Ayhan Gazi KALAYCI, FADLİ DEMİR, Hasan YILDIRIM, Şükrü KÜÇÜKÖDÜK

Çocuklarda kolestatik tip hepatit A enfeksiyonu

Çalışmamızın amacı çocukluk yaş grubupda kolestatik hepatit A enfeksiyonunun klinik seyrini ve prognozunu değerlendirmektir. Haziran 1998 ile Mayıs 2002 tarihleri arasında akut hepaüt A enfeksiyonu nedeniyle hastaneye yatırılan 33 çocuk hasta retrospektif olarak değerlendirildi. Direkt bilirubin düzeyi total bilirubinin %50'sinden fazla ve total bilirubini en az dört hafta süreyle 10 mg/dl'nin üzerinde olan hastalar kolestatik hepatit olarak tanımlandı. Hastaneye yatırılan hepatit A hastalarından beş hasta (%15.2) kolestatik hepatit tanısı aldı. Bu beş hastanın birinde akut hepatit A enfeksiyonunun iki varyantı olan relapsing ve kolestatik form birlikte mevcuttu. Hastalarda saptanan bulgular uzamış sarılık, kaşıntı ve hepatomegali idi. Tüm vakalarda kolestatik bulgular ön planda idi ve bilirubin düzeyleri 24-45 mg/dL arasında değişiyordu. Üç hastada protrombin zamanı uzundu ve K vitamini tedavisi ile normale döndü. Dört hasta ursodeoksikolik asit, bir hasta ise ursodeoksikolik asit tedavisi yanısıra kısa süreli prednizolon tedavisi aldı. Hastalarda sekelsiz tam iyileşme görüldü. Çocuklarda kolestatik tip hepatit'A enfeksiyonu nadir görülen benign bir hastalık formudur, Hepatit A enfeksiyonunun bu nadir formunun bilinmesi, obstrüktif sarılıktan şüphe edilen hastalarda gereksiz invaziv işlemlerin uygulanmasını engelleyebilir.

Anahtar Kelimeler:

Hepatit A, Geriyedönük çalışma, Çocuk, Ursodeoksikolik asit, Kolestaz, Bilirubin, Sarılık

Cholestatic hepatitis A infection during childhood

The aim of this study was to evaluate the clinical evolution and prognosis of cholestatic hepatitis A during childhood. A retrospective study of 33 children hospitalized for acute hepatitis A infection between June 1998 and May 2002 were studied. Cholestauc hepatitis was defined by a direct bilirubin higher than 50% of the total bilirubin and serum bilirubin levels greater than 10 mg/dL during at least 4 weeks. Five cases were identified, which represents 15.2% of all hospitalized hepatitis A cases. One of the five cases had a combination of the two variants of acute viral hepatitis A, the relapsing and cholestatic forms. Physical findings include prolonged jaundice, pruritis and hepatomegally. Cholestatic symptomatology was predominant in all cases with bilirubih values ranging from 24 to 45 mg/dL. Prolonged prothrombin times, corrected with vitamin K, were seen in three of these patients. Four patients were treated with ursodeoxycholic acid, one patient with ursodeoxycholic acid plus short-term pretinisbne therapy- All patients recovered completely without sequelae. Cholestatic hepatitis is an infréquent and benign form of acute hepatitis A in childhood. Knowledge of this unusual manifestation of hepatitis A may help avoid potentially invasive procedures involved in the evaluation of suspected obstructive jaundice.

Keywords:

Hepatitis A, Retrospective Studies, Child, Ursodeoxycholic Acid, Cholestasis, Bilirubin, Jaundice,

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