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After the full moon of Xiao Yun (pseudonym), jaundice still subsides very slowly. At first, the jaundice index of percutaneous test decreased after examination at the local hospital, so the parents did not pay much attention to it and chose to continue to observe at home for a while.
Unexpectedly, the jaundice index became higher and higher, and the father and mother quickly took the child to Hangzhou Children's Hospital for treatment.
01
Jaundice does not subside after the full moon
It turned out to be biliary obstruction
Liver function test found that Xiao Yun's bilirubin reached 136umol/L, glutamyl transpeptidase 1643u/L, total bile acid 236umol/L... Too high indicators indicate that Xiao Yun's jaundice is not ordinary, and her biliary tract is likely to be obstructed!
In addition to jaundice that does not subside, Xiao Yun has other symptoms: at birth, the stool slowly changes from dark green to light yellow, and later the color becomes lighter and lighter, showing terracotta gray-white. The urine is also particularly yellow and dark.
Qiu Yuhui, deputy director and deputy chief physician of the Department of General Surgery (neonatology), carefully examined Xiao Yun, and the skin sclera was moderately yellow, the abdominal liver was swollen and obvious, and the texture was medium to hard. Subsequent hepatobiliary ultrasound examination results also showed that the child's liver was enlarged, no obvious gallbladder structure was seen in the gallbladder position, and the extrahepatic bile duct system was not clear.
All these symptoms make doctors highly suspected of biliary atresia, and surgical exploration and intraoperative cholangiography are required to confirm the diagnosis.
Intraoperative angiography
Led by Deputy Chief Physician Qiu Yuhui, Xiao Yun underwent cholangiogram and Kasai surgery when he was 55 days old, and the operation was successful. After the operation, the bile drainage was good, and the color of the stool finally changed to green and brown. After comprehensive treatment after surgery, Xiaoyun was successfully discharged from the hospital.
One month later, Xiao Yun came to the hospital for re-examination, and the direct bilirubin index decreased significantly. By the time of regular follow-up 2 months after discharge, direct bilirubin indicators were basically normal. Such a recovery situation means that Xiao Yun can rely on her own liver to survive, which makes Qiu Yuhui feel very gratified.
02
Biliary atresia is not treated promptly
Can be life-threatening
Biliary atresia (BA) is one of the most common severe hepatobiliary disorders in infancy, characterized by progressive inflammation and fibrosis of the intrahepatic and external bile ducts.
The incidence of biliary atresia varies ethnically and regionally, with around 1 in 10,000 in Asia. The cause of biliary atresia is not clear, but current studies believe that it is related to viral infections (cytomegalovirus, rotavirus), immune damage, and genetic factors.
If left untreated, biliary cirrhosis, portal hypertension, liver failure, and life-threatening diseases will occur in the advanced stage. Without treatment, children mostly live between 1 and 1 1/2 years of age.
The accepted treatment for biliary atresia is Kasai surgery. At present, it is generally believed that the Kasai procedure for biliary atresia is best performed within 2 months of age and no later than 3 months of age. Because the younger the age, the higher the bile drainage rate after Kasai's surgery, the slower progression of cirrhosis, and the more conducive to the long-term survival of the autologous liver.
Schematic diagram of the anastomosis of the Kasai liver phylum
However, when children with biliary atresia are older than 3 months and have developed liver decompensation, or liver failure or decompensation occurs due to poor bile drainage after Kasai surgery, liver transplantation is required.
03
Biliary atresia has early onset and rapid progression
Stool screening to help
Qiu Yuhui reminded that biliary atresia has an early onset and rapid progression, and there are certain difficulties in early screening. The use of "stool coloricard" screening is critical. Abnormal stool color ranges from white clay to light yellow, and normal stool color includes yellow to green.
Although there are differences in the time of abnormal stool color in children with biliary atresia, fecal card screening can remind parents of children to seek medical attention in time and make early diagnosis, greatly reducing the age of surgery and improving the survival rate of autologous liver.
Typically, biliary atresia is suspected when serum bilirubin levels are elevated ≥300 mg/mL on blood liver function tests and direct bilirubin levels account for more than 50% of total hemebin. Surgical exploration and intraoperative cholangiography can confirm the diagnosis of biliary atresia.
Qiu Yuhui Deputy Chief Physician
Deputy Director and Deputy Chief Physician of the Department of General Surgery (Neonatology) of Hangzhou Children's Hospital, and a youth committee member of the Pediatric Surgery Branch of Hangzhou Medical Association. Graduated from Zhejiang University School of Medicine with a master's degree in clinical medicine, he has rich experience in the diagnosis and treatment of common diseases in pediatric general surgery, neonatal gastrointestinal surgery and urology. He specializes in laparoscopic surgery, such as common bile duct cyst, Hirschsprung disease, anal atresia, biliary atresia, neonatal gastrointestinal malformations, intra-abdominal teratomas, inguinal hernias, hydrocele effusion, cryptorchidism, occult penis, etc.
Outpatient hours (Hangzhou Children's Hospital):
Monday morning, Friday afternoon, Saturday all day
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