Pediatric liver disease includes dozens of conditions with similar symptoms, but different causes and treatments. At Doernbecher, your child will get the care they need for their condition.
We offer leading-edge treatment, including:
- Care from the only board-certified pediatric hepatologist (liver specialist) in Oregon.
- Thorough testing to find the cause of your child’s symptoms.
- Access to programs that help with anxiety, sleep and nutrition.
- A team of doctors working together to find the best solution for your child.
- Advanced medical and surgical options.
Understanding pediatric liver disease
The liver is part of the digestive system and the largest organ in the body. One of the liver’s most important jobs is to remove toxins from the blood. It also helps with digestion, metabolism and keeping the body safe from infection. Sections of the liver are called lobes. Inside the liver are bile ducts, the portal vein and the hepatic artery.
- Bile ducts are tubes that carry bile out of your liver. The liver makes bile (a yellow fluid) to help the body break down and absorb fats.
- The portal vein carries blood to the liver from the intestines. It supplies the liver with 80% of the blood it needs.
- The hepatic artery supplies the remaining 20% of the blood your liver needs. The hepatic artery carries blood to the liver from the heart.
What is pediatric liver disease?
Liver disease can happen when the bile ducts, portal vein or hepatic artery are not working correctly. There are many reasons that parts of the liver stop working well, and the liver is also impacted by other parts of the digestive system.
Who gets pediatric liver disease?
Each year in the U.S., 1 in 2,500 babies is born with liver disease. 15,000 children are hospitalized with liver-related conditions each year. Children of any age, sex and race can develop liver disease.
What causes pediatric liver disease?
Pediatric liver disease has many causes, including:
- Genetics or hereditary factors. Some babies have genes that cause liver disease.
- Autoimmune problems (autoimmune means the body mistakenly attacks itself).
- Infections, usually caused by viruses.
- An injury to the liver.
- Exposure to toxins, like accidentally ingesting a poisonous chemical or taking too much medication (like Tylenol) at once.
Pediatric liver disease is usually not caused by lifestyle factors, like alcohol use or unhealthy diets.
Signs and symptoms of pediatric liver disease
Some signs of pediatric liver disease increase slowly over time. Others appear suddenly. If your child has any of these symptoms, take them to their pediatrician:
- Jaundice (yellowing of the skin and eyes)
- Itching, especially on the hands and feet and at night
- Abdominal pain and/or swelling
- Trouble sleeping or feeling very tired during the day
- Nausea and vomiting
- Grey or pale stool
- Loss of appetite
- Losing weight or not gaining weight
Some symptoms of liver disease need immediate medical attention. If your child has any of the following symptoms, call 911 or take them to the emergency room:
- Black, tarry stool
- Severe abdominal pain
- Vomiting blood (sometimes this looks like coffee grounds)
Conditions We Treat
At Doernbecher, we treat genetic, metabolic, autoimmune and neonatal liver conditions, including:
Acute liver failure is sudden and severe. It happens when a child is exposed to a toxin that harms the liver. Viral hepatitis is a common cause of acute liver failure. Overdosing on drugs, including over-the-counter medicines like Tylenol, can also cause acute liver failure.
In Alagille Syndrome, babies are born without enough bile ducts to remove bile (or waste) from the liver. This causes bile to build up in the liver, which leads to liver damage.
This disease is caused by a genetic mutation that means the body does not produce enough of an important enzyme. This leads to abdominal swelling and jaundice.
Benign tumors and cysts are non-cancerous masses on the liver. Some babies are born with tumors or cysts, or they can also appear later. A surgeon can remove big or bothersome masses. Rarely, tumors are malignant, or cancerous. In these cases, we refer children to Doernbecher’s pediatric cancer specialists.
Biliary atresia is a congenital disease, which means babies are born with it. It is a blockage in the tubes (bile ducts) that carry bile away from the liver.
