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Jaundice, dark urine, clay stool and yellowness, new born - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Child Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1777 Questions
User :   Hi. I need some advice. Any pedaetrician available?
Doctor :   Hi
User :   Hi Sir
Doctor :   please proceed with your query
User :   My baby boy was born on 16th Nov last yr
Doctor :   ok
User :   He has shown signs of jaundice - dark urine, clay stool and yellowness in his entire body
Doctor :   ok
User :   doctors suspect biliary atrisia based on LFT
Doctor :   has any ultrasound has been done ?
User :   YES
Doctor :   can u give me the LFTs please ?
User :   IT SAYS sgot 180
User :   SGPT 68
User :   GGTP 337
Doctor :   The ALP is high indicating involvement of the biliary ducts ;
Doctor :   ok
User :   I understand that..
User :   however is it complusory to have weight loss in case if biliary atrisia?
Doctor :   what happens here in this condition is fats and vitamins are not absorbed due to lack of secretion of bile in to the intestine
Doctor :   so there is usually no growth or increase in weight per se
Doctor :   but it is unusual to gain weight and then loose it
User :   my baby is showing increase in weight since dec..
User :   at birth he was 3.08kg, then he came down to 2.6 and now he is 4.78kg
User :   can this be a case of neonatal hepatitis?
Doctor :   that is usually normal to loose weight after birth due to loss of excess fluid in the body
Doctor :   and then as the fluid balance is maintained the weight is gained
User :   my baby got jaundice right after birth however he recovered showed steady weight gain thereafter
Doctor :   No in neonatal hepatitis, there will be elevation of AST & ALT to vvery high levels (greater than 250)
Doctor :   in your baby, these enzymes are nominally increased
User :   what is AST AND ALT?
Doctor :   SGPT = ALT and SGOT = AST
User :   OK i SEE
Doctor :   they are different names for the same enzymes
Doctor :   sgot and sgpt are old names
User :   OK
Doctor :   Usually after birth, the excess of blood cells in the newborn are destroyed and this can result in jaundice which last for about a week or so
Doctor :   in your baby there is high levels of ALT , and high direct bilirubin
Doctor :   also the GB is not visualised
User :   ok
Doctor :   hence this could be due to bile duct anomalies , which is usually called as biliary atresia
Doctor :   The infant may gain weight normally for the first month,
Doctor :   but then weight gain becomes slow
Doctor :   later .. he becomes irritable, and have worsening jaundice.
User :   tomorrow we are going for hida scan any risk involved?
Doctor :   all the symptoms mentioned initially do support this diagnosis
Doctor :   no there is no risk with HIDA scan
Doctor :   this is the next logical step to see the function of biliary system of the liver
User :   any risk with kasai procedure if required?
Doctor :   Hepatobiliary iminodiacetic acid (HIDA) scan, also called cholescintigraphy, helps to determine whether the bile ducts and gallbladder are working properly
Doctor :   no there is no risk
Doctor :   the kasai procedure is the only treatment that has met with some sucess in treatment of biliary atresia
User :   just to add urine routine was clear
Doctor :   Early surgery will improve the survival of more than a third of babies with this condition.
User :   he is going to be of 3 months on 16th Feb
Doctor :   thats is fine and it is also a proof of the current diagnosis is correct
Doctor :   if the urine was dark ,m it means that the bilirubin is entering the intestines , which is not possible in biliary atresia
User :   what should be the urine clolor in biliary atresia
Doctor :   usually surgery is advised and is always better when done within 8 weeks
Doctor :   but better a bit later than never is the policy
Doctor :   urine will be clear as in this case (no urobilin in the urine - this is the compound which gives urine the color in normal urine)
User :   his urine color is yellow
User :   dark yellow
Doctor :   we dont use the urine color for diagnosis of the condition, it still is a nonspecific finding
Doctor :   you need not bother about the color, too much
User :   I am from bangalore, who will be the best surgeon to approach can you suggest some one?
Doctor :   give me a few minutes
Doctor :   let me get you some one
Doctor :   you need to see a pediatric gastroentrrologist or hepatologist in your case
Doctor :   i am finding one for you
User :   thats fine. now what precautions should be take after the kasai procedure
User :   will he growup as a normal infant?
Doctor :   yes
Doctor :   steroid therapy with medications that stimulate bile flow will have to be given for some time
Doctor :   this will improve the post op bile flow and decrease the jaundice
User :   ok
Doctor :   DR.GAYATHRI GOPALKRISHNAN MD, DNB at narayana hrudayalaya
Doctor :   DR. XXXXXXXX BELLIAPPA - consultant surgeon at the same hospital
User :   I am consulting sagar hospital
User :   at present
User :   will it b a good idea to change consultant at this point of time?
Doctor :   DR AAAAAAA D XXXXXXXX M.Ch at the same hospital is a senior pediatric surgeon in hepatobiliary and transplantation
Doctor :   It will be your decision
Doctor :   if you choose you can always have a second opinion
User :   ok
Doctor :   I am providing the information, that you had asked for
User :   thanks
Doctor :   you are most welcome
User :   in case kasai is done, will my baby grow and play as a normal kid.
Doctor :   Dr XXXXXXXX has more than 30 yrs of experince
Doctor :   yes definitely
User :   what are the chances of liver transplant requirement?
User :   we are nearing 3 months for my baby now..
Doctor :   40-50% is the probabity
User :   what is the cost ivolved in transplant cases?
Doctor :   50000 - 75000 would be the cost
User :   i heard it runs in lakhs..
Doctor :   it depends on the hospital and the doctor you choose
User :   ok..
Doctor :   some may charge less, some charge more
User :   what is your opinion on Sagar Hospital bangalore?
Doctor :   I do not have any first hand experience in that hospital
User :   ok..
Doctor :   but it being a corporate hospital, it provides good service and is considered a good hospital
User :   ok..
Doctor :   the ultimate thing in this case, is the doctor who does the surgery and it does not depend much on the hospital
Doctor :   Even marthas hospital is a good one, that provides quality treatment at afforedable cost
User :   will HIDA scan diagnose the problem?
Doctor :   yes definitely
User :   or is there a chance diagnostic surgery?
Doctor :   the hida will be followed by a liver biopsy
Doctor :   that will give a 100% diagnosis
User :   ok..
User :   will HIDA scan be painful for my baby?
Doctor :   no it does not cause any pain
Doctor :   here just a medicine is given by IV infusion
Doctor :   and scans are taken to see the flow of the isotope through the liver
Doctor :   and biliary ducts
User :   ok..
User :   does be reqd to be off feeding before the scan?
Doctor :   not necessarily
User :   how much wd the scan cost?
Doctor :   may be about 10000
User :   ten thousand?
Doctor :   it depends on the hospital
User :   ok..
User :   cost for liver biopsy?
Doctor :   may be about 3-4 thousand , depending on the doctor
User :   ok..
User :   thanks a lot doc..
Doctor :   you are welcome
User :   bye..
Doctor :   i hope all ur questions are answered
Doctor :   kindly leave your feedback ,
User :   yes, you have..
User :   sure..
Doctor :   thanks and have a good night
User :   and you..
Doctor :   take care and bye for now
User :   bye
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