Paediatric hepatobiliary: biliary atresia: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Paediatric hepatobiliary: biliary atresia

Sample item

A 5-week-old breastfed girl has persistent jaundice, pale stools and dark urine. Conjugated bilirubin is 7 mg/dL, ultrasound shows a triangular cord sign at the porta hepatis and a hepatobiliary scan shows no excretion into the bowel at 24 hours. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intraoperative cholangiogram and Kasai portoenterostomy without delay

Biliary atresia is progressive obliteration of the extrahepatic ducts causing conjugated hyperbilirubinaemia in the neonate. The Kasai hepatoportoenterostomy gives the best drainage if done before about 8 weeks of age, and transplantation is reserved for failure of the Kasai or for late presentation. Delay worsens fibrosis and survival with the native liver.

Option by option

  • A. Intraoperative cholangiogram and Kasai portoenterostomy without delay (correct)

    Correct. Early Kasai portoenterostomy, ideally before 8 weeks, offers the best chance of bile flow.

  • B. Observation and repeat bilirubin at 3 months

    Waiting for 3 months allows irreversible cirrhosis and makes drainage surgery much less effective.

  • C. Liver transplantation as the primary procedure now

    Transplantation is a salvage option after failed Kasai and not the first procedure in an infant who can still be drained.

  • D. Phenobarbitone and breastfeeding cessation only

    Medical treatment cannot relieve a mechanical obliteration of the bile ducts.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Intraoperative cholangiogram and Kasai portoenterostomy without delay. Biliary atresia is progressive obliteration of the extrahepatic ducts causing conjugated hyperbilirubinaemia in the neonate.

Why is "Observation and repeat bilirubin at 3 months" not the answer?

Waiting for 3 months allows irreversible cirrhosis and makes drainage surgery much less effective.

Why is "Liver transplantation as the primary procedure now" not the answer?

Transplantation is a salvage option after failed Kasai and not the first procedure in an infant who can still be drained.

Why is "Phenobarbitone and breastfeeding cessation only" not the answer?

Medical treatment cannot relieve a mechanical obliteration of the bile ducts.

What concept does this question test?

It tests Paediatric hepatobiliary: biliary atresia in General Surgery. The Kasai hepatoportoenterostomy gives the best drainage if done before about 8 weeks of age, and transplantation is reserved for failure of the Kasai or for late presentation. Delay worsens fibrosis and survival with the native liver.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric hepatobiliary: biliary atresia?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.