Percutaneos Liver Biopsy in Pediatric Patient : Diagnostic Significance and Pattern of Liver Diseases

Liver disease has a wide varied range of diseases that affect liver. In pediatrics, liver diseases can be categorized according to the underlying cause into: Acquired liver disease (as viral hepatitis, non-viral hepatitis, fatty liver, etc.), Autoimmune liver disease (Type1 autoimmune hepatitis, type 2 autoimmune hepatitis; thats more common in pediatrics), Congenital anomalies (biliary atresia, biliary (choledochal) cyst, Alagille syndrome), Metabolic liver disorder, a group of diseases occur when there is an abnormal gene in the metabolic pathway resulting in affection of the enzyme function, structure or amount, and Genetic diseases of liver (as Alpha 1 Antitrypsin Deficiency thats the most common genetic cause of liver disease in children) (1). However, liver disease may be part of a syndrome. In general, liver diseases are often asymptomatic in children; however commonest presenting signs and symptoms include jaundice, vomiting, coagulopathy or hepatomegaly (2,3).

In neonates, the first week of life is the mean age of onset of biliary atresia and galactosemia; however, symptoms may present in infancy. Also, viral hepatitis is commonly asymptomatic in neonates. In case of infants and children below 5 years, they may experience more presentation in liver disease. For example; glycogen storage diseases, alpha-1 antitrypsin deficiency, autoimmune hepatitis and others are more presented in the first five years of life. In neonates, infants and children; liver diseases are more common in males rather than females, except in autoimmune liver diseases; females are more common (2).

Diagnosis of liver disease in pediatrics represents a challenge because the majority of pediatrics has no symptoms especially in the early stages. Diagnostic tools of liver disease vary between laboratory investigation as Complete blood count (CBC), Liver function test (LFT), Viral markers, etc., imaging as abdominal ultrasonography (US), abdominal Computed tomography (CT),magnetic resonance imaging (MRI) and / or liver biopsy (4).

Liver biopsy is considered the best diagnostic tool in multiple diseases of liver and help clinicians in decision making. There are several types of liver biopsy: Percutaneous Liver Biopsy (PLB): it is the less invasive and the frequent used modality that can be conducted through physical examination (percussion over the upper right quadrant of the abdomen) or by sonar guidance. Trans-jugular Liver Biopsy; this technique is performed when patient has severe liver disease and coagulopathies or haematological condition and PLB is contraindicated. Surgical or Laparoscopic Liver biopsy; although it provides a large specimen size, it is done when there is increased risk of bleeding or in ascites of unknown cause and according to European Society for Pediatric Gastroenterology Hepatology and Nutrition

(ESPGHAN) laparoscopic liver biopsy used after failure of previous PLB, evaluation of abdominal mass or large liver sample for enzymatic analysis (5).