Biliary Atresia Investigation — RACP Paediatrics MCQ

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ModerateGastroenterologyBiliary Atresia InvestigationRACP Paediatrics

A 4-month-old breastfed infant has persistent conjugated jaundice (direct bilirubin 80 umol/L), hepatomegaly, and pale stools. What investigation should be prioritised to exclude biliary atresia?

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Correct answer: D — Abdominal ultrasound (looking for triangular cord sign and absent/abnormal gallbladder)

Biliary atresia must be excluded urgently in any infant with conjugated hyperbilirubinaemia and pale stools. USS looking for the triangular cord sign (echogenic density at the porta hepatis), absent or abnormal gallbladder, and hepatic abnormalities is the first-line investigation. Prompt surgical referral is critical as Kasai outcomes worsen after 60 days.

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