the best test to diagnose biliary atresia

[usmlethinking]

This is a 4 week old female who presents to the office with parental reports of increasing jaundice over the last week. Her parents report that 2 weeks ago, she began to have yellowing of her eyes with subsequent yellowing of her skin when she was diagnosed with physiologic jaundice. After persistent jaundice for 5 days, her parents changed her from breast-feeding to a commercial formula. Since the jaundice appears to be worsening, her parents decided to bring her in for re-evaluation. Her stools have been pale in color for the past 10 days along with darker urine.


She was born by spontaneous vaginal delivery to a G2P1 A+ mother at 39 weeks with Apgar scores of 9 and 9 and 1 and 5 minutes. There were no complications noted at birth, the nursery, or at discharge home. The patient was not jaundiced at discharge or when seen at initial office visits. Her highest bilirubin previously was 12.0 and her blood type is A+.


Exam: VS Normal. Weight and height are at the 60th percentile. She is awake, alert, in no acute distress and is easily comforted by her mother during the exam. Her skin is jaundiced, most notably in the cephalic and truncal areas, with scleral icterus. Her liver is slightly enlarged without nodularity. No splenomegaly is noted. The remainder of her exam is normal.
Laboratory examinations reveal a total bilirubin of 15 mg/dL, direct bilirubin of 12.3 mg/dL, ALT 45 U/L, AST 52 U/L, and an alkaline phosphatase of 2007 U/L.


What is your diagnose? How do you confirm it?

[sniperscare]

Neonatal Cholestasis:
DD:
1. Biliary Atresia.
2.Choledochal Cyst.

Inv: Ultrasonography f/b ERCP.

[RUBABA TAHERI PANAH]

HIDA SCAN.[99Tc hepatic iminodiacetic acid scan] to assess the the patency of biliary tree.if this is a choledochal cyst then ultra sound examination is also helpful to rule it out.

[student-2]

Ultra sound easiest way to go. Choledochal cysts usually appear later in childhood.
Can consider allagille syndrome