases

Alkaline phosphatase

Gamma-glutamyl transferase

Albumin and globulin

25-OH vitamin D, parathyroid hormone, calcium, phosphorus, magnesium

Urea, creatinine

Lactic acid, fasting blood glucose, uric acid

Serum transferrin and ferritin saturation

Serum ceruloplasmin and copper, 24 h urinary copper (if age > 3 yr)

Alpha-1-antitrypsin phenotype

If ascites present

Paracentesis (in case of fever or sudden-onset ascites):

Cell count, albumin, total protein, neutrophil count

Amylase, cytology, PCR and mycobacterial culture (according to clinical suspicion)

Serum sodium, potassium, bicarbonate, chloride, urea and creatinine

Urinary sodium excretion

Immunology

Smooth muscle, mitochondrial, anti-nuclear, anti-LKM-1 antibodies

Hepatitis B antigen

Anti-HCV

α-fetoprotein

Immunoglobulins

HIV serology

Genetic-metabolic diseases

Metabolic screen (urine and serum amino acids, urine organic acids)

Genetic tests (if alpha-1-antitrypsin deficiency, Alagille syndrome, etc., suspected)

Sweat electrolytes test

Urine and serum analysis for bile acid and acid precursors (if PFIC suspected)

Bone marrow examination and skin fibroblast culture (if glycogen storage disease suspected)

Other:

Endoscopy (if prophylactic treatment is considered)

Abdominal ultrasound (computed tomography or MRI in selected cases)

Needle liver biopsy (if blood coagulation permits)

EEG (if neuropsychiatric changes present)

Adapted from: McCormick[57], 2011; Högler et al[35], 2012. LKM-1: Liver/kidney microsomal; PFIC: Progressive familial intrahepatic cholestasis; MRI: Magnetic resonance imaging; INR: International normalized ratio; HIV: Human immunodeficiency virus.