Viral Hepatitis In Children

Causes Of Childhood Hepatitis

There are two main categories of hepatitis causes in children: infectious and noninfectious. 

Infectious Causes

Foreign substances that compromise the liver's structural and functional integrity are considered infectious agents. They are listed below. 

• Vives Hepatotropic -  The liver is the main organ affected by these viruses.
  • Hepatotropic viruses are classified into five categories: hepatitis A, B, C, D, and E viruses.
  • Hepatitis is also caused by a subclass of non-A-to-E viruses, which are hepatotropic viruses.
  • Infections of the system that result in hepatitis
  • The agents include HIV, Varicella Zoster virus, parvovirus B-19, Herpes Simplex virus, adenovirus, arbovirus, coxsackie, rubella, Epstein-Barr, cytomegalovirus, enterovirus, and adenovirus.
  Hepatitis can also result from leptospirosis, brucellosis, sepsis, histoplasmosis, amoebiasis, and tuberculosis. 

Non-infectious Causes

• Autoimmune Diseases: Systemic lupus erythematosus, primary sclerosing cholangitis, and autoimmune hepatitis are among them.
Tyrosinemia, alpha1-AT deficiency, and Wilson disease are examples of metabolic liver disorders.
• Disorders caused by drugs.
• The most frequent medication-induced hepatitis in children is caused by acetaminophen or paracetamol.
• Budd-Chiari syndrome, shock, and congestive heart failure are examples of hemodynamic events.
The disease of non-alcoholic fatty liver.
Anatomic anomalies include choledochal cysts and extra-hepatic biliary atresia.
• Acute inflammation of the liver is referred to as acute hepatitis. However, full clinical and biochemical recovery can happen in four to six weeks. 

In decreasing order, viral hepatitis, hepatitis A virus (caused in roughly 50% of cases in India), and hepatitis E virus (10–15%) are the most common causes of acute hepatitis in children.
• Viral hepatitis B: 7–17%
• Substances
Metabolic disorders of the liver

In 12–20% of instances, there is coinfection with two or more hepatotropic viruses. The hepatitis A and E viruses are the most frequent coinfections. Nonetheless, hepatitis B is a need for hepatitis D infection. 

Clinical Characteristics Of Hepatitis In Children

Many individuals have an early prodromal stage, which is absent in some; infants under one year old may be asymptomatic or exhibit modest symptoms. Fever, anorexia, vomiting, irritability, and tiredness are the hallmarks of the phase. Clinical icterus follows the menstruation, causing the patients to seek medical assistance. Patients may also exhibit extra-systemic illnesses including rashes and arthritis. Their frequency is higher in HBV and HCV. 

Dark urine from increased bilirubin excretion and white or clay-colored stools from decreased stercobilin synthesis
• Hepatomegaly, splenomegaly, and lymphadenopathy may be present in certain cases.
• Modified sensorium or bleeding symptoms point to potential problems down the road, such as fulminant hepatic failure or hepatic decompensation. 

Also Read: Pediatric TB - Guidelines, Diagnosis And Management

Pathogenesis Of Viral Hepatitis In Children

Hepatotropic viruses, first and foremost, induce hepatotoxicity and necrosis, particularly in the centrilobular region.

• They induce inflammation, which starts in the periportal area and progresses to the liver's lobules.
• Only hepatitis C virus infection results in fatty alterations; unless fulminant necrosis is present, the lobular architecture is unaltered. Hepatocytes frequently degenerate into balloons, though.
• The proliferation of iliary ductules occurs without ductule injury. 

Three biochemical change patterns. (overlapping one another):

• Elevated ALT and AST are a sign of transaminitis, which is brought on by cytotoxicity of liver cells.
• Conjugated hyperbilirubinemia caused by cholestasis manifests as dark urine and clay-colored feces.
• Acute inflammation-induced abnormal liver synthetic functioning leading to prothrombin time lengthening (bleeding symptoms), hypoalbuminemia, hypoglycemia, lactic acidosis, and hyperammonemia (leads to altered sensorium and encephalopathy).

The majority of instances are characterized by cytotoxicity and cholestasis, with aberrant synthetic functioning occurring in severe and late-stage cases of hepatitis. 

The prothrombin time is indicative of a factor 7-dependent extrinsic coagulation mechanism. The factor's half-life is the shortest, at two to four hours. Prothrombin time is extended when factor 7 activity is hampered by impaired synthetic function. Bleeding results from the prolongation.

Also Read: Rapid Acquisition Of Key Concepts Infections

Importance Of Urine And Stool Investigations

Urine 

Conjugated bilirubin is a sensitive early indicator of acute hepatitis that manifests prior to the onset of clinical jaundice.

• Late pre-icteric phase uribilinogenuria follows bilirubinuria.
• At the height of the disease, there is very little bilirubin flowing into the colon. Urobilinogenuria therefore vanishes.
• In many situations, its reappearance in the urine suggests recovery.

Stools 

Lower stercobilin levels—pale stools

• The return of color is a rough sign that healing is about to occur. 
• A sharp decline in AST and ALT along with an increase in bilirubin or PT suggests a very bad prognosis and a high death rate.
• For liver injury, altered synthetic function—which includes elevated PT—is the most significant indicator.

Also Read: Anaerobic Bacterial Infections In Children

Hope you found this blog helpful for your NEET SS Pediatrics Infections preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.