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Biliary Atresia — RACP Paediatrics MCQ

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ModerateGastroenterologyBiliary AtresiaRACP Paediatrics

A 4-week-old term infant presents with persistent jaundice. Total bilirubin is 180 μmol/L with a conjugated fraction of 85 μmol/L. The infant is breastfeeding well and gaining weight. Stools are pale/acholic. What investigation should be performed most urgently?

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Correct answer: B — Liver ultrasound

Conjugated hyperbilirubinaemia with pale stools in a neonate is biliary atresia until proven otherwise. Liver ultrasound (looking for absent or abnormal gallbladder, triangular cord sign) is the initial investigation. Definitive diagnosis requires intraoperative cholangiography. The Kasai portoenterostomy should be performed before 60 days of age for optimal outcomes. All other causes of neonatal cholestasis should also be investigated.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Jaundice in Early Infancy