THE RED CELL PEROXIDE HEMOLYSIS TEST IN THE DIFFERENTIAL DIAGNOSIS OF OBSTRUCTIVE JAUNDICE IN THE NEWBORN PERIOD

The erythrocyte peroxide hemolysis test (PHT) was compared to the I131 rose bengal excretion test (RBE) in the detection of complete biliary obstruction in the newborn period. Twenty-three infants with obstructive jaundice were studied. In 16 infants with surgically proven biliary atresia both the PHT and RBE were abnormal. During the course of evaluation of the other seven patients, with neonatal hepatitis, the PHT was normal in six and abnormal in one, whereas, RBE was normal in two patients and abnormal in five. The simplicity and reliability of the PHT and the ease with which it can be repeated indicate that it may be more valuable than the RBE in evaluating the cause of obstructive jaundice in infants.

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Fecal Excretion of Rose Bengal I131 in the Diagnosis of Obstructive Jaundice in Infancy with Special Reference to Biliary Atresia

PEDIATRICS ◽

10.1542/peds.48.6.966 ◽

1971 ◽

Vol 48 (6) ◽

pp. 966-969

Author(s):

João Gilberto Maksoud ◽

Anneliese Fischer Thom ◽

Julio Kieffer ◽

Virgilio A. Carvalho Pinto

Keyword(s):

Differential Diagnosis ◽

Obstructive Jaundice ◽

Biliary Atresia ◽

Special Reference ◽

Rose Bengal ◽

Poor Prognosis ◽

Surgical Intervention ◽

Correct Diagnosis ◽

Fecal Excretion ◽

The Poor

Despite the poor prognosis of biliary atresia, there are a small number of cases in which early surgery will be of real benefit. Every effort must therefore be made to arrive at the correct diagnosis as quickly as possible so as not to delay surgical intervention. In our experience, FERB I131 has been the most reliable diagnostic test; we are convinced that this test must be done in every case in which the differential diagnosis of neonatal or infantile jaundice is not clear.

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The differential diagnosis of neonatal hepatitis and biliary atresia

Journal of Pediatric Surgery ◽

10.1016/0022-3468(74)90108-0 ◽

1974 ◽

Vol 9 (5) ◽

pp. 699-705 ◽

Cited By ~ 10

Author(s):

David P. Campbell ◽

J.Rainer Poley ◽

Petar Alaupovic ◽

E.Ide Smith

Keyword(s):

Differential Diagnosis ◽

Biliary Atresia ◽

Neonatal Hepatitis

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Choledochal Cyst: Delayed Diagnosis in a Jaundiced Infant

PEDIATRICS ◽

10.1542/peds.62.2.235 ◽

1978 ◽

Vol 62 (2) ◽

pp. 235-237

Author(s):

Vivian J. Harris ◽

John Kahler

Keyword(s):

Obstructive Jaundice ◽

Biliary Atresia ◽

Choledochal Cyst ◽

Delayed Diagnosis ◽

Clinical Situation ◽

Diagnostic Evaluation ◽

Newborn Period ◽

Surgical Exploration ◽

The Past ◽

Young Infants

Obstructive jaundice in young infants represents a clinical situation whose diagnostic evaluation has changed dramatically over the past few years.1-3 Biliary atresia and some forms of neonatal hepatitis are the most common diseases to be differentiated. Emphasis has shifted in recent years toward early surgical exploration for the possibility of performing some form of portoenterostomy. Among surgically correctible lesions, the choledochal cyst, although a rare cause of obstructive jaundice during the newborn period, should be considered and actively pursued since irreversible cirrhosis is a major sequela in untreated cases.4 We describe a patient who was considered to have biliary atresia but on whom a choledochal cyst was discovered at 5½ months of age.

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BILE-PLUG SYNDROME: A CORRECTABLE CAUSE OF OBSTRUCTIVE JAUNDICE IN INFANTS

PEDIATRICS ◽

10.1542/peds.43.2.273 ◽

1969 ◽

Vol 43 (2) ◽

pp. 273-276

Author(s):

Jay Bernstein ◽

Raul Braylan ◽

A. Joseph Brough

Keyword(s):

Liver Biopsy ◽

Obstructive Jaundice ◽

Biliary Atresia ◽

Choledochal Cysts ◽

Newborn Period ◽

Surgical Exploration ◽

Obstructive Lesion ◽

Hepatocellular Damage ◽

Conjugated Hyperbilirubinemia ◽

Histopathological Effects

Conjugated hyperbilirubinemia in the newborn period and early infancy can result from choledochal obstruction or hepatocellular damage. Examples of the former include biliary atresia, choledochal cyst, and choledochal bile plugs. The recognition of these conditions and their differentiation are of importance in determining the best and most effective course of therapy. Choledochal cysts and bile plugs can be corrected surgically, and the presence of these two conditions is best determined by surgical exploration and transcholecystic cholangiography. Previous liver biopsy is helpful in establishing the presence of an obstructive lesion; but, because of the similarity of histopathological effects on the liver, it will be of little help in differentiating the causes of obstruction.

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PROBLEMS IN NEONATAL OBSTRUCTIVE JAUNDICE

PEDIATRICS ◽

10.1542/peds.33.5.735 ◽

1964 ◽

Vol 33 (5) ◽

pp. 735-748

Author(s):

Dale E. Bennett

Keyword(s):

Obstructive Jaundice ◽

Biliary Atresia ◽

Giant Cell ◽

Poor Prognosis ◽

Neonatal Hepatitis ◽

Final Conclusion ◽

High Morbidity ◽

Bile Duct Proliferation ◽

Hazardous Procedure ◽

Giant Cell Hepatitis

All cases of neonatal obstructive jaundice at St. Louis Children's Hospital were reviewed. The total of 57 included 32 cases of extrahepatic biliary atresia and 16 biopsy-proven cases of giant-cell hepatitis. As a result, the author has reached the following conclusions: Giant-cell hepatitis can be distinguished from extrahepatic atresia in almost all cases by study of a liver biopsy. The important morphologic criteria include the presence in atresia of bile duct proliferation and of intraductal bile stasis, and the absence of significant hepatic architectural disorganization early in the course of the disease. Clinical data and most laboratory tests are of little use in distinguishing between atresia and neonatal hepatitis. Serial bilirubin determinations are useful, as falling levels over a period of weeks is strong evidence for hepatitis. At laparotomy cholangiography is the most valuable diagnostic tool, with frozen section of value when radiographic studies cannot be made. Biliary atresia carries an extremely poor prognosis, for few patients have a correctable lesion (12% in this series). Furthermore, the mortality and morbidity of biliary tract surgery in infants is high, irrespective of the age of the patient at operation. This poor prognosis is not due to delay in operation, since cirrhosis and hepatic insufficiency develop relatively late in biliary atresia. Delay of operation until age three months will adversely affect only a very rare patient with atresia. Neonatal hepatitis is a frequent cause of neonatal obstructive jaundice. Exploratory laparotomy in these patients has a high morbidity and mortality, especially when a prolonged ductal dissection is performed. Early operation (4-8 weeks) will result in more cases of hepatitis being subjected to a hazardous procedure. There is evidence to indicate that if operation is delayed until 3 months of age, many of these patients will show evidence of resolution of their disease, especially a serial fall in bilirubin, and need not be explored. It is the final conclusion of the author that the management of obstructive jaundice in this age group should be conservative, and that operation should not be performed until a patient is three months of age, and even later if a falling trend is noted in serial bilirubins.

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99mTc sestamibi imaging

Nuklearmedizin ◽

10.3413/nukmed-0205 ◽

2009 ◽

Vol 48 (03) ◽

pp. 100-103 ◽

Cited By ~ 1

Author(s):

H. R. Kianifar ◽

V. R. D. Kakhki ◽

R. Zakavi ◽

K. Ansari ◽

R. Sadeghi

Keyword(s):

Differential Diagnosis ◽

Biliary Atresia ◽

Neonatal Hepatitis ◽

Hepatobiliary Scintigraphy ◽

Neonatal Cholestasis ◽

Major Disadvantage ◽

99Mtc Mibi ◽

Diagnostic Work ◽

Mibi Scintigraphy ◽

99Mtc Sestamibi

Summary Aim: Hepatobiliary scintigraphy is an integral part in the diagnostic work-up of the neonatal cholestasis syndrome. However, less than optimal specificity is its major disadvantage. Differentiation between biliary atresia and neonatal hepatitis is nearly impossible in some cases with poor hepatocellular function. 99mTc sestamibi (MIBI) is a cationic lipophilic agent which is a substrate of P-glycoprotein. This glycoprotein is normally expressed in biliary canalicular surfaces of hepatocytes. This property provides a hepatic excretory mechanism which is different from bilirubin excretion. In this study we evaluated the value of 99mTc MIBI in differential diagnosis of neonatal cholestasis. Patients, methods: 20 infants with a mean age of 2.41 months (range, 0.1–5 months) were included in the study. Ten infants turned out to have extrahepatic biliary atresia and the other ten had neonatal hepatitis. Hepatobiliary (with 99mTc BrIDA) and 99mTc MIBI scintigraphy were performed for all the patients. Results: 99mTc MIBI scintigraphy has shown bowel activity in all patients, including the patients with biliary atresia. Hepatobiliary scintigraphy revealed bowel activity only in five patients with neo natal hepatitis. Conclusion: Bowel visualization with 99mTc MIBI may be seen in patients with biliary atresia and 99mTc MIBI has limited value in differential diagnosis of neonatal chole stasis.

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