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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 1  |  Page : 151-159

Clinicopathological differentiation between biliary atresia and other causes of neonatal cholestasis


1 Department of Pathology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt

Correspondence Address:
Mona S Tantawy
Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_366_16

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Objective To differentiate biliary atresia (BA) from other causes of neonatal cholestasis (NC) regarding clinicopathological features. Background There is a high degree of overlap in clinical, biochemical, and histological characteristics of BA and other causes of NC. There is an increased need of early diagnosis of BA, as timely surgical portoenterostomy is necessary to prevent liver cirrhosis. Patients and methods This retrospective study included 61 (32 diagnosed as BA and 29 as non-BA) infants. Data were collected from the medical records of the Pediatric Hepatology Department, National Liver Institute, and paraffin blocks from the archives of the Pathology Department, National Liver Institute, Menoufia University, during the period from January 2014 to December 2015. Results The study showed that clinically, clay stool (P < 0.0001), hepatomegaly (P = 0.003), and noncontractile gallbladder (P < 0.0001) emerged as the best indicators of BA. Regarding laboratory parameters, the mean levels of each of γ-glutamyl transferase (P < 0.0001), aspartate aminotransferase (P = 0.025), alanine aminotransferase (P = 0.012) and platelets (P = 0.002) were significantly higher in BA than that in non-BA cases. γ-Glutamyl transferase was the most accurate test in discrimination between BA and non-BA groups. Of all histopathological data, portal changes [portal tract edema (P < 0.0001), fibrosis of portal tracts (P < 0.0001), bile ductular proliferation (P < 0.0001) and bile plugs (P < 0.0001)] were more prominent in BA than that in non-BA cases, whereas parenchymal changes [hepatocellular swelling (P = 0.004) and extramedullary hematopoiesis (P = 0.004)] were more prominent in non-BA cases. Conclusion Combined clinical, laboratory, and histopathological parameters are greatly helpful in differentiating BA from other causes of NC. All of these investigations should be done for all suspected cases of BA to decrease the frequency of negative laparotomy finding and achieve cost–benefit with reduced morbidity.


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