Biliary atresia (BA) is a congenital biliary disorder, which is characterised by an absence or severe deficiency of the extra-hepatic biliary tree. It is one of the most common causes of neonatal cholestasis, often causing cirrhosis immediately and leading to death and accounts for over half of children who undergo liver transplantation.
It is thought to affect 1 in 10,000 - 15,000 newborn infants. There is a recognised male predilection.
It precipitates within the first 3 months of life. Infants with biliary atresia may appear normal and healthy at birth. Most often, symptoms develop between two weeks to two months of life, and may include :
- dark yellow or brown urine
- pale or clay-colored (acholic) stools
Prompt diagnosis ensures early treatment and results in improved prognosis.
- echogenic triangular cord sign
- larger hepatic arterial calibre 2
Nuclear medicine (hepatobiliary (HIDA) scan)
Tc-99m diosgenin (DISIDA) and mebrofenin (BRIDA) have highest hepatic extraction rate and shortest transit time of hepatobiliary radiotracers. Cases of biliary atresia typically demonstrate relatively good hepatic uptake with no evidence of excretion into the bowel at 24 hours. Pretreatment with phenobarbital (5 mg/kg/day for 5 days) to increase biliary secretion by stimulating hepatic enzymes is freqeuently helpful to minimize the possibility of a false-positive study in a patient with a patent biliary system but poor excretion.
Treatment and prognosis
Management options include
- Kasai portoenterostomy
- liver transplantation
More content required for prognosis
General differential considerations include
- 1. Humphrey TM, Stringer MD. Biliary atresia: US diagnosis. Radiology. 2007;244 (3): 845-51. doi:10.1148/radiol.2443061051 - Pubmed citation
- 2. Lee MS, Kim MJ, Lee MJ et-al. Biliary atresia: color doppler US findings in neonates and infants. Radiology. 2009;252 (1): 282-9. doi:10.1148/radiol.2522080923 - Pubmed citation
- 3. Kanegawa K, Akasaka Y, Kitamura E et-al. Sonographic diagnosis of biliary atresia in pediatric patients using the "triangular cord" sign versus gallbladder length and contraction. AJR Am J Roentgenol. 2003;181 (5): 1387-90. AJR Am J Roentgenol (full text) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Biliary atresia (BA)||✗|
|Atresia of the bile ducts||✗|