Biliary atresia is often complicated with portal hypertension, which induces a series of hemodynamic changes leading to splenomegaly. Splenomegaly is a common in patients with biliary atresia, which indicates the status of portal hypertension, esophageal varices, and the progression of hepatic fibrosis. Furthermore, it can help monitor the native liver survival status after Kasai procedure and the need for liver transplantation. For patients with biliary atresia presenting splenomegaly and/or hypersplenism, the treatment strategy, involving the pharmacological or surgical options, should be individually selected based on specific clinical condition. This article reviews the value of splenomegaly in the diagnosis and management of biliary atresia, aiming to provide references for clinical practice.

Biliary atresia is a progressive disease involving the intrahepatic and extrahepatic bile ducts. At present, the widely used treatment strategy is portojejunostomy (Kasai procedure). However, fat-soluble vitamin deficiency is common in children with biliary atresia, leading to growth retardation and malnutrition, which further affects the therapeutic effect prognosis of children. This article reviews the etiology, performance, prevention and treatment of fat-soluble vitamins deficiency in children with biliary atresia.

Biliary atresia is often complicated with portal hypertension, which induces a series of hemodynamic changes leading to splenomegaly. Splenomegaly is a common in patients with biliary atresia, which indicates the status of portal hypertension, esophageal varices, and the progression of hepatic fibrosis. Furthermore, it can help monitor the native liver survival status after Kasai procedure and the need for liver transplantation. For patients with biliary atresia presenting splenomegaly and/or hypersplenism, the treatment strategy, involving the pharmacological or surgical options, should be individually selected based on specific clinical condition. This article reviews the value of splenomegaly in the diagnosis and management of biliary atresia, aiming to provide references for clinical practice.

Biliary atresia is a progressive disease involving the intrahepatic and extrahepatic bile ducts. At present, the widely used treatment strategy is portojejunostomy (Kasai procedure). However, fat-soluble vitamin deficiency is common in children with biliary atresia, leading to growth retardation and malnutrition, which further affects the therapeutic effect prognosis of children. This article reviews the etiology, performance, prevention and treatment of fat-soluble vitamins deficiency in children with biliary atresia.

The incidence rate of abdominal trauma is increasing year by year in pediatric trauma， and traumatic pancreatic injury should be taken seriously by clinicians. The pancreas is located behind the peritoneum， and it is difficult to make an early diagnosis of pancreatic injury， especially in children with grade ‍Ⅰ‍/Ⅱ injury. Through a literature review， this article analyzes the application value of endocrine indices and abdominal ultrasound in the early diagnosis of pediatric pancreatic injury， so as to improve the rate of early diagnosis and avoid the onset of related complications. Changes of the endocrine indices such as serum insulin and C Peptide have certain advantages in diagnosing and evaluating the degree of pediatric pancreatic injury and can thus be used as early warning indices for pediatric pancreatic injury. Ultrasound elastography provides a new method for the diagnosis and differentiation of pancreatic injury； contrast-enhanced ultrasound， which has no radioactive damage， has relatively high specificity and sensitivity in identifying pediatric pancreatic injury， and therefore， it is expected to become an alternative to CT examination.

Kasai portoenterostomy is the preferred treatment for biliary atresia. Age at Kasai portoenterostomy is an important factor affecting the prognosis of children with biliary atresia and avoiding liver transplantation. Choosing the appropriate surgical age, restoring good bile drainage, improving the native liver survival rate, and avoiding early liver transplantation are the items that clinicians have always been working on. The age at Kasai portoenterostomy was correlated with the jaundice clearance rate, native liver survival rate, and the incidence of postoperative cholangitis. This article systematically reviewed the research advances on the relationship between age at Kasai portoenterostomy and prognosis for biliary atresia, aiming to provide the basis for the ideal surgical age of Kasai.

Objective:To study the relationship and the role of leptin in children with biliary atresia and hepatic fibrosis to provide a treatment basis for these patients.Methods:The clinical data of children with biliary atresia or congenital biliary dilatation (CBD) who underwent surgical treatment at the Department of General Surgery of Tianjin Children's Hospital from August 2019 to August 2021 were retrospectively analyzed. Of 31 children included in this study, there were 14 males and 17 females, with age of 60 (30, 63) d. Children with biliary atresia served as the study group ( n=26) and children with CBD served as the control group ( n=5). Leptin protein, α-smooth muscleactin (α-SMA) and phosphorylation of extracellular-regulated protein kinase 1/2 (p-ERK1/2) in liver tissues were detectd by immunohistochemistry (IHC). The expression level of leptin mRNA in liver tissues were detected by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). Results:The average optical density values of leptin protein, α-SMA protein and p-ERK1/2 protein in the liver tissues of children in the study group were significantly higher than the control group ( P<0.05). The expression levels of leptin, α-SMA and p-ERK1/2 in liver tissues of children with biliary atresia significantly increased with increase in fibrosis degree ( P<0.05). The expression level of leptin in liver tissues of children with biliary atresia was positively correlated with the liver fibrosis grade ( rs=0.876), α-SMA ( r=0.723) and p-ERK1/2 ( r=0.725) ( P<0.01). The results of qRT-PCR showed that the content of leptin mRNA in liver tissues of children with biliary atresia was significantly higher than that of children with CBD ( P<0.05). Conclusion:Expressions of leptin increased with aggravation of degrees of hepatic fibrosis in biliary atresia. Leptin may be involved in activation of HSCs through the ERK1/2 signaling pathway in the process of hepatic fibrosis due to biliary atresia.

Biliary atresia is a disease characterized by progressive inflammation and fibrosis of intrahepatic and extrahepatic bile ducts, which is an important cause of persistent jaundice in infants, Without timely treatment, it can develop rapidly into cirrhosis, and the child will die of liver failure. Therefore, the early diagnosis of biliary atresia is particularly important. The diagnosis of biliary atresia mainly depends on intraoperative cholangiography and liver biopsy, but they have the disadvantages including invasion, complex operation and many complications, which is not conducive to the early diagnosis of biliary atresia. In comparison, some non-invasive examination methods such as laboratory examination and imaging examination have obvious advantages. In this paper, the value of various diagnostic methods of biliary atresia is analyzed, which provides new ideas for its early diagnosis.

Objective To evaluate GGT in combination with B ultrasound for the diagnosis of biliary atresia (BA) infants suffering from obstructive jaundice.Methods A retrospective analysis was made on 69 sick infants including 55 BAs and 14 non-BAs as identified by intraoperative cholangiography.The preoperative laboratory GGT and ultrasound data were collected and analyzed.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were compared.Results BA patients had significantly higher GGT than Non-BA patients (t =-4.164,P ＜ 0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of GGT ＞ 306 U/L were 69.1％,92.9％,97.4％,43.3％,73.9％,respectively.In BA group,abnormal gallbladder was significantly associated with proadening portal vein,broadening hepatic artery compared with Non-BA patients (x2 =9.995,P ＜0.05).The accuracy of abnormal gallbladder on ultrasound was 78.3％.When two method combined for the diagnosis of BA,the sensitivity,specificity,positive predictive value,negative predictive value were 92.7％,92.9％,98.1％ and 76.5％ and accuracy can reach 92.8％.Conclusions For obstructive jaundice infants with GGT ＞ 306 U/L and abdominal gallbladder ultrasound finding intraoperative cholangiography should be carried out to make definite diagnosis of BA.