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POST-OPERATIVE COMPLICATIONS OF BILIARY ATRESIA

POST-OPERATIVE COMPLICATIONS OF BILIARY ATRESIA. HEPATOPORTOENTEROSTOMY. “Kasai procedure” - The most effective surgical treatment to promote bile flow into the intestine. Source: Schwartz’s Manual of Surgery. HEPATOPORTOENTEROSTOMY.

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POST-OPERATIVE COMPLICATIONS OF BILIARY ATRESIA

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  1. POST-OPERATIVE COMPLICATIONS OF BILIARY ATRESIA

  2. HEPATOPORTOENTEROSTOMY • “Kasai procedure” • - The most effective surgical treatment to promote bile flow into the intestine Source: Schwartz’s Manual of Surgery

  3. HEPATOPORTOENTEROSTOMY • A third of patients remain symptom-free after the procedure, but a remainder require liver transplantation because of progressive liver failure. Source: Schwartz’s Manual of Surgery

  4. COMPLICATIONS AFTER KASAI PROCEDURE: ASCENDING CHOLANGITIS • Most common complication • A bacterial infection of the biliary tree • Bacteria normally found in the small intestine moves up the Roux-en-Y causing infection. • - It has a strongly negative influence • on prognosis after successful surgical repair, being the cause of progressive cirrhosis and death in a considerable number of cases. Source: http://www.classkids.org/library/biliaryatresia.htm Case Report: Late Cholangitis After Kasai Procedure Detected with Magnetic Resonance Cholangiopancreaticography. Journal of Pediatric Gastroenterology and Nutrition.

  5. COMPLICATIONS AFTER KASAI PROCEDURE: Intravenous and long-term oral antibiotics are used to prevent and treat ascending cholangitis. Source: http://www.classkids.org/library/biliaryatresia.htm

  6. COMPLICATIONS AFTER KASAI PROCEDURE: PORTAL HYPERTENSION • Formation of scar tissue eventually leads to portal hypertension in many children. • Complications of portal hypertension include problems with bleeding and clotting; enlarged weak veins in the esophagus and stomach; and ascites. • The most common localisation of the varices are: esophagus, stomach, Roux en Y loop, rectum. In case of failed Kasai operation, portal hypertension is treated by liver transplantation, but often require sclerotherapy or variceal ligation before liver replacement. Source: http://www.classkids.org/library/biliaryatresia.htm http://www.md.ucl.ac.be/pedihepa/BILIARYATRESIA.htm

  7. COMPLICATIONS AFTER KASAI PROCEDURE: INTRAHEPATIC BILIARY CAVITIES • Large intrahepaticbiliary cysts may develop several months to years after the Kasai operation, even in patients with complete clearance of jaundice. • These cavities may become infected and/or compress portal vein, requiring external drainage. Cystoenterostomy or liver transplantation may eventually be required. Source: http://www.md.ucl.ac.be/pedihepa/BILIARYATRESIA.htm

  8. COMPLICATIONS AFTER KASAI PROCEDURE: POOR GROWTH AND MALNUTRITION • Adequate bile flow is needed for the digestion and absorption of dietary fats and fat-soluble vitamins, including vitamins A, D, E, and K. • Hence, when bile flow is reduced, poor growth and malnutrition may result. Special formulas containing medium-chain triglycerides (an easily digested form of dietary fat) and water-soluble vitamin supplements are often prescribed to maximize the child’s growth and development. Source: http://www.classkids.org/library/biliaryatresia.htm

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