First one with correct answer with justification win.

 

[size=20px]You are asked to see a four-week old female with direct hyperbilirubinemia. Ultrasound suggests a small collapsed gallbladder and HIDA study shows hepatic uptake without secretion. Studies for metabolic and infectious diseases are pending. The next best step in management of this child with jaundice is

 

A wait for metabolic and infection studies.

 

B laparoscopic cholangiogram, liver biopsy and possible Kasai portoeneroscopy.

 

C open cholangiogram, liver biopsy and possible Kasai portoenterostomy.

 

D liver transplant.[/size]

C

C

 

correct

 

Portoenterostomy continues to be the appropriate first line therapy for biliary atresia. After laparoscopic Kasai was initially described there was early enthusiasm for this minimally invasive approach. However, several retrospective studies and one recent prospective study have reported a significantly worse outcome with the laparoscopic operation. The reason for this difference is unclear.

The operation should not be delayed while awaiting final results for additional testing because it is widely believed that younger infants have better results than older ones. Liver transplant should be reserved for patients who fail the Kasai procedure.

C open cholangiogram, liver biopsy and possible Kasai portoenterostomy