Kroni̇k Hastalığı Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

EnglishTürkçe

BÖLÜM


DOI :10.26650/B/CH32.2024.010.016   IUP :10.26650/B/CH32.2024.010.016    Tam Metin (PDF)

Kroni̇k Karaci̇ğer Hastalığı Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

Zerrin Önal, Özlem Durmaz

Kronik karaciğer hastalığı, karaciğer parankiminde ilerleyici hasar ve rejenerasyon sonucunda fibrozis gelişmesi ile geri dönüşümü olmayan değişikliklerin oluştuğu ve sonuçta sirozun ortaya çıkabildiği bir süreçtir. Çocukluk yaş grubunda önemli morbidite ve mortalite nedenleri arasında yer almaktadır. Prognozu ve tedavisi, hastalığın etiyolojisine bağlıdır. Etiyoloji tedavi edilebilir olanların yanı sıra potansiyel olarak tedavi edilebilir veya tedavi edilemez hastalıkları içerir. Hedef ilerleyici karaciğerin hastalığının önlenmesi veya ilerleme hızının yavaşlatılmasıdır. Çocuklarda kronik karaciğer hastalığı, sağlık hizmeti veren ekip için zorlu bir dizi tıbbi ve psikososyal sorunu içerir. Kronik karaciğer hastalığı olan çocuklarda en sık portal hipertansiyon ve /veya malnütrisyonun oluşturduğu komplikasyonlar gözlenir. Son dönem karaciğer hastalığı olan çocuklarda özellikle beslenme sorunları mortalite ve morbiditeyi doğrudan etkiler. Malnütrisyon fizyopatolojisi multifaktöriyeldir. Etkili bir şekilde yönetilmezse, bu durum karaciğer nakli öncesi sonrasında geç dönem sonuçları ve sağ kalımı önemli ölçüde etkiler. Optimal sonuçlara ulaşmak ve yüksek kaliteli pediatrik sağlık bakımı sağlamak için aşılama durumuna ve sağlık hizmetinin verildiği klinik ortama dikkat edilmesi elzemdir. Kronik hastalığın getirdiği sorunlar, çocuklarda ve ebeveynlerde yaşam kalitesinde bozulma ve azalmayla birlikte tedaviye uyum zorluğunu da beraberinde getirir. Kronik karaciğer hastalığına bağlı gelişebilecek tibbi ve psikososyal komplikasyonlar sağ kalımı ve yaşam kalitesini doğrudan etkileyeceğinden bunların ön görülmesi, önlenmesi ve kontrol edilmesi çok önemlidir. Bunun için kronik karaciğer hastalığı olan çocuğun yönetiminde multidisipliner bir yaklaşım uygulanmalıdır.


Anahtar Kelimeler: Çocuk, kronik karaciğer hastalığı, komplikasyon, yönetim, izlem
DOI :10.26650/B/CH32.2024.010.016   IUP :10.26650/B/CH32.2024.010.016    Tam Metin (PDF)

Follow-up and Community Care of the Child with Chronic Liver Disease

Zerrin Önal, Özlem Durmaz

Chronic liver disease is characterized by irreversible changes in liver parenchyma accompanied by progressive damage and regeneration resulting in fibrosis and possible cirrhosis. Chronic liver disease is an important cause of morbidity and mortality in childhood. Therefore, its prognosis and treatment depend on the diagnosis of the underlying disease including potentially treatable or incurable diseases. Management is aimed at preventing or slowing down the progression of liver disease. Pediatric chronic liver disease involves a wide range of medical and psychosocial challenges for the healthcare team. Portal hypertension-related complications and those caused by malnutrition are common. Nutritional problems directly affect mortality and morbidity in children with end-stage liver disease. The pathophysiology of malnutrition is multifactorial and, if not managed efficiently, worsens longterm outcomes and survival before and after liver transplantation. Vaccination status should be reviewed carefully, and healthcare should be provided in the optimal clinical setting, to optimize outcomes and ensure high-quality pediatric care. Issues associated with chronic liver disease lead to difficulty in patient compliance to the treatment, as well as disease progression and decrease in the life quality of patients and their parents. Since possible medical and psychosocial complications associated with chronic liver disease directly affect survival and quality of life, timely prediction, prevention, and control is very crucial. To achieve this, a multidisciplinary approach is ideal.


