Biliary Atresia | Testing and Diagnosis

How is biliary atresia diagnosed?

The first step in treating your child is forming an accurate and complete diagnosis. If your child has biliary atresia, it’s important that she be diagnosed quickly, since surgery must be performed early in order to be effective.

Usually, the diagnostic process begins when you or your child’s pediatrician notices that your child appears jaundiced. The doctor will do one or more blood tests to determine whether it may be because of a liver problem.

These blood tests may include:

  • bilirubin level test
  • liver enzymes and bile duct enzymes tests
  • blood cultures – can show bacterial infections that may affect the liver
  • viral tests – some viruses can cause liver damage
  • tests for some metabolic diseases (such as enzyme deficiencies) that can cause early jaundice and liver test abnormalities
  • tests for cystic fibrosis, such as a sweat test

The doctor may also want to check your child’s urine and stool.

He or she may also order diagnostic tests to view your child’s biliary system, including:

  • abdominal ultrasound to see if there is a normal gallbladder or abnormalities that may explain the jaundice
  • biliary excretion or “HIDA” scan – a special chemical is injected into your baby’s vein, then pictures are taken to see if it is excreted normally by the liver, just as bile would be.

Finally, if the diagnosis is still not definitive, we may need to perform a diagnostic surgical procedure. These may include:

  • liver biopsy – a tissue sample is taken from your child's liver and examined for abnormalities
  • operative cholangiogram – a small incision is made in your child’s abdomen, and a contrast agent is injected into her bile duct. This agent can be seen on a special monitor, helping surgeons to see any blockages in the bile ducts.

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we’ll meet with you and your family to discuss the results and outline the best treatment options.