Sonographic features of bile plug syndrome.

Pfeiffer, W. R.; Robinson, Lawrence H; Balsara, V. J.

doi:10.7863/jum.1986.5.3.161

Cited by 16 publications

(9 citation statements)

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“…Inspissated bile syndrome may be associated with dehydration, total parenteral nutrition and massive hemolysis (20). However, as far as we know, no ensuing study has been reported subjecting phototherapy and the inspissated bile syndrome.…”

Section: Discussionmentioning

confidence: 96%

Phototherapy-Related Transient Direct Hyperbilirubinemia

Kanburoğlu¹,

Cizmeci²,

Akelma³

et al. 2016

Turkish J Pediatr Dis

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Objective: We aimed to investigate the frequency and possible risk factors of phototherapy-related direct hyperbilirubinemia. Material and Methods:We scanned the medical records of 1301 patients who were admitted to the neonatology unit for indirect hyperbilirubinemia between 2005 and 2013. Infants with a clinical condition other than hyperbilirubinemia were excluded. Results:Following phototherapy both the direct bilirubin level and direct bilirubin/total bilirubin ratio increased (p<0.001 and p<0.001, respectively). The frequency of phototherapy-related direct hyperbilirubinemia was found to be 0.9% if the direct bilirubin/total bilirubin cut-off level was set to 20%. The elevated direct bilirubin level and direct bilirubin/total bilirubin ratio returned to normal within three days, although they were still significantly higher than the pre-phototherapy levels (p < 0.001; p < 0.001, respectively). The increase in direct bilirubin level and direct bilirubin/total bilirubin ratio were found to be brisker in patients with ABO incompatibility (p < 0.001 and p < 0.001, respectively). Conclusion:The direct bilirubin level and direct bilirubin/total bilirubin ratio may temporarily rise following phototherapy. This deviation is short term, and ABO incompatibility is the only identified risk factor.To prevent unnecessary investigations this phenomenon should kept in mind by the physicians caring for infants. Bulgular: Fototerapiyi takiben hem direkt bilirubin seviyesi hem de direkt bilirubin/total bilirubin oranı artmaktadır (sı-rasıyla p < 0.001 ve p < 0.001). Patolojik direkt bilirubin/total bilirubin sınırı %20 alındığında, fototerapi ile ilişkili direkt hiperbilirubinemi sıklığı %0.9 olarak bulundu. Artmış direkt bilirubin seviyeleri ve direkt bilirubin/total bilirubin oranı 3 gün içerisinde normale dönmekteydi, fakat bu değerler halen fototerapi öncesindeki değerlere göre anlamlı olarak yüksekti (sırasıyla p < 0.001 ve p < 0.001). ABO uygunsuzluğu olan hastalarda direkt bilirubindeki ve direkt bilirubin/total bilirubin değerindeki artışın daha hızlı olduğu saptandı (sırasıyla p < 0.001 ve p < 0.001).Sonuç: Fototerapi sonrasında direkt bilirubin düzeyi ve direkt bilirubin / total bilirubin oranı geçici olarak artabilmektedir. Bu durum kısa sürelidir ve saptanabilen tek risk faktörü ABO uygunsuzluğudur. Gereksiz ileri araştırmaların önüne geçil-mesi açısından yenidoğanların tedavisinde görev alan doktorların bu durumu akılda tutmaları yararlı olacaktır.

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Section: Discussionmentioning

confidence: 96%

Phototherapy-Related Transient Direct Hyperbilirubinemia

Kanburoğlu¹,

Cizmeci²,

Akelma³

et al. 2016

Turkish J Pediatr Dis

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“…Our patient showed dilatation of both intra and extra-hepatic bile ducts and a distended gall bladder. The sonographic appearance of a choledochal cyst is reported to mimic bile-plug syndrome [5] with either a concentric or an eccentric dilatation of the common bile duct [8,9]. Echogenic structures are reported to fill the common bile duct and are also seen in the gall bladder.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatobiliary imaging with ultra-sonography and radionuclide scan together with liver biopsy are further tests that assess type of pathology and aid in diagnosis. The value of these tests have been the subject of controversy [5,6,7]. The sonographic features of both neonatal hepatitis and biliary atresia are nonspecific although bile duct dilatation does not occur in biliary atresia [2,6].…”

