title: Ascitic form of sporadic acute viral hepatitis in children: a distinct entity for recognition.
abstract: OBJECTIVE
  This study looked at the frequency and differences in presentation, laboratory parameters, and outcome between ascitic acute viral hepatitis (AAVH) and nonascitic acute viral hepatitis (NAVH) in children.
  
  
  METHODS
  Diagnosis of AVH was based on clinical features, >3-fold elevation of alanine aminotransferase, viral marker positivity (IgM antihepatitis A virus, IgM antihepatitis E virus, hepatitis B surface antigen, and IgM antihepatitis B core antigen) at presentation, absence of history of liver disease, and subsequent normalization within 6 months of clinical features and liver functions including sustained resolution of ascites in AAVH on follow-up.
  
  
  RESULTS
  A total of 139 children (121 children with NAVH and 18 with AAVH, 12.9%) were studied. Children with AAVH in comparison with those with NAVH were younger (median age 4 vs 8 years), had lower frequency of prodrome (22% vs 51%), lower serum albumin (median 2.8 vs 3.7 g/dL), low total serum protein (median 6.5 vs 7.4 g/dL), and prolongation of prothrombin time (median 4.8 vs 1.05 seconds); all P < 0.03. No significant differences were found in sex, height standard deviation scores, duration of symptoms, liver span or consistency, transaminases, alkaline phosphatase, and etiology of NAVH versus AAVH. Among the AAVH group clinically detectable ascites was present in 38.9% (7/18), spontaneous bacterial peritonitis in 11%, and diuretics had to be used in 44% of cases. Ascites resolved in all of the cases in 8 weeks (94.4% cases in <4 weeks) and liver functions normalized in 17%, 50%, and 33% cases in <4, 4 to 8, and >8 weeks duration, respectively.
  
  
  CONCLUSIONS
  We report AAVH as a distinct entity that affects younger children. This subgroup has compromised biosynthetic liver functions irrespective of viral etiology with total recovery.
authors: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. skyachha@sgpgi.ac.in
authors: Surender K
authors: SK
authors: Yachha
authors: Amit
authors: A
authors: Goel
authors: Vikrant
authors: V
authors: Khanna
authors: Ujjal
authors: U
authors: Poddar
authors: Anshu
authors: A
authors: Srivastava
authors: Uttam
authors: U
authors: Singh
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D001201:Ascites / Q000097:blood / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D002648:Child; D002675:Child, Preschool; D005260:Female; D006405:Hematology; D006525:Hepatitis, Viral, Human / Q000097:blood / Q000150:complications*; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008297:Male; D010538:Peritonitis / Q000150:complications / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D011517:Prothrombin Time; D012709:Serum Albumin
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; D012709:Serum Albumin