Identification of factors contributing to hepatomegaly in severely burned children

Robert E. Barrow, Hal K. Hawkins, Asle Aarsland, Robert Cox, Judah Rosenblatt, Laura N. Barrow, Marc G. Jeschke, David N. Herndon

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Hepatomegaly is a common postmortem observation in severely burned children, with the liver often tripling in size when compared with normal livers for age, weight, and sex. Lesions identified at autopsy include deposition of large and small fat droplets in the hepatocyte, congestion, centrilobular necrosis, and cholestasis. The present study was designed to identify the primary causes of hepatomegaly in severely burned children postmortem. For this purpose, 41 autopsies were reviewed and, when available, blood and tissue samples were studied. Histopathologic findings showed that large intrahepatocytic fat droplets within hepatocytes and cholestasis were important contributors to hepatomegaly. Liver density and wet/dry weight ratios significantly decreased with increasing liver size. Hepatocyte volume increased with increasing liver size (P < 0.001) as did total fat content (P < 0.001). The liver enzymes, alanine aminotransferase and aspartate aminotransferase, remained normal except within 5 to 10 days of injury and 5 to 10 days of death. Triglycerides made up 4% to 70% of the total fat, with the percentage of triglycerides increasing with the severity of hepatomegaly. Saturated fatty acids represented about 85% of the total fatty acids in normal-sized livers, whereas in the largest livers (400% of predicted), only 25% of the fatty acids were saturated. This study provides evidence that 85% to 90% of the hepatomegaly observed in severely burned children postmortem is associated with hepatocyte enlargement, which includes up to 19% intracellular fat. Increases in extracellular protein, intracellular glycogen, and fluid accumulation may make a minor contribution to postburn hepatomegaly.

Original languageEnglish (US)
Pages (from-to)523-528
Number of pages6
JournalShock
Volume24
Issue number6
DOIs
StatePublished - Jan 2006

Keywords

  • Burn hepatomegaly
  • Hepatic fat and triglycerides
  • Hepatocyte enlargement
  • Liver enzymes

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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    Barrow, R. E., Hawkins, H. K., Aarsland, A., Cox, R., Rosenblatt, J., Barrow, L. N., Jeschke, M. G., & Herndon, D. N. (2006). Identification of factors contributing to hepatomegaly in severely burned children. Shock, 24(6), 523-528. https://doi.org/10.1097/01.shk.0000187981.78901.ee