Investigation of choice to rule out biliary atresia in a 2-month-old child is:
Hepatic scintigraphy
ERCP
USG
CT scan.
Ans: A. Hepatic scintigraphy(Ref. Nelson 20/e p1934, 19/e p1385; Sabiston 20/e p1880, I9/e p1852-1853; Schwaz 10/e p1628, 9/1438-1440; Bailey 27/e p1196, 26/e p1104-1105; Blumga 5/e p595-603; Shackelford 7/e p1390-1396)* Investigation of choice to rule out biliary atresia in a 2- month-old child = Hepatic scintigraphy.Hepatobiliary scintigraphy with technetium-labeled iminodiacetic acid derivatives (HIDA scan):* Used to differentiate biliary atresia from non-obstructive causes of cholestasis.Normal hepatic uptake -* In biliary atresia.* Excretion into intestine is absent.Impaired uptake -* In neonatal hepatitis.* Excretion into intestine occur.* Follow-up scan after 24 hours - Determines the biliary tree patency.* Phenobarbital administration (5 mg/kg/day) for 5 days before scan recommended.* Enhances biliary isotope excretion.Hepatobiliary scintigraphy:* Very sensitive.* Non-specific test for biliary atresia.* Fails to identify other structural abnormalities of biliary tree or vascular anomalies.