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DIAGNOSTIC ANCILLARY PROCEDURES AND FINDINGS. RICCEL, VON AT EMAN. ULTRASOUND. Ultrasound tests can show whether the liver or bile ducts are enlarged and whether tumors or cysts are blocking the flow of bile. Initial test of choice Assess any abnormalities of the heptabiliary tract - PowerPoint PPT Presentation
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DIAGNOSTIC ANCILLARY PROCEDURES AND FINDINGS
RICCEL, VON AT EMAN
ULTRASOUND
– Ultrasound tests can show whether the liver or bile ducts are enlarged and whether tumors or cysts are blocking the flow of bile.• Initial test of choice
– Assess any abnormalities of the heptabiliary tract– It cannot be used to make a diagnosis of biliary atresia, but it
does help rule out other common causes of jaundice• Produces an image on a computer screen using sound
waves.
Hepatobiliary scintigraphy
• Demonstrates bile duct patency using radionucleotide (DISIDA)
• A new diagnostic approach to biliary atresia with emphasis on the ultrasonographic triangular cord sign
• Triangular cord sign – Sensitivity 100% and
Specificity 100%– Liver hilum appears
hyperechogenic
LIVER SCANS• HEPATOBILIARY IMINODIACETIC
ACID (HIDA) SCANNING– Traces the path of bile in the body
and can show whether bile flow is blocked
– Infants with biliary atresia usually have normal uptake of the isotope but absent excretion into the biliary system and small intestine
– Enhance isotope excretion with 5 days of pretreatment with phenobarbital
LIVER BIOPSY– It can help rule out
other liver problems, such as hepatitis• Recommended before
surgical procedure• Portal tract edema,
fibrosis, inflammation, intracellular and canalicular cholestasis, proliferation of bile ductules
OPERATIVE CHOANGIOGRAPHY• Gold standard for the diagnosis of BA • If intact extrahepatic biliary system is not visualized,then
extrahepatic biliary atresia is evident. • If an intact biliary tree is visible, then perform an
intraoperative cholangiogram – Cannulate the bile duct through transverse abdominal
incision and inject contrast to determine if the biliary ducts are patent
– At the porta hepatis there are microscopic bile ductules that have proliferated which communicate with the intrahepatic system
• Correctable lesion – 20%– fibrosis of the distal biliary tree, however proximal biliary
tree and intrahepatic bile ducts are patent • Excise fibrotic area and direct drainage to bowel
• Non – correctable – 80%– Fibrosis to the level of the porta hepatis– Kasai procedure
TREATMENT
• The current management of BA patients involves two steps: – Kasai operation (in
the neonatal period), which aims to restore bile flow.
Fig. 1: KASAI procedure
Fig. 2: Hepatoporto-cholecystostomy
• Liver transplantation in those where the Kasai operation has failed in its primary aim or complications of biliary cirrhosis have supervened
REFERENCES
• Sabiston Textbook of Surgery 17th Edition• Harrison’s Principles of Internal Medicine 17th
Edition• http://digestive.niddk.nih.gov/ddiseases/
pubs/atresia/BiliaryAtresia.pdf
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