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The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome
The differentiation, in an infant with cholestasis, between extrahepatic biliary atresia (EHBA) and the neonatal hepatitis syndrome (NHS) is important in that laparotomy is always indicated in EHBA but is undesirable in NHS. This differentiation is particularly difficult in those infants with comple...
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| Format: | Thesis |
| Language: | English |
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Division of Nuclear Medicine
2017
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| _version_ | 1867613177059999744 |
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| access_status_str | Open Access |
| author | Daubenton, John David |
| author2 | Mann, Michael D |
| author_browse | Daubenton, John David Mann, Michael D |
| author_facet | Mann, Michael D Daubenton, John David |
| author_sort | Daubenton, John David |
| collection | Thesis |
| description | The differentiation, in an infant with cholestasis, between extrahepatic biliary atresia (EHBA) and the neonatal hepatitis syndrome (NHS) is important in that laparotomy is always indicated in EHBA but is undesirable in NHS. This differentiation is particularly difficult in those infants with complete cholestasis. Hepatobiliary scintigraphy is a commonly used investigation in infants with obstructive jaundice. The scintigraphic demonstration of excretion into the gut excludes extrahepatic obstruction, however, absence of excretion may be due to EHBA, severe cholestasis with patent extrahepatic bile ducts or poor uptake of the agent, and is therefore not diagnostic. This study has examined the quantitative measurement of the hepatic uptake of p-butyl IDA and Sn colloid, and an estimation of liver shape, in a group of patients with complete cholestasis in whom conventional scan interpretation, based on excretion into the-gut, would not be useful. The scans were recorded as dynamic studies and the resultant time-activity curves were subjected to curve fitting to calculate a rate constant for uptake of radiopharmaceutical. Liver shape was determined from the anterior static image of the colloid scan. The results show a significant difference between the EHBA and the NHS patients in the rate of uptake of p-butyl IDA, in the ratio of the rate of uptake of p-butyl IDA/the rate of uptake of colloid and in the measurements used to express liver shape. Using this method of scan interpretation, a diagnostic accuracy of 85% was achieved in this study of patients who clinically, and on scan, had no evidence of bile flow. Hepatic scintigraphy is therefore a useful investigation in the diagnostic work-up of infants presenting with obstructive jaundice even when bile flow is completely absent. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/26576 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:58.458Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Division of Nuclear Medicine |
| publisherStr | Division of Nuclear Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/26576 The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome Daubenton, John David Mann, Michael D Bile ducts - Obstructions Biliary atresia Cholestasis in children Hepatitis in children Children - Diseases Bile Duct Obstruction, Extrahepatic - in infancy & childhood Biliary Atresia - in infanc The differentiation, in an infant with cholestasis, between extrahepatic biliary atresia (EHBA) and the neonatal hepatitis syndrome (NHS) is important in that laparotomy is always indicated in EHBA but is undesirable in NHS. This differentiation is particularly difficult in those infants with complete cholestasis. Hepatobiliary scintigraphy is a commonly used investigation in infants with obstructive jaundice. The scintigraphic demonstration of excretion into the gut excludes extrahepatic obstruction, however, absence of excretion may be due to EHBA, severe cholestasis with patent extrahepatic bile ducts or poor uptake of the agent, and is therefore not diagnostic. This study has examined the quantitative measurement of the hepatic uptake of p-butyl IDA and Sn colloid, and an estimation of liver shape, in a group of patients with complete cholestasis in whom conventional scan interpretation, based on excretion into the-gut, would not be useful. The scans were recorded as dynamic studies and the resultant time-activity curves were subjected to curve fitting to calculate a rate constant for uptake of radiopharmaceutical. Liver shape was determined from the anterior static image of the colloid scan. The results show a significant difference between the EHBA and the NHS patients in the rate of uptake of p-butyl IDA, in the ratio of the rate of uptake of p-butyl IDA/the rate of uptake of colloid and in the measurements used to express liver shape. Using this method of scan interpretation, a diagnostic accuracy of 85% was achieved in this study of patients who clinically, and on scan, had no evidence of bile flow. Hepatic scintigraphy is therefore a useful investigation in the diagnostic work-up of infants presenting with obstructive jaundice even when bile flow is completely absent. 2017-12-12T14:22:14Z 2017-12-12T14:22:14Z 1989 Doctoral Thesis Doctoral MD http://hdl.handle.net/11427/26576 eng application/pdf Division of Nuclear Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Bile ducts - Obstructions Biliary atresia Cholestasis in children Hepatitis in children Children - Diseases Bile Duct Obstruction, Extrahepatic - in infancy & childhood Biliary Atresia - in infanc Daubenton, John David The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| thesis_degree_str | Doctoral |
| title | The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| title_full | The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| title_fullStr | The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| title_full_unstemmed | The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| title_short | The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| title_sort | differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome |
| topic | Bile ducts - Obstructions Biliary atresia Cholestasis in children Hepatitis in children Children - Diseases Bile Duct Obstruction, Extrahepatic - in infancy & childhood Biliary Atresia - in infanc |
| url | http://hdl.handle.net/11427/26576 |
| work_keys_str_mv | AT daubentonjohndavid thedifferentiationofextrahepaticbiliaryatresiafromtheneonatalhepatitissyndrome AT daubentonjohndavid differentiationofextrahepaticbiliaryatresiafromtheneonatalhepatitissyndrome |