Table 4.
Investigation of chronic liver disease and cirrhosis in childhood and adolescence
| Hematology |
| Hemoglobin, leukocyte and platelet count, prothrombin time (INR) |
| Coombs test, blood type, Rh factor |
| Biochemistry |
| Bilirubins |
| Transaminases |
| Alkaline phosphatase |
| Gamma-glutamyl transferase |
| Albumin and globulin |
| 25-OH vitamin D, parathyroid hormone, calcium, phosphorus, magnesium |
| Urea, creatinine |
| Lactic acid, fasting blood glucose, uric acid |
| Serum transferrin and ferritin saturation |
| Serum ceruloplasmin and copper, 24 h urinary copper (if age > 3 yr) |
| Alpha-1-antitrypsin phenotype |
| If ascites present |
| Paracentesis (in case of fever or sudden-onset ascites): |
| Cell count, albumin, total protein, neutrophil count |
| Amylase, cytology, PCR and mycobacterial culture (according to clinical suspicion) |
| Serum sodium, potassium, bicarbonate, chloride, urea and creatinine |
| Urinary sodium excretion |
| Immunology |
| Smooth muscle, mitochondrial, anti-nuclear, anti-LKM-1 antibodies |
| Hepatitis B antigen |
| Anti-HCV |
| α-fetoprotein |
| Immunoglobulins |
| HIV serology |
| Genetic-metabolic diseases |
| Metabolic screen (urine and serum amino acids, urine organic acids) |
| Genetic tests (if alpha-1-antitrypsin deficiency, Alagille syndrome, etc., suspected) |
| Sweat electrolytes test |
| Urine and serum analysis for bile acid and acid precursors (if PFIC suspected) |
| Bone marrow examination and skin fibroblast culture (if glycogen storage disease suspected) |
| Other: |
| Endoscopy (if prophylactic treatment is considered) |
| Abdominal ultrasound (computed tomography or MRI in selected cases) |
| Needle liver biopsy (if blood coagulation permits) |
| EEG (if neuropsychiatric changes present) |