Anahtar Kelimeler: Pediatric patients, chronic liver disease, complication, management, follow-up

Referanslar

  • 1. Pinto RB, Schneider AC, da Silveira TR. Cirrhosis in children and adolescents: An overview. World J Hepatol. 2015;7(3):392-405. google scholar
  • 2. Dhole SD, Kher AS, Ghildiyal RG, Tambse MP. Chronic liver diseases in children: clinical profile and histology. J Clin Diagnostic Res. 2015;9(7):SC04-SC07. google scholar
  • 3. Ruzman l, Mikolasevic I, Baraba Dekanic K, Milic S, Palcevski G. Advances in diagnosis of chronic liver diseases in pediatric patients. World J Pediatr. 2018;14(6):541-7. google scholar
  • 4. Nobrega S, Varma S, Stephenne X, Sokal Em. Diagnostic approaches to common pediatric liver problems. Kleinman R, Goulet OJ, Mieli-Vergani G, Sanderson IR, Sherman Pm, Shneider Bl, editors. Walker’s Pediatric Gastrointestinal Disease.North Carolina: PMPH USA;2018. p.3052-61. google scholar
  • 5. Shepherd RW, Ramm GA. Fibrogenesis and cirrhosis. Kleinman R, Goulet OJ, Mieli-Vergani G, Sanderson IR, Sherman PM, Shneider BL, editors. Walker’s Pediatric Gastrointestinal Disease. North Carolina:PMPH USA;2018p.2984-3025. google scholar
  • 6. Hsu EK, Murray KF. Cirrhosis and chronic liver failure. Suchy FJ, Sokol RJ, Balistreri WF, editors. Liver disease in children. Cambridge: Cambridge University press; 2014. p. 5-46. google scholar
  • 7. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of liver Diseases and the European Association for the Study of the liver. Hepatology. 2014;60(2):715-35. google scholar
  • 8. Plauth M, Cabre E, Riggio O, Assis-Camilo M, Pirlich M, Kondrup J, DGEM (German Society for Nutri-tional Medicine), ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN guidelines on enteral nutrition: liver disease. Clin Nutr. 2006; 25(2):285-94. google scholar
  • 9. Dara N, Sayyari AA, Imanzadeh F. Hepatic encephalopathy: early diagnosis in pediatric patients with cirrhosis. Iran J Child Neurol. 2014; 8(1):1-11. google scholar
  • 10. Shanmugam NP, Dhawan A. Complication of cirrhosis. Guandalini S, Dhawan A, Branski D, editors. Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Switzerland: Springer International Publishing; 2016. p.843-59. google scholar
  • 11. Rajanayagam J, Kelly DA. Liver Failure. Wyllie R, Hyams J, Kay M, editors. Pediatric Gastrointestinal and Liver Disease. Philadelphia: Elsevier; 2016. p.944-62. google scholar
  • 12. Murray KF, Carithers RL. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology. 2005;41(6):1407-32. google scholar
  • 13. Cartin-Ceba R, Krowka MJ. Pulmonary complications of portal hypertension. Clin Liver Dis. 2019;23(4):683-711. google scholar
  • 14. El-Shabrawi MH, Kamal NM. Medical management of chronic liver diseases (CLD) in children (part II): focus on the complications of CLD, and CLD that require special considerations. Paediatr Drugs. 2011;13 (6):371-83. google scholar
  • 15. Simonetto DA, Gines P, Kamath PS. Hepatorenal sydrome: pathophysiology, diagnosis and management. BMJ. 2020;370:m2687. google scholar
  • 16. Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka P, et al. EASL Clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60. google scholar
  • 17. Karagiannakis DS, Papatheodoridis G, Vlachogiannakos J. Recent advances in cirrhotic cardiomyopathy. Dig Dis Sci. 2015; 60(5):1141-51. google scholar
  • 18. A Celtik C, Durmaz O, Oner N, Yavuz T, Gökce S, Aydogan A, et al. Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension. J Pediatr Gastroenterol Nutr. 2015; 60(2):177-81. google scholar
