Concise pediatric and adolescent hepatology

This book, the 16^th volume in the book series, “Pediatric and Adolescent Medicine” is dedicated to liver diseases in children and adolescents. Over a span of 250 odd pages the book manages to span the length, breadth and to an extent even depth of paediatric hepatology.

It covers the ‘classic’ topics of various cholestatic liver diseases of infants, autoimmune liver disease, Wilson's disease, viral hepatitis and acute liver failure adequately. A practical approach to the diagnosis and management of these common disorders is a highlight of the book; however, the emerging problems, that are more pertinent to the modern era of paediatric hepatology, like intestinal failure and total parenteral nutrition (TPN)-related liver disease and liver transplantation (LT) including auxiliary liver transplantation, are expounded in a masterly manner.

Non-alcoholic fatty liver disease (NAFLD) in particular is dealt with in the relevant paediatric perspective with respect to approach and management. The pathophysiology of intestinal failure and TPN-related liver disease is extensively discussed along with medical and surgical approaches to prevent and treat associated liver disease, backed by an extensive review of literature. The chapter on liver transplantation elucidates the pre-intraoperative and post-transplant issues and also debates the various options available for LT along with their pros and cons. The long term concerns in long term transplant survivors are nicely discussed.

Acute liver failure is dealt with comprehensively, touching all relevant areas, from aetiology to management. Similarly, the clinical and therapeutic aspects of the progressive familial intrahepatic cholestasis (PFIC) syndrome, are backed by a detailed elucidation of the genetic and molecular basis of the disorders. A fresh look at the aetiopathogenesis in the light of current evidence, makes the age-old topic of biliary atresia also a very interesting read. The pathophysiology of the multisystem involvement in Alagille syndrome is nicely linked once again to its genetic basis.

Another chapter is devoted to the primary malignancies of the liver in children and an optimal approach to the same is presented. The book also addresses, the less commonly dealt with topics of immune deficiency-related liver diseases, non-viral infections of the liver and non-cirrhotic portal hypertension; the latter being of a particular importance to paediatricians.

The concluding chapter on the “Omics” gene therapy and hepatocyte transplantation brings us to the exciting cutting edge advances in the field of molecular biology and therapeautics. Hepatocyte transplantation has been especially dealt with in considerable depth.

The book is a refreshing blend of traditional and modern concepts with the natural history, approach and management being discussed in the light of current advances in the understanding of pathophysiology, molecular basis of disease as well as modern technology. The psychological and psychosocial aspects of dealing with children and especially adolescents with chronic liver disease- an integral part of management in the current scenario, given the longevity granted to these children by advances in molecular and surgical technology have been incorporated. The importance of keeping in mind the biopsychosocial environment of the child with chronic liver disease (the influence of family, friends, school and society on the disease), especially compliance with medical advice (the potential problems that can arise) and the need to assess the coping ability of the child within his/her specific environment are highlighted. The only lacuna in the book is the lack of inherited metabolic liver diseases, which probably would be the subject of another “concise” volume.

The content of this volume is thus relevant to current paediatric hepatology practice. The strength of the book is an extensive relook at the pathophysiology of several of the disorders which provides new insight into these topics. This is balanced by a practical and current approach to management. Surgical aspects of paediatric hepatology receive their fair share of space, while maintaining continuity of content. The bibliography is adequate, given the constraint to keep the volume concise. The major objective of the book, to elucidate the natural history of childhood liver diseases in the context of modern advances as well as current needs, is adequately fulfilled. The book bears the unmistakable imprint of several of the experts in the field of paediatric hepatology from across the world. Overall, this is an easy to read and refreshing treatise which comprehensively fills the gaps in knowledge of not only trainee but also practicing paediatricians and paediatric hepatologists.