From the Guidelines
Elevated liver enzymes in children are most commonly caused by nonalcoholic fatty liver disease (NAFLD), viral hepatitis, and autoimmune hepatitis, as well as other conditions such as alpha-1 antitrypsin deficiency and Wilson disease, as supported by the most recent study 1. The causes of elevated liver enzymes in children can be varied and multifactorial.
- Viral hepatitis, including hepatitis A, B, C, E, and other viruses like Epstein-Barr and cytomegalovirus, is a common cause of elevated liver enzymes in children.
- Medication toxicity, from drugs like acetaminophen, valproic acid, and certain antibiotics, can also lead to elevated liver enzymes.
- Autoimmune hepatitis, metabolic disorders such as Wilson's disease, alpha-1 antitrypsin deficiency, and glycogen storage diseases, are other potential causes.
- Fatty liver disease, increasingly common due to childhood obesity, is another significant cause of elevated liver enzymes in children.
- Biliary tract disorders, like biliary atresia and choledochal cysts, can also lead to elevated liver enzymes. When evaluating a child with elevated liver enzymes, a thorough assessment should include a detailed medical history, physical examination, and appropriate laboratory tests to determine the underlying cause. The pattern of enzyme elevation can provide diagnostic clues, with predominantly elevated aminotransferases (ALT, AST) suggesting hepatocellular injury, and elevated alkaline phosphatase and gamma-glutamyl transferase indicating biliary tract involvement, as noted in the study 1. Early identification of the cause is crucial, as some conditions require prompt intervention to prevent progressive liver damage, and treatment depends entirely on the underlying cause, ranging from supportive care for viral infections to specific medications for autoimmune conditions or dietary modifications for metabolic disorders, as discussed in the study 1.
From the Research
Common Causes of Elevated Liver Enzymes in Children
Elevated liver enzymes in children can be caused by various factors, including:
- Viral hepatitis, as mentioned in the study 2
- Genetic liver diseases such as Wilson's disease or hemochromatosis, as discussed in studies 2, 3, and 4
- Drug-induced liver diseases, as noted in study 2
- Alpha-1 antitrypsin deficiency, as explored in studies 5, 3, 4, and 6
- Cholestatic liver diseases, as described in study 2
- Non-alcoholic fatty liver disease, as mentioned in study 2
- Infiltrating liver diseases, as noted in study 2
Diagnostic Approaches
To diagnose the underlying cause of elevated liver enzymes in children, the following approaches can be taken:
- Ultrasound study to discern intra- from extrahepatic cholestasis, as suggested in study 2
- Isoelectric focusing for identifying alpha-1 antitrypsin phenotypes, as performed in study 5
- Histopathological examination, as done in study 5
- Molecular analysis of AAT and HFE genes, as mentioned in study 3
- Non-invasive diagnostic tests, such as those reviewed in study 6
Importance of Early Diagnosis
Early diagnosis of the underlying cause of elevated liver enzymes in children is crucial to initiate specific treatment and prevent irreversible organ damage, as emphasized in study 6