  • 19. Handzlik G, Holecki M, Wilczynski K, Dulawa J. Osteoporosis in liver disease: pathogenesis and mana-gement. Ther Adv Endocrinol Metab. 2016;7 (3):128-35. google scholar
  • 20. Barbu EC, Chitu EC, Lazar M, Olariu C, Bojinca M, Lonescu RA, et al. Hepatic osteodystrophy: a global (re)view of the problem. Acta Clin Croat. 2017;56(3):512-25. google scholar
  • 21. Nwabukol OC, Eke R. Hepatic related hematologic disorders in children. Int J Child Health Hum Dev. 2020;13(1):21-32. google scholar
  • 22. Jagadisan B, Srivastava A. Child with jaundice and pruritus: how to evaluate? Indian J Pediatr. 2016; 83(11):1311-20. google scholar
  • 23. Kriegermeier A, Green R. Pediatric cholestatic liver disease: review of bile acid metabolism and discussion of current and emerging therapies. Front Med. 2020;7:149. google scholar
  • 24. Karpen SJ, Kelly D, Mack C, Stein P. Ileal bile acid transporter inhibition as an anticholestatic therapeutic target in biliary atresia and other cholestatic disorders. Hepatol Int. 2020;14(5):677-89. google scholar
  • 25. Ferreira LG, Martins AIF, Cunha CE, Anastacio LR, Lima AS, Correia MITD. Negative energy balance secondary to in adequate dietary intake of patients on the waiting list for liver transplantation. Nutrition. 2013;29(10):1252-8. google scholar
  • 26. Young S, Kwarta E, Azzam R, Sentongo T. Nutrition assessment and support in children with end stage liver disease. Nutr Clin Pract. 2013;28(3):317-29. google scholar
  • 27. Baker A, Stevenson R, Dhawan A, Goncalves I, Socha P, Sokal E. Guidelines for nutritional care for infants with cholestatic liver disease before liver transplantation. Pediatr Transplant. 2007;11(8):825-34. google scholar
  • 28. Mouzaki M, Bronsky J, Gupte G, Hojsak I, Jahnel J, Pai N, et al. Nutrition support of children with chronic liver Diseases: A joint position paper of the North American Society for Pediatric Gastroenterology, Hepa-tology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2019;69(4):498-511. google scholar
  • 29. Khanna R,Verma SK. Pediatric hepatocellular carcinoma. World J Gastroenterol. 2018;24(35):3980-99. google scholar
  • 30. Hadzic N, Finegold MJ. Liver neoplasia in children. Clin Liver Dis. 2011;15(2):443-62. google scholar
  • 31. Sintusek P, Phewplung T, Sanpavat A, Poovorawan Y. Liver tumors in children with chronic liver diseases. World J Gastrointest Oncol. 2021;13(11):1680-95. google scholar
  • 32. Arora G, Keeffe EB. Management of chronic liver failure until liver transplantation. Med Clin North Am. 2008;92(4):839-60. google scholar
  • 33. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberget CL,et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-70. google scholar
  • 34. Mcdiarmid SV, Ravinder A, Lindblad AS, Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group. Development of a pediatric end stage liver disease score to predict poor outcome in children awaiting liver transplantation Transplantation. 2002;74(2):173-81. google scholar
  • 35. Dehghani SM, Gholami S, Bahador A, Haghighat M, Imanieh MH, Nikeghbalian S. Comparison of Child-Turcotte-Pugh and pediatric end-stage liver disease scoring systems to predict morbidity and mor-tality of children awaiting liver transplantation. Transplant Proc. 2007;39(10):3175-7. google scholar
  • 36. Ruf A, Dirchwolf M, Freeman RB. From Child-Pugh to MELD score and beyond: taking a walk down memory lane. Ann Hepatol. 2022;27(1):100535. google scholar
  • 37. Causey MW, Steele SR, Farris Z, Lyle DS, Beitler AL. An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery. Am J Surg. 2012;203(5):589-93. google scholar
