DOI: 10.5005/jp-journals-11009-0110 |
Open Access |
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How to cite this article:
Reddy DV, Sarma MS, Mathiyazhagan G. Hepatobiliary Involvement of Hematolymphoid Malignancies in Children: From a Pediatric Gastroenterologist's Perspective. Ann Pediatr Gastroenterol Hepatol 2022; 4 (4):57-62.
Aim: To describe hepatobiliary involvement in pediatric hematolymphoid malignancies and their approach in clinical practice. Background: Pediatric hematolymphoid malignancies primarily consist of leukemias, lymphomas, and Langerhans cell histiocytosis (LCH). Although they involve the hepatobiliary system frequently, they are often misdiagnosed as infectious or inflammatory diseases. Also, consolidated literature on their presentation and approach is scarce in children. Review results: Hepatobiliary involvement is seen in up to 60% of acute leukemias and LCH and up to 40% of lymphomas in children. Clinical features result from infiltration, compression, overwhelmed immune system, and chemotherapy-related hepatotoxicity. Hepatobiliary involvement in hematolymphoid malignancies is diverse, ranging from subtle asymptomatic hepatomegaly, raised transaminases, and biliary obstruction to fulminant presentations like liver failure and decompensated biliary cirrhosis due to sclerosing cholangitis. The majority of the chemotherapeutic drugs have the potential for hepatic impairment, necessitating pharmacovigilance. Conclusion: Hepatobiliary involvement in children can present with a wide range of manifestations, from asymptomatic hepatomegaly to fulminant liver failure. Pivotal for favorable outcomes is to arrive at an early diagnosis of malignancy by differentiating it from inflammatory and infectious diseases. Hepatotoxicity can be reduced or even prevented by practicing pharmacovigilance. Clinical significance: Liver involvement in hematolymphoid malignancies often overlaps with common infectious and inflammatory diseases requiring a high index of suspicion. It is essential to improve cross-referrals between a hemato-oncologist and a pediatric gastroenterologist for optimal outcomes.
Inflammatory bowel disease (IBD) remains intriguing and challenging for a pediatrician and the causes remain elusive. Past decades have shown an increasing trend in the number of children diagnosed with IBD, and the treatment modalities and diagnostic aids have advanced significantly with increasing awareness and growing scientific evidence. Treatment has evolved from steroids to biologicals, and a majority of children have been managed aggressively with medical treatment solely. The Indian subcontinent has seen an increasing number of children with IBD, as reported by data from various centers, which is very challenging for clinicians and has led to better sensitization of this conundrum in pediatric practice. This review article aims to offer better clarity and to enrich the knowledge of clinicians who either want to know about the multifaceted presentations of pediatric Crohn's disease (CD) or the complexity involving the management of pediatric Crohn's disease has intestinal and extraintestinal manifestations and literally can involve anywhere from mouth to anus. This review aims to cover extensively from the incidence to the complications of Crohn's disease and the newer evolutions in the treatment.
What is the gut? The Webster's English Dictionary defines it as a tube in the body through which the food passes after it leaves the stomach. Though I love words and playing with them, this write-up is not meant for that. It is instead meant to look into a word that affects all of us, the gut. A different view of the gut.