As a rule, in children most often we are talking about the development of intrahepatic cholestasis, less often - extrahepatic. In the vast majority of cases, the causes of extrahepatic cholestasis are congenital malformations of the biliary tract: atresia or stenosis of the common bile duct. Cases when there is an obstruction from the inside outflow of bile (closing the lumen with gallstones), in children's practice is a rather rare phenomenon.
Causes
The causes of moderate cholestasis in children, as a more common form in children's practice, are:
- congenital metabolic defects of certain enzymes that are involved in the biosynthesis and conjugation of bile acids;
- tubular secretion disorders (progressive familial cholestasis);
- metabolic diseases that can occur with or without involvement of the biliary tract (defects in the oxidation of fatty acids);
- Alagil syndrome is a rare genetic disease that is the most common cause of neonatal cholestasis;
- sclerosing cholangitis, which manifests itself as a narrowing of the walls of the bile ducts as a result of inflammatory changes in them;
- viral agents: viral hepatitis A, B, C, D, E, F, Epstein-Barr virus;
- uncontrolled administration of drugs such as Erythromycin, Ampicillin, Furazolidone, Furadonin;
- helminthic infestations, which are quite common in children.
How to identify the disease?
Most parents are interested in the question of what symptoms and signs can determine the presence of the disease. Doctors say that the symptoms of cholestasis in children can be different, since a lot depends on the age of the child, the individual characteristics of the child's body, as well as on the form of this serious disease.
Symptoms
One of the very first external signs that can be detected immediately is a strong and constant skin itch, accompanied by a rash, although this symptom is most often observed in adolescents, it is much less common in young children. Parents should immediately contact their local pediatrician if the child has an itch, as well as a rash and peeling on the skin in the buttocks and abdomen. Some patients complain of severe itching and a rash on the legs as well as the arms. A common sign of cholestasis in very young children is jaundice, and you can determine it by a uniform yellowish tint of the skin of the whole body, as well as the face. In addition, the mucous membranes and whites of the eyes acquire a yellowish tint.
With cholestasis in children of any age, symptoms such as vomiting and severe sudden nausea can be observed, and parents should pay attention to such signs in the first place, since it is likely that the disease has gone into acute form, requiring quick and professional treatment. Feces in children with cholestasis become very light, and urine acquires a dark shade. All these manifestations of cholestasis can be accompanied by fever, indicating that the disease is progressing, and the condition of the child is getting worse.
Diagnostics
Diagnosis of cholestasis in children should be started as early as possible to avoid complications (cholestatic cirrhosis). Diagnostic requirements are an integrated approach and quick obtaining of research results for early initiation of therapy.
What does this procedure include?
First of all, this is a history taking. You need to pay attention to whether there are similar cases of the disease in the family, congenital malformations, hereditary diseases.
The next stage of diagnosis is laboratory research:
- clinical blood test;
- biochemical analysis of blood (total protein and its fractions);
- total bilirubin and its fractions, cytolysis enzymes - ALT, AST;
- thymol test, which reflects the protein-synthetic function of the liver;
- coagulogram (prothrombin index, fibrinogen);
- markers of blood cholestasis (in dynamics with an interval of 2-3 weeks): gamma-glutamintransferase (GGT), cholesterol, alkaline phosphatase, bile acids.
Well, of course, additional instrumental diagnostic methods (visualization of the hepatobiliary system of the child) will allow to finally confirm the diagnosis, such as:
- Ultrasound of the liver and gall bladder;
- retrograde cholecystocholangiography (RCP);
- magnetic resonance imaging (MRI) ;
- liver biopsy (morphological examination of liver tissue has a high evidence base): determination of the severity of bile stasis in the ducts.
Treatment
Cholestasis syndrome in children is stagnation of bile in the ducts of the gallbladder, which leads to the development of severe intoxication of the body, the formation of stones, allergic reactions, and poisoning of the liver. Diagnosis and treatment of this type of disease is carried out in a hospital. The doctor of the Department of Gastroenterology and Pulmonology, based on the results of a biochemical and general blood analysis, as well as ultrasound diagnostics, prescribes a comprehensive treatment for the disease.
As part of the therapeutic approach, the following can be used:
- the purpose of the diet;
- medicinal substances choleretic and for the treatment of the liver;
- antibiotics for fever.
- antihistamines;
- drugs to stabilize digestive function;
- probiotics, prebiotics;
- vitamin complex and folic acid;
- sorbents;
- in rare cases, an operation is performed to eliminate a malformation.
