Biliary Atresia (Infant)

• Serial blood tests showing total and conjugated bilirubin, liver enzymes, albumin and clotting, with dates so the trend is visible.
• Abdominal ultrasound report, including gallbladder appearance and any triangular cord sign, and any HIDA scan or liver biopsy report.
• The operative note and date of the Kasai portoenterostomy if it has been done, with the child's age at surgery.
• A record of cholangitis episodes, weight gain, vitamin supplements, bleeding problems and ascites.
• Blood group, vaccination record and parents' details if a living-donor liver graft is considered.

1. Has biliary atresia been proven, and what other causes of jaundice have been excluded?
2. Is the Kasai operation still appropriate at my child's age, and where is it best done?
3. How will we know whether the Kasai has worked?
4. What signs of cholangitis or liver failure should prompt immediate care?
5. When should we start planning a liver transplant, and what are the donor options?
6. How should my child's feeding, vitamins and vaccinations be managed?

Without surgery biliary atresia is fatal in early childhood. The Kasai operation works best when done in the first two months of life; about half of children achieve good bile flow and clear jaundice, and some of these do well for years. Most children, including many after a successful Kasai, eventually develop liver scarring and need a transplant. Transplant outcomes in children are good, with long-term survival in the large majority. Outcome depends on age at surgery, bile flow, and complications such as cholangitis.