Hello and welcome to the Zero to Finals podcast.

My name is Tom, and in this episode I'm going to be talking to you about Billory Atresia.

And if you want to follow along with written notes on this topic,

you can follow along at zero tofinals.com slash bilary atresia

or in the gastroenterology section of the zero definals pediatrics book.

So let's get straight into it.

Billory atresia is a congenital condition where a section of the bile duct is either narrowed or absent.

And this results in colistasis, where the bile cannot be transported from the liver to the bowel. Conjugated

bilirubin is excreted in the bile. Therefore, bilireotresia prevents the excretion of conjugated

bilirubin. Bilariotresia presents shortly after birth with significant jaundice due to high levels of

conjugated bilirubin. Suspect bilariotresia in babies with persistent jaundice due to high levels of conjugated bilirubin.

Suspect biliria in babies with persistent jaundice, lasting more than 14 days in term

babies, or more than 21 days in premature babies.

The initial investigation for possible bilirotresia is to calculate the conjugated and the unconjugated bilirubin.

A high portion of conjugated bilirubin suggests the liver is processing the bilirubin for excretion

by conjugating it, but is not able to excrete the conjugated bilirubin because it cannot flow

through the billory duct to the bowel.

There are many causes of jaundice in the neonate.

The majority of cases are benign, such as breast milk jaundice.

However, more serious causes such as biliratesia need to be excluded by measuring the conjugated bilirubin level.

How is it managed? Well, management of biliratesia is with surgery.

A procedure called the Casai Portoenterostomy involves attaching a section of the small intestine to the opening of the liver where the bile dock normally attaches.

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