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.