Neonatal jaundice By Dr Hatem El Gohary
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Transcript of Neonatal jaundice By Dr Hatem El Gohary
Biliary System
&Neonatal
Jaundice
Dr Hatem El GoharyLecturer of General Surgery
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.
Physiology of Bilirubin
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)
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.
Congenital Anomalies of
the Biliary System
Anatomy of Biliary SystemLiver
Right hepatic artery
Cystic Artery Cystic Duct
Gall Bladder
Common Bile Duct
Duodenum (2nd part)
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.
Clinical Picture
Progressive Jaundice at birth.
Pale stool
Dark urine.
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).
Choledochal cyst
Definition:
congenital dilatations of the intra- and/or
extrahepatic biliary system.
Risk:
Development of Cholangiocarcinoma.
Types (type 1 most common)
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.
DiagnosisSymptoms:
Jaundice
fever
abdominal pain .
Signs:
Right upper quadrant mass
Investigations:
Ultrasound Cyst
MRI/MRCP will reveal the anatomy and
the type.
Treatment
1- Radical excision of the cyst
2- Reconstruction of the biliary tract using a
loop of jejunum.