Jaundice
Everything in the library about jaundice — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
1 item
Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
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New Article you should know by Dr. Cecilia Gigena from Journal of Pediatric Surgery.
"Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels"
Authors: Jingying Jiang, Yifan Yang, Xue
video0:55 · Jul 2024
Case-Based Learning
1 item
Biliary Atresia-Case Presentation and Panel Discussion: Update Course 2014
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During the 2ndAnnual Stay Current in Pediatric Surgery Update Course in 2014, Dr. Robert Parry, Director of Pediatric Surgery, Akron Children's Hospital, and Dr. Nick Bruns present a clinical case of biliary atresia diagnosis. Topics discus
video23:47 · Jan 2019
In-Depth Reviews
1 item
Hepatoblastoma: Update Course 2014
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During the 2nd Annual Stay Current in Pediatric Surgery Update Course in 2014,Dr. Matthew Clifton presents on hepatoblastoma.Topics discussed includepre-treatment extent of disease (pretext) and post-treatment extent of disease staging for
video · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Biliary Atresia-Case Presentation and Panel Discussion: Update Course 2014
French registry data show significantly better 5- and 10-year native liver survival when Kasai performed before 30 days versus after 90 days, with nearly twice the survival rate
clinical2:44 ↗
In a Michigan series, children who had Kasai after 3 months had the best drainage and long-term outcomes
clinical1:03 ↗
Under 60 days there was a clear difference in outcomes; procedures done on weekends if approaching day 60
clinical1:50 ↗
The critical factor determining outcome is the degree of cirrhosis developed in the liver, which varies among children and does not always correlate directly with age
clinical3:24 ↗
Biliary atresia does not start at day zero in all patients; some may begin at day 20 and progress from there
clinical3:53 ↗
A series from Rich Ricketts showed not statistically significant better results with Kasai performed at 76 days or older versus 0-75 days
clinical4:03 ↗
Peter Altman from Columbia, who had the largest US series, argued Kasai should be done between 60 and 75 days
opinion5:57 ↗
Reversal of portal flow is very concerning because patients can achieve good biliary drainage and normal bilirubin but portal hypertension continues to progress, leading to transplant need
clinical9:19 ↗
Performing Kasai can buy time and increase the donor pool potential, even if the liver looks horrible
clinical10:05 ↗
Transplant becomes technically easier in older children with lower risk of hepatic artery thrombosis
clinical10:27 ↗
Hepatologists can manage biliary atresia patients medically for about a year in the absence of Kasai or transplant, though nutritional status is not optimal
clinical10:41 ↗
If patients have signs of end-stage liver disease with profound fibrosis and reversal of portal flow, Kasai may not improve outcomes and the operation may stress them unnecessarily
opinion10:56 ↗
The Kasai operation itself is not technically demanding with low technical risk, so if uncertain, redo procedures are reasonable
opinion11:44 ↗
Some biliary atresia cases show a race between hepatocyte regeneration and fibrosis progression; one patient's bilirubin dropped to normal 5 months post-op
clinical12:20 ↗
If liver biopsy is suggestive of biliary atresia, additional testing is not needed
opinion14:02 ↗
HIDA scan with phenobarbital has high sensitivity and specificity for biliary atresia
clinical15:21 ↗
An effective HIDA requires at least 5 days of phenobarbital at therapeutic levels
clinical15:47 ↗
In cases where initial HIDA without adequate phenobarbital was negative, about one-third showed biliary atresia when repeated with proper phenobarbital levels
clinical16:40 ↗
A recent paper in Gastroenterology showed a scoring system combining liver biopsy with clinical parameters had almost 100% ability to predict biliary atresia
clinical17:35 ↗
Pathologists' understanding of what to look for in biliary atresia biopsies has improved compared to 20 years ago
clinical18:01 ↗
Interventional radiologists can perform percutaneous liver biopsies safely and routinely
clinical18:10 ↗
Patent gallbladder in true biliary atresia is super rare
clinical18:41 ↗
In Milwaukee, percutaneous cholangiography combined with biopsy can quickly provide answers when successful
clinical18:59 ↗
If percutaneous cholangiography shows contrast in the gallbladder and bowel, biliary atresia is ruled out without need for surgery
clinical19:49 ↗
Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent
clinical20:44 ↗
Japanese centers still recommend steroids either routinely or when drainage decreases after Kasai
clinical21:46 ↗
Japanese surgeons now perform Kasai with wider porta dissection than Dr. Kasai originally did
clinical22:15 ↗
Japanese technique uses more superficial sutures to avoid damaging ductules and avoids placing sutures at 10 o'clock and 3 o'clock positions where normal bile ducts bifurcate
clinical22:39 ↗
Japanese centers claim better results with modified technique, though numbers are not statistically valid
clinical23:06 ↗
Yamataka is attempting to show laparoscopic Kasai results are as good as open, contrary to IPEG recommendations
clinical23:08 ↗
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