The liver is a vital organ that serves as the chemical factory of the body.  When the liver stops working, a child can become sick quickly.  Minor liver dysfunction may go unnoticed because symptoms do not appear until most of the liver has been affected.  The cause of acute liver failure in children is often not discovered, but some of the known causes are toxins, medications, infections, bile obstruction, and metabolic diseases.  Symptoms of liver dysfunction are jaundice (yellow skin color), scleral icterus (yellow color to the white part of the eye), pale stools, dark urine, unexplained bleeding and bruising, ascites (fluid buildup in the body), and encephalopathy (changes in mental ability or wakefulness).  Treatment for liver dysfuction involves removing the offending agent if possible and supportive care while the liver recovers.  For liver failure, sometimes a liver transplant is necessary.

What causes liver failure or dysfunction?

• Infections - Hepatitis A, hepatitis B, Epstein-Barr virus (EBV), cytomegalovirus (CMV), paramyxovirus, varicella-zoster virus, herpesvirus, parvovirus and adenovirus.  Severe bacterial infections of many types can cause liver dysfunction, especially in newborn infants.
• Metabolic diseases - These diseases often show symptoms or liver dysfunction shortly after birth.  Examples include: galactosemia, tyrosinemia, fructosemia, and neonatal iron storage disease.  Alpha-1-antitrypsin deficiency and Wilson disease may present in older children.
• Medicines or toxins - The majority of medications available for children are processed, at least partially, by the liver.  Medicines may cause mild, temporary damage, or in rare cases may lead to liver failure.  One of the most recognized causes of medicine-related liver failure is acetaminophen (Tylenol) overdose.
• Bile duct blockage - Congenital disorders of bile drainage include biliary atresia and Alagille syndrome.
• Vascular problems - Heart disease, sepsis, shock and blood clots.
• Other - Autoimmune hepatitis, cancers.
• Unknown causes - Close to half of all cases of liver failure in children are caused for unknown reasons.

What are the symptoms of liver failure or dysfunction?

• Jaundice (yellow skin color)
• Scleral icterus (yellow color to the white part of the eye)
• Itching
• Pale stools
• Dark, brownish urine
• Unexplained bleeding and bruising
• Ascites (fluid buildup in the body)
• Encephalopathy (changes in mental ability or wakefulness)

How is liver dysfunction evaluated?

• Blood tests of liver function and damage
• Ultrasound of the liver, bile ducts and blood vessels
• Liver biopsy

How is liver dysfunction treated?

• Remove the offending agent if possible (example - medications)
• Provide medical support (intravenous fluids, electrolytes, glucose, blood products, etc.)
• For Tylenol overdose an antidote is available.
• Most cases of liver dysfunction will improve with time.

How is liver failure treated?

If the liver is unable to recover on its own, liver transplantation may be necessary.  This could be a partial liver from a live donor or a whole liver from a deceased donor.