sis, in which gallstones escape from the gallbladder
and lodge in a bile duct, blocking the flow of bile
and causing PAIN. CANCERof the bile ducts, called
cholangiocarcinoma, occurs though is rare.
For further discussion of the bile ducts within
the context of gastrointestinal structure and func-
tion, please see the overview section “The Gas-
trointestinal System.”
See also GALLBLADDER DISEASE; PANCREAS; PRIMARY
BILIARY CIRRHOSIS; PRIMARY SCLEROSING CHOLANGITIS.
biliary atresia Absence or malformation of the
BILE DUCTS, also called neonatal CHOLESTASIS. Biliary
atresia is nearly always congenital (present at
birth). In some infants biliary atresia appears to
develop as a consequence of an inflammatory
process that occurs shortly after birth, destroying
the bile ducts. Biliary atresia prevents the flow of
BILEfrom the LIVER, causing toxins to accumulate
in the liver. Symptoms depend on the extent of
the atresia and may become apparent within days
of birth or manifest slowly over the first six
months of life. Symptoms include
- JAUNDICE, a yellowish discoloration of the SKIN
resulting from the liver’s inability to break
down BILIRUBINinto components the body can
excrete as waste - stools that are pale in color, the consistency of
clay, and unusually foul smelling - dark URINE
- failure to grow or gain weight
- ABDOMINAL DISTENTION resulting from enlarged
SPLEEN - fussiness and irritability
NEONATAL JAUNDICE
NEONATAL JAUNDICE is fairly common, affecting
about 50 percent of full-term and 80 percent of
preterm (premature) newborns. It points to bil-
iary atresia or other LIVERconditions only when it
is apparent within the first 24 hours after birth or
persists despite treatment.The diagnostic path includes blood tests to meas-
ure the amounts of bilirubin in the blood and PERCU-
TANEOUS LIVER BIOPSY to determine whether the
hepatocytes, the cells that process bilirubin, are nor-
mal. Normal hepatocytes strongly suggest biliary
atresia. Other diagnostic procedures may include
ULTRASOUND and intraoperative cholangiography
(injecting dye into the bile ducts to visualize them
using FLUOROSCOPYor other imaging technologies).
The only treatments for biliary atresia are surgi-
cal procedures to help restore the flow of bile. The
first of these procedures is hepatic portoenteros-
tomy, in which the surgeon creates an opening
between the JEJUNUM (middle segment of the
SMALL INTESTINE) and the bile duct structures that
exist outside the liver. This procedure allows bile
to drain directly from the liver into the small
intestine and can achieve adequate liver function
for up to several years. However, it does not cor-
rect the structural defects of the bile transport net-
work within the liver, and damage to the liver
(fibrosis and CIRRHOSIS) continues. Nearly all
infants who have biliary atresia require LIVER
TRANSPLANTATION, the second surgical procedure to
treat the condition, before they are three years
old. Long-term success of liver transplantation
depends on numerous variables.
See also CONGENITAL ANOMALY; LIVER FAILURE.bilirubin A metabolic product of ERYTHROCYTE
(red BLOODcell) heme that is a key component of
HEMOGLOBIN. Bilirubin exists in two forms, conju-
gated (also called direct), which is water soluble,
and unconjugated (also called indirect or free),
which is fat soluble. The amounts and ratios of
bilirubin present in the BLOODhelp doctors assess
LIVERand GALLBLADDERfunctions.NORMAL BLOOD BILIRUBIN VALUES
unconjugated (indirect) bilirubin 0.1 to 1.0 milligrams per
deciliter (mg/dL)
conjugated (direct) bilirubin 0.0 to 0.4 mg/dL
total bilirubin 0.3 to 1.9 mg/dLThe SPLEENremoves old erythrocytes (red blood
cells), which contain high concentrations of
hemoglobin, from the circulation and begins to
break them down into their components. The
bilirubin that results from this process is unconju-
gated, a form the body cannot eliminate. ALBUMIN,
a protein in the blood, transports this unconju-
gated bilirubin to the liver. There, actions of an
enzyme—glucuronyl transferase—help a chemicalbilirubin 19