GALD is a congenital disease, which means babies are born with it. Cells in the baby's liver don’t respond correctly to protective proteins (antibodies) in the mother's blood. GALD can lead to severe liver damage or liver failure.
Hepatitis is inflammation of the liver, often caused by a virus. Several viruses can cause hepatitis, and they are passed through fecal matter and blood. Some children have an autoimmune problem that causes hepatitis. A baby may be born with hepatitis, if their mother has it.
Many babies are born with jaundice. It happens when bilirubin (a yellow pigment the body makes) moves through the body too slowly. Jaundice usually goes away on its own within a few weeks. But jaundice is also a symptom of other liver problems. If it does not go away, it is important to find out why.
NAFLD is the build-up of too much fat in the liver. This can cause inflammation, irritation, and cirrhosis (severe scarring).
In PSC, bile ducts are so inflamed and scarred that they can’t carry bile (waste) away from the liver. Over time, PSC causes the bile ducts to be completely blocked and can lead to liver failure. Doctors are not sure what causes PSC, but many people who have it also have inflammatory bowel disease (IBD).
PFIC is caused by a genetic mutation. Bile can’t drain from the liver and toxins build up, leading to liver failure.
This rare genetic disorder stops the body from getting rid of copper. This leads to excess copper in the liver and brain.
Diagnosing pediatric liver disease
If your child has symptoms that could be liver disease, we have many tests to help us find the cause. These tests include:
Blood tests: This simple blood draw is called a liver panel. The results show how well your child’s liver is working.
Ultrasound: We take pictures of your child’s liver, from outside the body, with a handheld ultrasound device called a transducer. Sometimes, your child will need to stop eating or drinking a few hours before an ultrasound.
Liver biopsy: A surgeon will take a very small piece of your child’s liver so doctors can see it under a microscope. For this test, your child will be asleep and will not feel pain.
Imaging and scans: We have many tools available that help us look closely at your child’s liver. Depending on which we use, your child may need to stop eating or drinking a few hours before the test. For some tests, they will drink a special liquid called contrast to help us see the liver better. Our imaging tools include:
- CT scan (computerized tomography)
- MRCP (magnetic resonance cholangiopancreatography)
- MRI (magnetic resonance imaging)
- HIDA scan (hepatobiliary iminodiacetic acid)
- Cholangiogram (an X-ray for the bile ducts)
ERCP (endoscopic retrograde cholangiopancreatography): We place a camera on a long and flexible tube into your child's throat. This lets us see their digestive system from the inside. Your child will be asleep during ERCP, and will not feel pain. They will need to stop eating or drinking a few hours before the test.
Pediatric liver disease treatments
Your child’s treatment will depend on their condition and symptoms. Some types of pediatric liver disease are hard to treat. Often, the best treatment is to manage symptoms.
Medication: There are many medications that help with liver disease symptoms, like itching, abdominal pain and inflammation. We have medicines that help bile flow more easily and medications to treat specific diseases, like hepatitis.
Nutrition: Many children with liver disease struggle to get the nutrients they need. Our dietitians may recommend a special diet or tube feeding. Babies with liver disease may need a special infant formula that they can digest more easily than breastmilk or regular formula.
Surgery: Surgery can help with many liver disease symptoms and conditions. If your child needs surgery, our skilled Doernbecher pediatric surgery team can help. We offer many advanced and less invasive surgical options.
In rare cases, the only treatment option is a liver transplant. A liver transplant is a surgery to replace an unhealthy liver with a healthy liver from a donor. The liver usually comes from someone who has died. Sometimes, a living person may donate a piece of their liver.
The most common reason a child needs a liver transplant is biliary atresia. If your child needs a liver transplant, we will work with a pediatric transplant center at another hospital in our region. Our goal is to get them the best care available.
How to reach us:
- Refer your patient to OHSU Doernbecher.
- Call 503-346-0644 to seek provider-to-provider advice.
- Fax patient records and gastroenterology related lab work to 503-346-6854.
Medical treatment guides: