Biliary atresia and neonatal hepatitis two early clinical manifestations and signs similar to performing jaundice, hepatomegaly. Therefore, differential diagnosis more difficult. But they are two distinct clinical disease development, and different methods of treatment : The former only through early surgery, biliary drainage side might be, there is a hope of survival; while the latter is more than can be cured by medical therapy. Therefore, the clinical diagnosis of biliary atresia and neonatal hepatitis make identification is particularly important. Clinically, a combination history, examination, laboratory and imaging data for a comprehensive analysis before making the right judgment.

History and signs

1, hepatitis than baby boy, and biliary atresia baby girl more than that.

2, jaundice in hepatitis bar, and volatility, or change medication significantly reduced; Persistent increase jaundice and biliary atresia, white pottery Tuse droppings.

3, hepatitis hepatomegaly lighter than biliary atresia, seldom more than quarter of the right oblique 4cm; biliary atresia hepatomegaly Obviously, the quality of hard-edged blunt, sometimes accompanied by splenomegaly.

Laboratory

A. With : dynamic detection of serum bilirubin treatment of hepatitis serum bilirubin concentration curve gradually declining condition, and the development of serum bilirubin concentrations with the disease biliary atresia curve showed a sustained increase. But heavy cholestatic hepatitis serum bilirubin concentration can also be performance curve continued to rise, this time to identify difficulties.

B. Low-density lipoprotein X (Lp-X) Determination : biliary atresia, the intrahepatic bile stasis. Lp-X were significantly increased serum; early neonatal hepatitis were negative. If after more than 1.5 Lp-X show negative, may be excluded from biliary atresia.

C. Acid early biliary atresia : Quantitative Determination of serum bile acid were significantly higher than those in neonatal hepatitis. Dynamic testing is more differential diagnosis.

D. Detection of bilirubin duodenal fluid.

And other imaging examination

A. B : first non-invasive inspection, testing and replicable dynamic observation. Neonatal hepatitis in the liver and extrahepatic bile ducts were normal diameter opening image. In hepatic biliary atresia is a linear function of the extrahepatic biliary or cords can be unearthed. Small traces shriveled gallbladder was not visualized gallbladder or images, and the liver is often accompanied by increased splenomegaly.

B. 99mTC-IDA : scintillation excretion test. Early in biliary atresia, liver function was near normal cells, after injection of radioactive substances. Continuous dynamic observation of liver enhancement can be seen after five minutes, but disappeared after biliary opacification Pai people within 24 hours without any bowel imaging. Although poor neonatal hepatitis and liver function, but duct, and thereby revealed within the foreseeable intestine radioactive substances.

C. MRCP (magnetic resonance imaging duct system) : The high resolution. and the B-neighborly relations of intrahepatic biliary atresia and neonatal hepatitis help imaging in the differential.

D. Laparoscopy : laparoscopic liver size, shape and color. If the gallbladder or was pale and shriveled appearance showed traces of a small number diagnosed with biliary atresia.

E. Histopathological examination : transhepatic biliary atresia in the early differential diagnosis of a certain significance. Neonatal hepatitis, liver lesions in the main, not the entire rank structure lambs liver cell necrosis, Giant cell degeneration and portal inflammation; biliary atresia and bile showed bile duct hyperplasia embolization. portal to the main regional fibrosis.

This article was posted on 2007-02-27