Biliary Atresia

Biliary Atresia Diagnosis, Management protocols and Recent advances Dr Ravi Kanojia PGIMER, Chandigarh India

Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Common case scenario ,[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical causes of jaundice ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Other Causes

Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Biliary USG ,[object Object],[object Object],[object Object],Measure GB length remains same before and after feeding All the 3 factors combined gives positive predictive value of > 90% JPS (2007) 42, 2093–2096

HIDA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MRCP ,[object Object],[object Object]

Liver Biopsy ,[object Object],[object Object],[object Object],[object Object]

Per op cholangiogram ,[object Object],? EHBA Laparotomy Bile in GB Aspirate GB if patent with lumen White bile Obtain Cholangiogram Proceed for Kasai Small non patent fibrotic GB EHBA confirmed

Duodenal Intubation ,[object Object],[object Object],[object Object],[object Object]

ERCP ,[object Object],[object Object],[object Object]

Laparoscopy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis pathway followed Clinical Suspicion (conjugated jaundice), acholic stools Hepatobiliary USG Hepatic nuclear excretion scans If no bilioenteric drainage POC and proceed

Pre op management protocol ,[object Object],[object Object],[object Object],[object Object]

Pre op management ,[object Object],[object Object],[object Object],[object Object]

Post operative management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Role of steroids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prognostic factors ,[object Object],[object Object],[object Object],[object Object],[object Object],MAP Score JPS, Vol31, No 10,1996: pp 1387-1390

Follow up protocol ,[object Object],[object Object],[object Object],[object Object]

Recent Advances ,[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PGI Experience ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Atretic GB with complete atresia of the EHBT Ty IIA Extrahepatic cyst with proximal atresia Per op findings 12 1 2

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lessons learnt ,[object Object],[object Object],[object Object],[object Object]

Kasai Portoenterostomy ,[object Object]

Biliary Atresia

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Biliary Atresia