Diet therapy
The main recommendation of a nutritionist is to refuse fatty foods, as well as the complete exception: sweets, foods belonging to the class of highly allergenic (red fish, caviar, mushrooms, pork, veal, chicken, tomato, red fruits and berries, melon, watermelon, cocoa , white sugar, vegetable oil, nuts, sorrel).
In any quantities you can eat:
- greens - dill, parsley, green onions and onions (if they do not cause heartburn);
- green vegetables and fruits - pear, apple, zucchini, cauliflower, celery and so on;
- yellow and orange fruits - carrots, pumpkins, apples, bananas, bell peppers;
- freshly squeezed juices diluted with water in a ratio of 2: 1, canned is strictly prohibited;
- stewed fruit, it is better to pick the pick yourself, use white raisins, a green apple fresh, prunes without third-party additives, dried apricots.
- low-fat white fish - pollock, hake;
- meat - beef tenderloin, necessarily boiled, the broth is not used (in the process of cooking, water in the pan must be changed at least 3 times, instead of chicken, you can use turkey fillet, cook on the same principle as beef, completely drain the broth);
- vegetable soup;
- olive oil;
- quail egg - yolk;
- sweetener - cane sugar syrup (you can cook it yourself);
- salt only in solution;
- dairy products as recommended by a doctor.
Drug therapy
Treatment of cholestasis in children with specialized drugs is prescribed only in the case of free open bile duct. If there is a bend or small anomaly of the body of the gallbladder, then surgery is performed in emergency mode. What drugs are most often used in the treatment of cholestasis in a child of 5 years and above to normalize the general condition?
- Pancreatin or Creon. They belong to the group of enzyme-containing products that help to normalize the processes of digestion and the absorption of beneficial trace elements from food.
- Antibiotics. If a local inflammatory process has begun, broad-spectrum antibiotics are prescribed. But since such cases are extremely rare, the use of potent drugs is not necessary.
- Polysorb, Enterosgel, Lact-Filtrum. Sorbents remove toxins from the blood that inhibit the growth of immune cells to enable natural healing mechanisms.
- Antihistamines (tablets and drops against allergies). The most common occurrence of cholestasis is skin itching and a local allergic reaction, while the type of food is completely irrelevant. It occurs as a response of the immune system to an irritant - bile.
- Probiotics, prebiotics. The occurrence of problems with the gastrointestinal tract, violation of the bowel movement is one of the side effects of cholestasis. Therefore, to protect the intestines from the appearance of ulcers, polyps, ruptures of the mucous membrane and the development of microbial lesions, probiotics are prescribed. Beneficial lactobacilli soothe and protect the walls of the intestines, stomach, restoring natural peristalsis, the system of collecting beneficial trace elements and their cleavage.
- Ursosan, Ursofalk. Drugs for the treatment of the liver are prescribed in case of its increase (poisoning with harmful substances). Within 1 month from the date of discharge, the patient is required to take special funds for the purpose of complex treatment and prevention of the development of a chronic condition. After the course is completed, repeat blood tests for biochemistry and ultrasound are prescribed. This helps to make sure that the danger has passed and the general condition of the body is within normal limits.
- Vitamin complexes and folic acid. Appointed for rehabilitation purposes and for the prevention of the development of other conditions associated with impaired metabolic functions, hypovitaminosis, anemia, and so on.
Effects
There are many consequences of cholestasis for a child. For example, low bone density, the so-called osteoporosis. With the disease, the level of various vitamins in the blood decreases:
- a lack of vitamin K contributes to the appearance of bleeding, vitamin A - a decrease in vision, hemeralopia;
- gallstones that provoke the appearance of cholangitis;
- the liver loses its properties and there is a risk of renal failure;
- liver tissue can be replaced by connective tissue - this is cirrhosis of the liver.
Disease prevention
To reduce the risk of disease, it is recommended:
- to take children on long walks in the fresh air;
- carefully monitor the diet, namely, do not overeat and eliminate junk food (fast foods, junk drinks, a large amount of sweet, salty, fried);
- Exercise (there are even special exercises for stagnation of bile).
The most important and important thing is to prevent the onset of the disease, and in which case to diagnose it in a timely manner. You need to be very attentive to your child, because the symptoms are not always pronounced. If something causes suspicion, consult a doctor immediately, do not self-medicate. The most important thing that can be done for the child is to follow simple rules for the prevention of the disease.