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Virtual Pediatric Hospital: Paediapaedia: Biliary Atresia and Neonatal Hepatitis Paediapaedia: Gastrointestinal Diseases

Biliary Atresia and Neonatal Hepatitis

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Obstructive jaundice with hyperbilirubinemia that persists beyond the immediate newborn period is due to biliary atresia or neonatal hepatitis and they need to be differentiated between because the Kasai procedure for biliary atresia is most successful when it is performed prior to 2 months of life.

Etiology/Pathophysiology:
These two entities are thought to be in the spectrum of the same inflammatory process with more advanced sclerosing cholangitis of the extrahepatic ducts in biliary atresia.

Pathology:
Not applicable

Imaging Findings:
Ultrasound shows the liver echogenicity and intrahepatic ducts to be usually unremarkable in both biliary atresia and neonatal hepatitis. In neonatal hepatitis the gall bladder is normal to absent while in atresia the gallbladder is small to absent.

Hepatobiliary imaging normally shows tracer extracted in the liver within 5 minutes, tracer accumulated in the gallbladder in 15 minutes, and tracer excreted into the small bowel in 15 minutes. In children with neonatal hepatitis there is normal to delayed extraction of tracer with eventual excretion of tracer into the small bowel. In children with biliary atresia there is normal extraction of tracer with no excretion of tracer into the small bowel.

DDX:

References:
See References Chapter.

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