Incidental hypertransaminasemia in children—a stepwise approach in primary care

Abstract

Children with elevated liver enzymes are occasionally discovered through laboratory work-up from different clinical scenarios. Although the majority will have transient and/or benign conditions, a subgroup will have underlying liver disorders. The differential diagnosis is broad and therefore, a systematic approach is of utmost importance. In this article, we reviewed the most recent and relevant literature to provide a comprehensive overview of the main disease processes that cause hypertransaminasemia in children. Ultimately, we propose a practical stepwise approach to guide primary care physicians in the evaluation of abnormal liver enzymes in asymptomatic children. The first step is to obtain a complete history along with a thorough physical examination to exclude red flags, which should dictate urgent consultation with a paediatric gastroenterologist or hepatologist. Conclusion : Hypertransaminasemia is a challenging scenario in the primary care setting. The aetiology can be broad, ranging from hepatic and extrahepatic to transient versus chronic liver disease. Timely referral to a specialised centre is of paramount importance for conducting targeted research and to not miss the chance of identifying a progressive, but still asymptomatic, treatable liver disease. What is Known: • Elevated liver enzyme is a challenging scenario in the primary care setting. • There are few studies guiding the evaluation of asymptomatic hypertransaminasemia in the paediatric population and a standardised approach is lacking. What is New: • We propose a practical stepwise approach to guide primary care physicians in the evaluation of abnormal liver enzymes.

Infant liver biochemistry is different than current laboratory accepted norms

“…Our follow-up extended up to 3 years of life, and there was no indication to further investigations on liver function in any of the children [ 1 ]. A recent review suggested to conclude follow-up of an asymptomatic patient with normal physical examination and normal values of liver function tests in the presence of two consecutive normal tests 1 month apart [ 11 ].…”

Nguyên Nhân Tăng Men Gan Ở Trẻ Em Điều Trị Tại Trung Tâm Nhi Khoa - Bệnh Viện Trung Ương Thái Nguyên

“…Kết quả nghiên cứu cũng tương tự như của Sanrni và cộng sự tại Thổ Nhĩ Kỳ cho thấy 194 (66,4%) là nam, (33,6%) là nữ, tuổi trung bình từ 6,5±5,4 tuổi [5]. Nghiên cứu của Costa (2023) [8], của Serdaroglu (2016) cũng tương tự [1].…”