Liver disease in early life in Kenya.

A survey of significant pathological abnormalities of liver in the first two decades of life is presented; this is based on biopsy and autopsy specimens received in the histopathology service in Nairobi over five years. It includes conditions which one might expect in a diagnostic service in any country, some of which are attributable to known local conditions, and others which show distinctive features in their occurrence of frequency. There is an unexpected number of cases of chronic aggressive hepatitis and cirrhosis and the latter is notable for its frequency in the first decade of life. Hepatocellular carcinoma also occurs rather commonly, although most often in the second decade and as a complication of cirrhosis. There is a marked male preponderance in chronic aggressive hepatitis, cirrhosis, hepatocellular carcinoma and schistosomiasis. It is unlikely that this is due to selection of cases and the series shows no indication of tribal influence. The possible role of infections and toxins, particularly in the genesis of chronic aggressive hepatitis and cirrhosis, is discussed. In the search for clues to pathogenesis, detailed systematic investigation of children with liver disease is advocated, paying particular attention to cultural background, and exposure to infections and toxic agents.