The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome

dc.contributor.advisorMann, Michael Den_ZA
dc.contributor.authorDaubenton, John Daviden_ZA
dc.date.accessioned2017-12-12T14:22:14Z
dc.date.available2017-12-12T14:22:14Z
dc.date.issued1989en_ZA
dc.description.abstractThe differentiation, in an infant with cholestasis, between extrahepatic biliary atresia (EHBA) and the neonatal hepatitis syndrome (NHS) is important in that laparotomy is always indicated in EHBA but is undesirable in NHS. This differentiation is particularly difficult in those infants with complete cholestasis. Hepatobiliary scintigraphy is a commonly used investigation in infants with obstructive jaundice. The scintigraphic demonstration of excretion into the gut excludes extrahepatic obstruction, however, absence of excretion may be due to EHBA, severe cholestasis with patent extrahepatic bile ducts or poor uptake of the agent, and is therefore not diagnostic. This study has examined the quantitative measurement of the hepatic uptake of p-butyl IDA and Sn colloid, and an estimation of liver shape, in a group of patients with complete cholestasis in whom conventional scan interpretation, based on excretion into the-gut, would not be useful. The scans were recorded as dynamic studies and the resultant time-activity curves were subjected to curve fitting to calculate a rate constant for uptake of radiopharmaceutical. Liver shape was determined from the anterior static image of the colloid scan. The results show a significant difference between the EHBA and the NHS patients in the rate of uptake of p-butyl IDA, in the ratio of the rate of uptake of p-butyl IDA/the rate of uptake of colloid and in the measurements used to express liver shape. Using this method of scan interpretation, a diagnostic accuracy of 85% was achieved in this study of patients who clinically, and on scan, had no evidence of bile flow. Hepatic scintigraphy is therefore a useful investigation in the diagnostic work-up of infants presenting with obstructive jaundice even when bile flow is completely absent.en_ZA
dc.identifier.apacitationDaubenton, J. D. (1989). <i>The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Nuclear Medicine. Retrieved from http://hdl.handle.net/11427/26576en_ZA
dc.identifier.chicagocitationDaubenton, John David. <i>"The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Nuclear Medicine, 1989. http://hdl.handle.net/11427/26576en_ZA
dc.identifier.citationDaubenton, J. 1989. The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Daubenton, John David AB - The differentiation, in an infant with cholestasis, between extrahepatic biliary atresia (EHBA) and the neonatal hepatitis syndrome (NHS) is important in that laparotomy is always indicated in EHBA but is undesirable in NHS. This differentiation is particularly difficult in those infants with complete cholestasis. Hepatobiliary scintigraphy is a commonly used investigation in infants with obstructive jaundice. The scintigraphic demonstration of excretion into the gut excludes extrahepatic obstruction, however, absence of excretion may be due to EHBA, severe cholestasis with patent extrahepatic bile ducts or poor uptake of the agent, and is therefore not diagnostic. This study has examined the quantitative measurement of the hepatic uptake of p-butyl IDA and Sn colloid, and an estimation of liver shape, in a group of patients with complete cholestasis in whom conventional scan interpretation, based on excretion into the-gut, would not be useful. The scans were recorded as dynamic studies and the resultant time-activity curves were subjected to curve fitting to calculate a rate constant for uptake of radiopharmaceutical. Liver shape was determined from the anterior static image of the colloid scan. The results show a significant difference between the EHBA and the NHS patients in the rate of uptake of p-butyl IDA, in the ratio of the rate of uptake of p-butyl IDA/the rate of uptake of colloid and in the measurements used to express liver shape. Using this method of scan interpretation, a diagnostic accuracy of 85% was achieved in this study of patients who clinically, and on scan, had no evidence of bile flow. Hepatic scintigraphy is therefore a useful investigation in the diagnostic work-up of infants presenting with obstructive jaundice even when bile flow is completely absent. DA - 1989 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 1989 T1 - The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome TI - The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome UR - http://hdl.handle.net/11427/26576 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/26576
dc.identifier.vancouvercitationDaubenton JD. The differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndrome. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Nuclear Medicine, 1989 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/26576en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Nuclear Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherBile ducts - Obstructionsen_ZA
dc.subject.otherBiliary atresiaen_ZA
dc.subject.otherCholestasis in childrenen_ZA
dc.subject.otherHepatitis in childrenen_ZA
dc.subject.otherChildren - Diseasesen_ZA
dc.subject.otherBile Duct Obstruction, Extrahepatic - in infancy & childhooden_ZA
dc.subject.otherBiliary Atresia - in infancen_ZA
dc.titleThe differentiation of extrahepatic biliary atresia from the neonatal hepatitis syndromeen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnameMDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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