PMID: 11560788Sep 19, 2001Paper

End-stage Liver Disease in Children

Current Treatment Options in Gastroenterology
Robert Squires

Abstract

The treatment of children with end-stage liver disease involves the coordinated management of nutritional deficiencies, ascites, pruritus, encephalopathy, and portal hypertension. The implementation of management strategies depends upon a parent or guardian to administer the plan in the context of a child at different stages of developmental, physiologic, emotional, and physical maturity. Fat-soluble vitamins (A, D, E, and K) and micronutrient levels should be monitored routinely and supplemented if deficient. In some patients, supplemental nutrition to provide additional energy and protein is needed to ensure optimal growth and development. Ascites often respond to spironolactone and sodium restriction, but may require the addition of a loop diuretic or even abdominal paracentesis. Pruritus significantly impairs the quality of life of patients and is typically treated with ursodeoxycholic acid, rifampin, or an antihistamine. Partial biliary diversion, or liver transplant in some instances, is necessary for patients with self-mutilating pruritus that results from intrahepatic cholestasis. Hepatic encephalopathy is poorly defined in infants and small children. Elevated serum ammonia serves as a surrogate marker for encephalopath...Continue Reading

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Citations

Mar 5, 2011·Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association·Praveen Sharma, Barjesh C Sharma
May 13, 2008·Gastroenterology·Mike A Leonis, William F Balistreri
Sep 5, 2006·Pediatrics·Laura P JamesUNKNOWN Pediatric Acute Liver Failure Study Group

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