9.1 Digestion and Biliary Atresia

Question 1

GI Development

Answer 1

24 Weeks
- When peristalsis begins

36 Weeks
- Baby can coordinate sucking, swallowing, movement through GI tract

Meconium - First stool
Contains - Epithelial cells, Digestive tract secretions, Residue of amniotic fluid
- Thick and greenish

• Meconium tells us there is movement in the GI tract and the GI system is working. It tell us that it is patent.

24 - 48 hours is when the first meconium should occur. If it does not occur then there may be issues such as a unperforated anus (anus never opens)

Question 2

Digestion

Answer 2

• Starts in mouth and saliva helps breakdown starches (beginning of digestion)
• Once food is swallowed, it is lubricated and moves down esophagus. (mucus is released in the esophagus too)
• Peristalsis (wave like movements) help move food through lower esophageal sphincter to the stomach
• Once food reaches the stomach it turns into chyme (partially digested food from enzymes such as bile from the liver or pancreatic enzymes)
• In the small intestines majority of digestion and absorption takes place. Bile helps to breakdown fats.
• Absence or blockage of bile increases fat in your poop (steatorrhea). Fat soluble vitamins cannot be absorbed if bile is obstructed.

Mechanical Digestion
- Churning food and moving food (peristalsis)

Chemical Digestion
- Enzymes, hormones, mucus that helps with digestion (salivary and pancreatic glands)

Question 3

Biliary Artesia

Answer 3

• Inflammatory condition that causes bile duct fibrosis and eventually obstruction
• Occurs later in gestation (abnormality)
• If untreated can lead to cirrhosis, liver failure, and death (due to bile buildup)

Manifestations
- Jaundice beyond 2 weeks (which can cause pruritis)
- Dark urine (due to bilirubin buildup)
- Gray stools
- Hepatomegaly
- Liver firm on palpation
- Failure to thrive due to lack of ability to absorb fat soluble vitamins.

Diagnosis
- Nuclear scintiscan (takes 5 days)
- HIDA scan (radioactive contrast)
- Liver biopsy
- EXPLORATORY LAPOROTOMY WITH INTRAOPERATIVE CHOLANGIOGRAM (X-RAY WITH CONTRAST) - FASTEST WAY

Treatment
- Liver transplant (challenging to get donors)
- Kasai Portoenterostomy (bypasses are created to pass obstructions in the biliary system)
- AGGRESSIVE NUTRITIONAL SUPPORT because they cannot absorb nutrients.

• Ursodeoxycholic (helps with pruritis from bile salt retention)