Diagnostic evaluation of infantile cholestasis

Objective: To evaluate diagnostic accuracy of some important clinical manifestations and different investigations in infantile cholestasis. Material and Method: Infants diagnosed with prolong conjugated hyperbilirubinemia and admitted to Chiang Mai University Hospital between Jan 1999 and Feb 2003....

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Main Authors: Wongsawasdi L., Ukarapol N., Visrutaratna P., Singhavejsakul J., Kattipattanapong V.
Format: Article
Language:English
Published: 2014
Online Access:http://www.scopus.com/inward/record.url?eid=2-s2.0-41749104001&partnerID=40&md5=cc2e13e90ef67b3dcaffcbd97e931540
http://www.ncbi.nlm.nih.gov/pubmed/18575287
http://cmuir.cmu.ac.th/handle/6653943832/2470
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Institution: Chiang Mai University
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spelling th-cmuir.6653943832-24702014-08-30T02:00:53Z Diagnostic evaluation of infantile cholestasis Wongsawasdi L. Ukarapol N. Visrutaratna P. Singhavejsakul J. Kattipattanapong V. Objective: To evaluate diagnostic accuracy of some important clinical manifestations and different investigations in infantile cholestasis. Material and Method: Infants diagnosed with prolong conjugated hyperbilirubinemia and admitted to Chiang Mai University Hospital between Jan 1999 and Feb 2003. Demographic and clinical data were recorded. Routine biochemical tests, and serology for TORCHS infections were carried out. An abdominal ultrasonography, DISIDA scan and percutaneous/open liver biopsy were performed. Hyperechoic band at the level of portal bifurcation, named triangular cord (TC) sign was blindly assessed on ultrasonography by the same radiologist. The patients were diagnosed as BA if either operative findings of atretic common bile duct/ gallbladder or evidence of bile duct obstruction demonstrated by intraoperative cholangiography was noted. Results: Sixty-one patients were diagnosed as BA (n = 31) and NH (n = 30) with an average age at diagnosis of 88.6 and 63.1 days respectively. Concerning clinical presentations, only the presence of acholic stool was significantly different between BA and NH (p = 0.006). The GGT level of greater than 500 IU/L was significantly found in BA (p < 0.001). The acholic stool and GGT level more than 500IU/L were highly specific for BA at 100 and 96.6% respectively. In addition, the sensitivity and specificity of US-TC and DISIDA scan were 87.4, 100 and 89.7, 92.0% respectively. The accuracy for diagnosis of BA were highest by DISIDA scan (96.3) followed by US-TC (86.9), GGT level of > 500 IU/L(81.0) and acholic stool(80.3) in order. Conclusion: There was no single laboratory investigation that could precisely make a definite diagnosis of BA. The acholic stool and GGT level of higher than 500 IU/L were highly specific for BA. The TC in ultrasound is noninvasive and easily available tests when combined with acholic stool and the GGT level is suggested plan of management. 2014-08-30T02:00:53Z 2014-08-30T02:00:53Z 2008 Article 01252208 18575287 JMTHB http://www.scopus.com/inward/record.url?eid=2-s2.0-41749104001&partnerID=40&md5=cc2e13e90ef67b3dcaffcbd97e931540 http://www.ncbi.nlm.nih.gov/pubmed/18575287 http://cmuir.cmu.ac.th/handle/6653943832/2470 English
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
language English
description Objective: To evaluate diagnostic accuracy of some important clinical manifestations and different investigations in infantile cholestasis. Material and Method: Infants diagnosed with prolong conjugated hyperbilirubinemia and admitted to Chiang Mai University Hospital between Jan 1999 and Feb 2003. Demographic and clinical data were recorded. Routine biochemical tests, and serology for TORCHS infections were carried out. An abdominal ultrasonography, DISIDA scan and percutaneous/open liver biopsy were performed. Hyperechoic band at the level of portal bifurcation, named triangular cord (TC) sign was blindly assessed on ultrasonography by the same radiologist. The patients were diagnosed as BA if either operative findings of atretic common bile duct/ gallbladder or evidence of bile duct obstruction demonstrated by intraoperative cholangiography was noted. Results: Sixty-one patients were diagnosed as BA (n = 31) and NH (n = 30) with an average age at diagnosis of 88.6 and 63.1 days respectively. Concerning clinical presentations, only the presence of acholic stool was significantly different between BA and NH (p = 0.006). The GGT level of greater than 500 IU/L was significantly found in BA (p < 0.001). The acholic stool and GGT level more than 500IU/L were highly specific for BA at 100 and 96.6% respectively. In addition, the sensitivity and specificity of US-TC and DISIDA scan were 87.4, 100 and 89.7, 92.0% respectively. The accuracy for diagnosis of BA were highest by DISIDA scan (96.3) followed by US-TC (86.9), GGT level of > 500 IU/L(81.0) and acholic stool(80.3) in order. Conclusion: There was no single laboratory investigation that could precisely make a definite diagnosis of BA. The acholic stool and GGT level of higher than 500 IU/L were highly specific for BA. The TC in ultrasound is noninvasive and easily available tests when combined with acholic stool and the GGT level is suggested plan of management.
format Article
author Wongsawasdi L.
Ukarapol N.
Visrutaratna P.
Singhavejsakul J.
Kattipattanapong V.
spellingShingle Wongsawasdi L.
Ukarapol N.
Visrutaratna P.
Singhavejsakul J.
Kattipattanapong V.
Diagnostic evaluation of infantile cholestasis
author_facet Wongsawasdi L.
Ukarapol N.
Visrutaratna P.
Singhavejsakul J.
Kattipattanapong V.
author_sort Wongsawasdi L.
title Diagnostic evaluation of infantile cholestasis
title_short Diagnostic evaluation of infantile cholestasis
title_full Diagnostic evaluation of infantile cholestasis
title_fullStr Diagnostic evaluation of infantile cholestasis
title_full_unstemmed Diagnostic evaluation of infantile cholestasis
title_sort diagnostic evaluation of infantile cholestasis
publishDate 2014
url http://www.scopus.com/inward/record.url?eid=2-s2.0-41749104001&partnerID=40&md5=cc2e13e90ef67b3dcaffcbd97e931540
http://www.ncbi.nlm.nih.gov/pubmed/18575287
http://cmuir.cmu.ac.th/handle/6653943832/2470
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