Biliary atresia
| Biliary atresia | ||
| ICD-10 | Q44.2 | |
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| ICD-9 | 751.61 | |
| OMIM | 210500 | |
| DiseasesDB | 1400 | |
| eMedicine | ped/237 | |
| MeSH | C06.130.120.123 | |
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Overview
Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. If unrecognised, the condition leads to liver failure but not (as one might think) to kernicterus. This is because the liver is still able to conjugate bilirubin, and conjugated bilirubin is unable to cross the blood-brain barrier. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.
Symptoms and diagnosis
Initially, the symptoms are indistinguishable from neonatal jaundice, a common phenomenon. Symptoms are usually evident between two and six weeks after birth. Besides jaundice, other symptoms include pale stools, dark urine, swollen abdominal region and large hardened liver (which may or may not be observable by the naked eye). Prolonged jaundice that is resistant to phototherapy and/or exchange transfusions should prompt a search for secondary causes. By this time, liver enzymes are generally measured, and these tend to be grossly deranged, hyperbilirubinaemia is conjugated and therefore does not lead to kernicterus. Ultrasound investigation or other forms of imaging can confirm the diagnosis. Further testing include radioactive scans of the liver and a liver biopsy.
Biliary atresia is a very rare disorder. About one in 10,000 to 20,000 babies in the U.S are affected every year. Biliary atresia seems to affect girls slightly more often than boys. Within the same family, it is common for only one child in a pair of twins or only one child within the same family to have it. Asians and African-Americans are affected more frequently than Caucasians. There does not appear to be any link to medications or immunizations given immediately before or during pregnancy.
Pathophysiology
There is no known cause of biliary atresia.
As the biliary tract cannot transport bile to the intestine, bile is retained in the liver (known as stasis) and results in cirrhosis of the liver.
Treatment
If the intrahepatic biliary tree is unaffected, surgical reconstruction of the extrahepatic biliary tract is possible. This surgery is called a Kasai procedure (after the Japanese surgeon who developed the surgery, Dr. Morio Kasai) or hepatoportoenterostomy.
If the atresia is complete, liver transplantation is the only option.
External links
- Intro. to pediatric blood tests for liver function
- Biliary Atresia, Liver Diseases and Treatments, Cincinnati Children's Hospital Medical Center
- Biliary Atresia Research Consortium (U.S.)
- Children's Liver Disease Foundation (U.K.)
- European Biliary Atresia Registry
- Imagine Bright Futures - Musings and research on biliary atresia (the leading cause of pediatric liver transplants).
- Fund for the Cure - Biliary Atresia from the Biliary Atresia Research Consortium and the American Liver Foundation
Research links
- Choledochal cyst associated with extrahepatic bile duct atresia
- Understanding How Inflammation Causes Biliary Atresia, Jorge Bezerra, MD, Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
Support groups