Section: Discussionmentioning

confidence: 99%

“…Bile-plug syndrome is associated with other etiological factors, as cystic fibrosis, severe erythroblastosis fetalis and altered biliary dynamics with total parenteral nutrition (TPN) [1,5,7]. Clinical and laboratory findings in cases of persistent neonatal jaundice may be identical [2,5]. Hepatobiliary imaging with ultra-sonography and radionuclide scan together with liver biopsy are further tests that assess type of pathology and aid in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Since its first recognition by Lightwood and Bodianin in 1946 [3], only few cases are on record [4,5]. Bile-plug syndrome is associated with other etiological factors, as cystic fibrosis, severe erythroblastosis fetalis and altered biliary dynamics with total parenteral nutrition (TPN) [1,5,7].…”

Section: Discussionmentioning

confidence: 99%

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Bile-plug syndrome

et al. 1988

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Duodenal Tube Test in the Diagnosis of Biliary Atresia

Larrosa–Haro,

Caro–López,

Coello–Ramírez

et al. 2001

J. pediatr. gastroenterol. nutr.

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BackgroundBiliary atresia (BA) is the main cause of severe liver damage in infants. Successful surgical treatment is related directly to an early and rapid diagnosis. The aim of this study was to determine specificity, sensitivity, and predictive value of the duodenal tube test (DTT) in the diagnosis of BA in a series of infants with cholestatic jaundice.MethodsThis was a descriptive study of a series of infants with cholestatic jaundice created to validate the sensitivity, specificity, and predictive value of the DTT in the diagnosis of BA. A total of 254 patients were identified from 1988 to 1998. The study cohort included 137 male infants (53.9%), and the mean age on admission was 8.3 weeks ± 2.47 weeks (standard deviation). Study protocol included liver function tests, liver ultrasound, metabolic screening and serology for viral hepatitis, and toxoplasma, rubella, cytomegalovirus, herpes, and others. A nasoduodenal tube was placed at the distal duodenum and the fluid was collected for 24 hours. DTT was considered bile positive when yellow biliary fluid was observed; the test was concluded at this time. When no yellow biliary duodenal fluid was observed, the collection was continued for 24 hours and, if negative, was reported as bile negative. The patients with a bile‐positive DTT were not explored surgically, and the cholestasis workup was completed. Laparotomy and a surgical cholangiogram were indicated in patients with bile‐negative DTT. If BA was verified, portoenterostomy was performed. The gold standard for BA diagnosis was the following: obstruction of the biliary tract confirmed by laparotomy and a surgical cholangiogram, and clinical outcome in patients without laparotomy (followed for a minimum of 18 months).ResultsThe results are as follows. BA: bile‐positive DTT, n = 3; bile‐negative DTT, n = 108. No BA: bile‐positive DTT, n = 134; bile‐negative DTT, n = 9. The following values were also determined: sensitivity, 97.3%; specificity, 93.7%; positive predictive value, 92.3%; and negative predictive value, 98.5%. The final diagnoses were as follows: BA, n = 111 (43.7%); neonatal hepatitis syndrome, n =103 (40.6%); cholestasis associated with inspissated bile syndrome, n = 13 (5.1%); choledochal cyst, n = 11 (4.3%); galactosemia, n = 9 (3.5%); cirrhosis of unknown etiology, n = 5 (2%), and Alagille syndrome, n = 2 (0.8%).ConclusionsThe data obtained from this series validate the DTT as a useful clinical tool for the differential diagnosis of the infant with cholestasis, particularly for indicating laparotomy and cholangiogram to substantiate BA. This diagnostic test is quick and simple, and offers the clinician valuable information with which to determine whether surgical intervention is necessary.

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Sonographic features of bile plug syndrome.

Cited by 16 publications

References 1 publication

Phototherapy-Related Transient Direct Hyperbilirubinemia

Phototherapy-Related Transient Direct Hyperbilirubinemia

Bile-plug syndrome

Duodenal Tube Test in the Diagnosis of Biliary Atresia

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