  • 38. Leonis MA, Balistreri WF. Evaluation and management of end stage liver disease in children. Gastroente-rology. 2008;134 (6):1741-51. google scholar
  • 39. Yang HC, Perumpail JB,Yoo ER, Ahmed A, Kerner JA. Nutritional needs and support for children with chronic liver Disease. Nutrients. 2017;9 (10):1127. google scholar
  • 40. Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN guideline on clinical nutri-tion in liver disease. Clin Nutr. 2019; 38 (2): 485-521. google scholar
  • 41. Lacaille F. Nutrition and liver disease. D’Antiga L. Pediatric Hepatology and Liver Transplantation. Swit-zerland: Springer International Publishing; 2019. p.397-407. google scholar
  • 42. Leise MD, Talwalker JA.Immunizations in chronic liver disease: what should be done and what is the evidence. Curr Gastroenterol Rep. 2013;15(1):300. google scholar
  • 43. Berzigotti A, Saran U, Dufour JF. Physical activity and liver diseases. Hepatology. 2016; 63(3):1026-40. google scholar
  • 44. Duarte-Rojo A, Ruiz-Margain A, Aldo J, Montano-Loza JA, Macias-Rodrıguez RU,Ferrando A,et al. Exercise and physical activity for patients with end-stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list. Liver Transpl. 2018;24(1):122-39. google scholar
  • 45. Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl. 2012;18 (2):146-51. google scholar
  • 46. Kappus MR, Mendoza MS, Nguyen D, Medici V, McClave SA. Sarcopenia in patients with chronic liver disease: can it be altered by diet and exercise? Curr Gastroenterol Rep. 2016;18 (8):43. google scholar
  • 47. Lai JC, Tandon P, Bernal W, Tapper EB , Ekong U , Dasarathy S, et al. Malnutrition, frailty, and sarcope-nia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(3):1611-44. google scholar
  • 48. Gilmour SM, Sorensen LG, Anand R, Yin W, Alonso EM, SPLIT Research Consortium. School outco-mes in children registered in the studies for pediatric liver transplant (SPLIT) consortium. Liver Transpl. 2010;16(9):1041-8. google scholar
  • 49. Gereige SR, Gross T, Jastaniah E. Individual medical Emergencies occurring at school. Pediatrics 2022; 150(1): e2022057987. google scholar
  • 50. Silva MEA, Moura FM, Albuquerque TM, Reichert APS, Collet N. Network and social support in children with chronic diseases: understanding the child’s perception. Texto Contexto Enferm. 2017;26(1):e6980015. google scholar
  • 51. Socha P, Janczyk W, Dhawan A, Baumann U, Dantiga L,Tanner S, et al. Wilson’s disease in children: A position paper by the Hepatology Committee of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018; 66 (2):334-44. google scholar
  • 52. Mieli-Vergani G, Vergani D, Baumann U, Czubkowski P, Debray D,Dezsofi A, Fischler B, et al. Diagnosis and management of pediatric autoimmüne liver disease: ESPGHAN hepatology committee position state-ment. J Pediatr Gastroenterol Nutr. 2018; 66 (2):345-60. google scholar
  • 53. Sezer TA, İlhan SE. Kronik hastalığa sahip çocuk-ergen ve ebeveynlerinin yaşam kalitesi algıları. STED 2019;28 (2): 127-36. google scholar
  • 54. Tehranian S, Jafari S, Yousofi J,Kiani M, Seyedin S, Khashour A, et al. Health-related quality of life (HRQOL) in children with chronic liver disease in North East Iran using PedsQL™ 4.0. Electron Physician. 2015;7(4):1214-9. google scholar
  • 55. Demiral M, Özkan TB, Özgür T, Özkan B, Eren G, Altay D. The assessment of the quality of life in children with chronic liver disease. Turk J Gastroenterol. 2021;32(9):774-81. google scholar


PAYLAŞ




İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.