1. Case Report DISIDA Scan

2. Case I Name: 劉亦承 Age: 2 m/o Sex: Male

3. Chief complain Prolonged jaundice since birth

4. Present illness A case of full-term(BBW:3400gm;NSD) born Jaundice was noted since he was 3-4 d/o. After going home, pale looking and jaundice was still noted. Impaired liver function (GOT/GPT:76/50) and hyperbilirubinemia (Bil(T/D):4.6/2.7) Abdominal echo revealed hepatomegaly.

5. Physical examination Cons: alert; conj: pale; sclera: not icteric HEENT: np Neck: supple, LAP(-) Chest: symmetric expansion HS:RHB, no murmur BS: no rale Abdominal: soft, ovoid, BS: normoactive ; Liver :2fb below RCM Limbs: free movable

6. Differential Diagnosis Common: 1. Biliary atresia 2. Neonatal hepatitis Uncommon: 1. Sepsis 2. Infectious hepatitis(TORCH, syphilis, HBV, Rubella) 3. Alpha-1 Antitrypsin Deficiency) 4. Other causes for high-grade obstruction

7. Plan HbsAg AFP TORCH + VDRL, α1-antitrypsin CMV (urine):- ; CMV (serum): + Rub IgG: + Liver biopsy Ultrasound DISIDA

8. Liver Biopsy Fatty metamorphosis, cholestasis and the presence of giant cells transformation. Portal areas are still shown, without bile ductules proliferation.

9. Abdominal Echo Liver: homogenous parenchyma and enlarged size GB and bile duct: normal Portal vein and hepatic vein: normal Pancreases and spleen: normal Ascites:Nil; no occupy lesion is noted. IMP: Hepatomegaly

10. Tc 99m DISIDA cholescintigraphy

11. Indication Evaluation cholecysitis Differentiate between obstructive and nonobstructive jaundice Investigate persons with upper abdominal pain Biliary assessment postsurgery and evaluation of biliary atresia

12. Normal DISIDA sacn

13. Biliary atresia

14. IMP: low probability of biliary atresia.

15. Biliary atresia ＆ Neonatal hepatitis Does not have true hepatocellular dysfunction such that tracer accumulation in the liver should be normal. Bowel activity should not been seen. Abnormal liver function leading to depressed hepatocellular accumulation of tracer and delayed transit through the liver. Bowel activity will eventually been seen

16. Definite Diagnosis Neonatal hepatitis

17. Case II Name: 呂彥霖 Age: 1m 4d/o Sex: Male

18. Chief Compliance Prolonged jaundice since birth

19. Present Illness This 1m 4d/o male infant was born on 90- 04-14. Prolonged jaundice was found later. He was brought to LMD and then was referred to our CNU due to elevated bilirubin level. (Bil(T/D):5.6/1.8)

20. Physical Examination Cons: alert; sclera: mild icteric Neck: supple, LAP (-) Chest: symmetric expansion HS: RHB, no murmur BS: clear Abd: Liver: 2cm below RCM Spleen: just palpable Limbs: free movable ; No pitting edema

21. Tc 99m DISIDA cholescintigraphy Good hepatic uptake on the 5 min image Homogeneous radiotracer distribution of liver on the 15 min image. Visualized radioactivity of GB on the 30-min image. Relatively low amount of intestinal radioactivity on the serial one and six hours images. Persistent hepatic radioactivity on the 24 hour image.

22. Impression Impaired bile passage, partial biliary atresia is considered. Functional GB.

23. MRCP Revealed visible common bile duct The gall bladder was roughly 3 cm in length Intrahepatic ducts were not dilated No abnormal signal intensity lesion in the liver parenchyma. Imp: No definite evidence of biliary atresia