An Obese Child With Fatty Liver and Abdominal Pain: The Gut/Liver Axis

Valerio Nobili, MD; Claudia Della Corte, MD; Laura Stronati, PhD; Salvatore Cucchiara, MD, PhD

Disclosures

January 13, 2016

In This Article

Case Presentation: Abdominal Pain in an Obese Child

Rick, a 12-year old obese child, was referred to the Bambino Gesù Children's Hospital in Rome for an evaluation after the incidental discovery of fatty liver on an abdominal ultrasound performed for abdominal pain. In the previous 6 months, Rick had had frequent episodes of abdominal pain, without other noticeable features.

History and Physical Examination

Medical history. The patient's medical history was unremarkable. There was no history of drug or alcohol intake. He underwent tonsillectomy at 5 years of age, performed in another hospital, without complications.

A review of systems was positive for a 6- to 8-month history of periumbilical abdominal pain, with five or six episodes every month. The abdominal pain was associated with loose stools and often improved with defecation. No nausea, vomiting, or weight loss or systemic symptoms or signs, such as fatigue, fever, or arthralgia, were reported.

The family history was positive for cardiovascular disease and type 2 diabetes mellitus in the paternal family. Both of Rick's parents are obese. His mother had experienced depressive syndrome in the past.

Physical examination. On examination, Rick was obese, with a body weight of 178 lb (> 97th percentile for age). His height was 66 inches, and his body mass index (BMI) was 28.4 kg/m2 (both also > 97th percentile for age).

The patient's abdominal circumference was 37 inches (> 95th percentile for age). His abdomen was protruding but soft, nontender to palpation, and slightly distended and meteoric. There was no appreciable hepatosplenomegaly.

Blood pressure was normal for age, sex, and height. The patient showed acanthosis nigricans at the posterior and lateral folds of the neck. His mental status was age-appropriate. The remainder of physical examination was unremarkable.

Diagnostic testing. Table 1 summarizes the patient's laboratory data. Abdominal ultrasound, repeated at our hospital, confirmed severe hepatic steatosis with mild hepatomegaly.

Table 1. Laboratory Results and Reference Values

Test Patient's Result Normal Range
Aspartate aminotransferase 44 U/L 15-45 U/L
Alanine aminotransferase 51 U/L 15-45 U/L
Gamma-glutamyltransferase 13 U/L 7-28 U/L
Alkaline phosphatase 178 U/L 79-205 U/L
Total bilirubin 0.6 mg/dL 0.3-1.2 mg/dL
Albumin 4.8 g/dL 3.2-5.1 g/dL
Total cholesterol 145 mg/dL < 170 mg/dL
Triglycerides 178 mg/dL 33-111 mg/dL
HDL cholesterol 42 mg/dL > 21% total
Fasting blood sugar 92 mg/dL 60-100 mg/dL
A1c 5.8% 5.0%-7.5%
Fasting insulin 28 μU/mL 5-25 μU/mL
Leukocyte count 5240 cells/μL 4500-13,500 cells/μL
Hemoglobin 14.4 g/dL 13.5-14.5 g/dL
Platelet count 257 × 103 cells/μL 150-350 × 103 cells/µL
Prothrombin time 12.2 sec 11-13.5 sec
C-reactive protein 0.3 g/dL < 0.5 mg/dL
Fecal occult blood Negative Negative

HDL = high-density lipoprotein

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