Neonatal jaundice By Dr Hatem El Gohary
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Transcript of Neonatal jaundice By Dr Hatem El Gohary
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Biliary System
&Neonatal
Jaundice
Dr Hatem El GoharyLecturer of General Surgery
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Neonatal Jaundice
What is Neonatal Jaundice?
Yellowish discoloration of sclera and skin
due to high levels of bilirubin which is
manifested above 5 mg/dl.
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Physiology of Bilirubin
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Classification
Physiological (unconjugated)
Pathological (first 24 hours).
Unconjugated
1.Haemolytic (ABO/Rh Incompatibility,
spherocytosis, thalassemia).
2.Non-Haemolytic
Conjugated Extra hepatic (Biliary Atresia)
Hepatic (Hepatitis B)
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Physiological jaundice
Causes:
1- Increased production of
bilirubin due to increased breakdown of fetal
RBCs(short half life).
2- Low hepatic activity.
C/P: jaundice after 24 hours.
Treatment: Phototherapy.
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Congenital Anomalies of
the Biliary System
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Anatomy of Biliary SystemLiver
Right hepatic artery
Cystic Artery Cystic Duct
Gall Bladder
Common Bile Duct
Duodenum (2nd part)
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Biliary Atresia
Aetiology:
Inflammatory process, which starts around the time
of birth.
Types:
• type I: atresia restricted to the common bile duct;
• type II: atresia of the common hepatic duct;
• type III: atresia of the right and left hepatic ducts.
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Clinical Picture
Progressive Jaundice at birth.
Pale stool
Dark urine.
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Treatment
Type 1 Hepatico-jujenostomy.
Type 2,3 Kasai procedure (excision of
all bile duct tissue up to the liver capsule +
jejunum is anastomosed to the exposed
area of liver capsule).
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Choledochal cyst
Definition:
congenital dilatations of the intra- and/or
extrahepatic biliary system.
Risk:
Development of Cholangiocarcinoma.
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Types (type 1 most common)
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Type Ia diffuse cystic
Ib diffuse cystic + extension into the pancreas.
Type II diverticulum of the common bile duct.
Type III: diverticulum within the pancreas.
Type IV: extension into the liver.
Type V: cystic dilatation only of the intrahepatic
ducts.
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DiagnosisSymptoms:
Jaundice
fever
abdominal pain .
Signs:
Right upper quadrant mass
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Investigations:
Ultrasound Cyst
MRI/MRCP will reveal the anatomy and
the type.
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Treatment
1- Radical excision of the cyst
2- Reconstruction of the biliary tract using a
loop of jejunum.
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