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== Clinical Summary ==
This eight-month-old female developed jaundice at one week of age. As the jaundice deepened, the child's bilirubin level was found to be over 30 mg/dL and the patient experienced a few convulsive episodes. A liver biopsy produced a diagnosis of extrahepatic bile duct obstruction. A subsequent exploratory laparotomy showed an absence of extrahepatic bile duct structures--including the gallbladder--and an intraoperative cholangiogram failed to show any large biliary channel. A jejunohepatostomy in the portal area was performed in the hope of establishing bile drainage and the patient was placed on the waiting list for a liver transplant. However, the patient progressively deteriorated, developed infections, and after a long turbulent course, died of pneumonia. An autopsy was performed and the diagnosis of extrahepatic bile duct obstruction was confirmed.
== Images ==
<gallery heights="250px" widths="250px">
File:IPLab13BiliaryAtresia1.jpg|This is a low power photomicrograph of a section of liverfrom this stillborn infant. Even at this low magnification, areas of fibrosis can be appreciated.
File:IPLab13BiliaryAtresia2.jpg|This medium-power photomicrograph of liver shows an area of portal fibrosis and bile duct proliferation (arrows). Adjacent to this fibrotic portal region, hepatocytes are seen separated by dilated sinusoids. Throughout this section are found accumulations of yellow-brown bile pigment.
File:IPLab13BiliaryAtresia3.jpg|This high-power photomicrograph of fibrotic portal region demonstrates proliferation of the bile ducts (arrows).
File:IPLab13BiliaryAtresia5.jpg|This is a medium-power photomicrograph of liver section stained with a trichrome stain to demonstrate the portal fibrosis. The fibrous connective tissue (collagen) stains blue.
</gallery>
== Virtual Microscopy ==
=== H&E ===
<peir-vm>IPLab13BiliaryAtresia_HE</peir-vm>
=== Masson Trichrome ===
<peir-vm>IPLab13BiliaryAtresia_Tri</peir-vm>
== Study Questions ==
# abnormal embryologic development--15 to 20% of EHBA patients have extrahepatic anomalies such as polysplenism, cardiovascular defects, and bowel atresias.</spoiler>
* <spoiler text="What is the standard treatment for extra-hepatic biliary atresia?">Liver transplantation.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/927029-overview eMedicine Medical Library: Pediatric Biliary Atresia]
* [http://www.merckmanuals.com/professional/pediatrics/gastrointestinal_disorders_in_neonates_and_infants/neonatal_cholestasis.html Merck Professional: Neonatal Cholestasis]
=== Journal Articles ===
* Davenport M, Caponcelli E, Livesey E, Hadzic N, Howard E. [http://www.ncbi.nlm.nih.gov/pubmed/18362634 Surgical outcome in biliary atresia: etiology affects the influence of age at surgery]. ''Ann Surg'' 2008 Apr;247(4):694-8.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/1750-intrahepatic_biliary_atresia PEIR Digital Library: Intrahepatic Biliary Atresia Images]
* [http://library.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html WebPath: Hepatic Pathology]
== Related IPLab Cases ==
* [[IPLab:Lab 5:Hemochromatosis|Lab 5: Liver: Hemochromatosis]]
{{IPLab 13}}
[[Category: IPLab:Lab 13]]