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DIAGNOSTIC ANCILLARY PROCEDURES AND FINDINGS

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

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DIAGNOSTIC ANCILLARY PROCEDURES AND FINDINGS

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  1. DIAGNOSTIC ANCILLARY PROCEDURES AND FINDINGS RICCEL, VON AT EMAN

  2. 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 biliaryatresia, but it does help rule out other common causes of jaundice • Produces an image on a computer screen using sound waves.

  3. Hepatobiliary scintigraphy • Demonstrates bile duct patency using radionucleotide (DISIDA) • A new diagnostic approach to biliaryatresia with emphasis on the ultrasonographic triangular cord sign

  4. Triangular cord sign • Sensitivity 100% and Specificity 100% • Liver hilum appears hyperechogenic

  5. 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 biliaryatresia 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

  6. LIVER BIOPSY • It can help rule out other liver problems, such as hepatitis • Recommended before surgical procedure • Portal tract edema, fibrosis, inflammation, intracellular and canalicularcholestasis, proliferation of bile ductules

  7. OPERATIVE CHOANGIOGRAPHY • Gold standard for the diagnosis of BA • If intact extrahepaticbiliary system is not visualized,thenextrahepaticbiliaryatresia is evident. • If an intact biliary tree is visible, then perform an intraoperativecholangiogram • Cannulate the bile duct through transverse abdominal incision and inject contrast to determine if the biliary ducts are patent • At the portahepatis there are microscopic bile ductules that have proliferated which communicate with the intrahepatic system

  8. 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 portahepatis • Kasai procedure

  9. TREATMENT

  10. 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

  11. Liver transplantation in those where the Kasai operation has failed in its primary aim or complications of biliary cirrhosis have supervened

  12. 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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