Hepatitis is a general term that simply means inflammation of the liver. There are many different causes of hepatitis in children.

Megan Butler, MD, an expert in pediatric hepatology at Duke, explains what hepatitis is and how it is treated. 

-- Dennis Clements MD, PhD, MPH

Megan Butler, MDHepatitis may be sudden onset (acute) or chronic (long standing). There is a wide range of clinical finding with hepatitis depending on the severity of the inflammation. 

Hepatitis may be mild and self-limiting and resolve with no treatment, or it may become chronic and lead to liver failure requiring liver transplant.

If the cause of the hepatitis can be treated quickly, the liver is likely to recover fully.

Causes of Hepatitis

Hepatitis has numerous causes. The following is a short list of possible causes of hepatitis and some examples of each:

• Infections: Viral, hepatitis A, hepatitis B, hepatitis C, fungal
• Toxin/medication: Tylenol overdose, poisonous mushrooms, alcohol
• Autoimmune: Immune cells of the body mistaking the liver cells as foreign and attacking the  healthy liver
• Genetic/metabolic: Cystic fibrosis, Wilson’s disease (copper buildup in liver), hemochromatosis, alpha-1-antitrypsin deficiency
• NAFLD: Fatty liver usually associated with obesity and metabolic syndrome

Hepatitis Symptoms

The symptoms of hepatitis are similar regardless of the cause of inflammation.

Initially your child may have non-specific flu-like symptoms including fever, fatigue, muscle aches, vomiting, diarrhea and rash. Abdominal pain, yellowing of the skin and eyes (jaundice), and dark urine may occur. A doctor may notice enlargement of the liver on exam.

As hepatitis becomes chronic, the liver may actually become smaller as inflammation is replaced by scarring (fibrosis) of the liver. Extensive scarring of the liver can lead to cirrhosis.

The liver may be unable to produce the proteins needed for normal body functions. This can lead to swelling of the abdomen with fluid (ascites), fluid accumulation of the legs, enlargement of the spleen, or easy bleeding and bruising.

Varices may develop. These are enlarged veins in the esophagus, stomach, intestine, and other organs that may produce life-threatening bleeding. Severe hepatitis may lead to problems with other organ systems such as lung, kidney, and central nervous system as well.

Diagnosis of Hepatitis

It is important to seek medical attention if you notice yellowing of your child’s eyes or skin. Your doctor will likely obtain laboratory testing to identify the extent of liver involvement as well as measures of the function of the liver.

They will also send tests to determine the cause of the hepatitis. They may obtain radiology studies of the liver (ultrasound, MRI, etc.).

At times, a biopsy of the liver is most informative. This is a procedure where a piece of liver tissue is obtained to be evaluated under a microscope.

Hepatitis Treatment

Treatment for hepatitis involves largely supportive therapy. Medications may be used to correct any abnormalities associated with liver dysfunction. Your child may be admitted to the hospital for observation or treatment.

Severe cases of hepatitis can cause significant dysfunction and be life threatening. These patients are critically ill and require careful monitoring in the intensive care unit. They may be placed on a ventilator to support breathing. They may require dialysis to support kidney function.

Medications and other techniques may be needed to maintain neurologic status. Significant bleeding is a risk with severe hepatitis and may require a procedure or surgery to stabilize.

If the underlying cause of hepatitis can be found, therapy may be direct toward that as well. In severe cases, liver transplant may be an option.

Prognosis

Prognosis for hepatitis is extremely variable. Some cases are transient mild elevation of liver enzymes that resolve with no intervention. These patients will typically have no further episodes of hepatitis and no future liver problems.

Other cases of hepatitis can lead to chronic hepatitis. These patients need to be followed by a pediatric gastroenterologist or pediatric hepatologist (liver doctor) and their liver function followed closely. They may need medications to maintain liver function, but otherwise can be fairly healthy and active. They may be at risk for liver cancers later in life. Severe cases may lead to liver failure.

It is important to see your doctor immediately if you think your child has any symptoms of hepatitis. Severe cases of hepatitis need to be evaluated by a pediatric liver transplant center as soon as possible.

-- Megan W. Butler, MD, is an assistant professor in Duke Pediatrics' Division of Gastroentorology, Hepatology, and Nutrition.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.