Hepatocyte injury can result in inflammatory cell Infiltration, or cell death, which may be followed by a healing process of scar formation (fibrosis) and, potentially, nodule formation (regeneration). Cirrhosis is the end result of any progressive liver disease, injury to individual hepatocytes can result from a viral infection, drug or toxins, hypoxia, immunologic disorders, or inborn errors of metabolism. The evoking process leads to repair, continuing injury with chronic changes or, in rare cases, to massive hepatic damage.

  The liver disease can often be life threatening and difficult to recognize. The clinical presentation varies depending on the etiology and severity of the liver insult and can be acute or chronic with various patterns of reaction of liver to cell injury. Knowledge of the varied manifestation, a high index of suspicion, and use of clinical diagnostic skills (especially liver enzyme level) are the 1st steps in identifying pediatric liver disease.