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Biliary atresia postoperative cholangitis — RACP Paediatrics MCQ

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HardGastroenterologyBiliary atresia postoperative cholangitisRACP Paediatrics

A 10-week-old who had a Kasai portoenterostomy for biliary atresia develops fever, worsening jaundice and pale stools. Examination shows hepatomegaly and blood tests show rising conjugated bilirubin and inflammatory markers. What is the most likely diagnosis?

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Correct answer: E — Ascending cholangitis

Fever, worsening cholestasis and pale stools after Kasai procedure are concerning for ascending cholangitis. Breast milk jaundice is unconjugated and would not explain fever or pale stools. Cholangitis requires urgent antibiotics and hepatobiliary specialist involvement.

Reference: RACP Knowledge Guides; Therapeutic Guidelines (eTG)