Transcript Epidemiology of chronic liver disease in Sudanese children

Dr. Omaima M. Sabir
Pediatric Gastroenterologist
Khartoum, Sudan
Introduction
 Chronic liver diseases in Sudanese
children are significant problem.
 The etiology of which have never been
determined before.
Objectives
 To determine the pattern of and the
histological features of chronic liver
diseases at Gaafer Ibn Auf Specialized
children hospital in Khartoum over the
last 3 years.
Methodology
 Prospective study of all children under
15 years of age who underwent liver
biopsies for :
 Prolonged jaundiced for > 6 weeks.
 Hepatomegaly.
 Persistent abnormal LFT.
 Portal hypertension.
Methodology/2
 Clinical and laboratory data were received.
 All liver biopsies slides were received by two
histopathologists and the author to confirm the
diagnosis.
 All the biopsies were taken by U/S guidance
technique using either true cut or suction needle
according to the age and the clinical status of the
child.
Results
 315 children were biopsied.
Age
No
M:F
Diagnosis
6/52 – 1 year
125
74 : 51
NH, BA,PFIC, syndromic &non
syndromic PDP, Metabolic LD
1 – 5 years
70
49 : 21
Fatty liver, viral & infectious,
metabolic, PFIC
5 – 15 years
120
80 : 40
Liver cirrhosis, viral &
infectious, AIH, HCC,
Metabolic, PFIC
Causes of chronic liver diseases in
infancy
Causes
NO
Neonatal Hepatitis
62
Billiary Atresia
22
Progressive familiar intrahepatic cholestasis
21
Metabolic liver diseases
13
Bile duct paucity (Syndromic & non Syndromic)
12
Miscellaneous
5
TOTAL
125
Causes of CLD in age group from
1 – 5 YEARS
Causes
NO
Fatty liver diseases
29
Viral hepatitis
20
Tropical (infectious) hepatitis
10
Metabolic liver diseases
5
Progressive familiar intrahepatic cholestasis
3
Miscellaneous
3
TOTAL
70
Causes of CLD in age group from
5 – 15 years
Causes
NO
Liver cirrhosis
60
Infectious hepatitis
23
Periportal fibrosis
10
Autoimmune hepatitis
7
Hepatocellular carcinoma
10
Metabolic liver diseases
7
Progressive familiar intrahepatic cholestasis
2
Miscellaneous
1
TOTAL
120
Discussion
 In infancy still neonatal hepatitis is the commonest
pathology in our country, congenital hepatitis still
encountered for the majority followed by sepsis.
 Billiary atresia is found to be high incidence compared
to the developed country and usually presented quite
late.
 Relevant high incidence of familiar hepatic disease due
to consanguinity who they don’t usually survive into
older age.
Discussion/2
 Fatty liver diseases compose of the majority of findings
in the age group 1 – 5 years followed by viral and
infectious hepatitis, which can be explained by
malnutrition and endemicity of hepatitis B and C.
 Metabolic and hereditary liver diseases are obvious
coming to small percentage could explain the natural
survival.
 The astonishing findings of high incidence of liver
cirrhosis in age group 5 – 15 years lead to the question.
Discussion/3
 ? Fatty liver is not as innocent as we thought.
 ? Presence of specific type of childhood cirrhosis in
our country.
 The impact of hepatitis B infection in our children.
 Periportal portal fibrosis surprisingly was not as high
as one expected, but that could be mainly because we
diagnose by sonography or it has been looked after by
our adult colleague.
 Micronodular and mixed cirrhosis were the main types
of cirrhosis which are identified.
Conclusion
 Liver diseases have a major impact among our
children.
 Late referral of prolonged neonatal jaundice.
 The possibility of specific type of childhood cirrhosis
in Sudan.
 High incidence of hepatocellular carcinoma in
Sudanese children.