Table 4.
Aetiology table and accompanying diagnostic work-up for children with IBD and nonacute abnormal liver blood tests
| Causes | Diagnostic tests | |
| Immune-related liver disease | ||
| Autoimmune hepatitis (AIH) | □ | Auto-antibodies (antimitochondrial, antismooth muscle, antinuclear and antiliver-kidney-microsome) |
| □ | Immunoglobulin G | |
| □ | Liver histology (interface hepatitis) | |
| Primary sclerosing cholangitis (PSC) | □ | MR cholangiopancreatography |
| Autoimmune sclerosing cholangitis (ASC) | □ | Auto-antibodies (antimitochondrial, antismooth muscle, antinuclear and antiliver-kidney-microsome) |
| □ | Immunoglobulin G | |
| □ | MR cholangiopancreatography | |
| □ | Liver histology (interface hepatitis and bile duct involvement) | |
| Viral hepatitis | ||
| □ | Hepatitis A (IgM) | |
| □ | Hepatitis B (HBsAg, anti-HBc IgM, anti-HBs) | |
| □ | Hepatitis C (Anti-HCV, HCV RNA) | |
| □ | Hepatitis E (IgM, HEV RNA | |
| □ | Cytomegalovirus (IgM, CMV-DNA) | |
| □ | Epstein--Bar virus (IgM, EBV-DNA) | |
| Drug-induced liver injury (DILI) | ||
| Thiopurines | □ | Thiopurine metabolite levels [6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP)] |
| Nonalcoholic fatty liver disease (NAFLD) | ||
| Hepatic steatosis caused by obesity | □ | BMI, ultrasound |
| Hepatic steatosis caused by starvation | □ | BMI, ultrasound |
| Biliary obstruction | ||
| Bile stones | □ | Ultrasound |
| Choledochal malformation | □ | Ultrasound |
| Vascular liver disease | ||
| Portal or hepatic vein thrombosis | □ | Doppler-ultrasound |
| Other | ||
| Celiac disease | □ | Celiac antibodies |
| Wilson disease | □ | Bloodmarkers (ceruloplasmin, free copper, Coomb's test) |
| □ | Urine (24 h copper excretion) | |
| □ | Liver biopsy (copper content) | |
| □ | Ophthalmologist (Kayser--Fleischer rings) | |
| □ | Genetic testing (ATP7B variants) | |
| Alpha-1-antitrypsin deficiency | □ | Alpha-1-antitrypsin in serum |
| □ | Alpha-1-antitrypsin phenotyping | |
| □ | Genetic testing (SERPINA1 variants) | |