Digestive Clinical Cases
Table of Contents

Pediatrics case

 Insufficient bile:
- Extra hepatic biliary atresia: idiopathic obliteration of the biliary duct. Patient’s birth was normal with normal birth weight. However jaundice was present with symptoms of “teary eye”. Hospital referral and checkup showed an extremely elevated level of bilirubin in blood and INR.
 Pathway of bilirubin:
- Senescent red blood cells are destroyed in the spleen and bone marrow and haemoglobin is released.
- Haemoglobin is broken down to heme and made into unconjugated bilirubin in the macrophages of the spleen and bone marrow
- The bilirubin is then bound to albumin and sent to the liver where a glucuronate is added forming a conjugate bilirubin, the final product for bile secretion
 Poor bile flow:
- nutritional failure: bile forms micelles around triglyceride and is important for long chain triglyceride (predominant in milk) and fat vitamins absorption. Lack of this will cause poor growth and steatorrhea.
- fat soluble vitamin deficiency: A deficiency cause visual loss while D is bone and calcium, E is hyporeflexia, and K coagulopathy
- ascending cholangitis: bacterial infection of the biliary tract causing biliary stasis
- portal hypertension: obstruction of bile causes fibrous scarring of the liver which will impede blood flow through liver and so flow is redirected through the spleen (enlarging it) and stomach causing esophageal varices.
- poor clotting: lack of vitamin K absorption causes abnormal coagulation hence high INR (international normalized ratio). Oral vitamin K have little effect while IV vitamin K restores normal INR, i.e 1.
 Inefficient exocrine pancreatic function:
- patient is a 15 yo girl presented with cystic fibrosis and low faecal chymotrypsin with abnormally low height, weight and BMI. She has moderate severe lung disease and pancreatic insufficiency.
- In addition there is decreased fat and delayed puberty and poor compliance of the girl in taking medicine – social issue
 Pancreatic insufficiency treatment:
- Supplement pancreatic enzyme extracted from pig pancreas can be taken as capsule with each meal.
- Fractional absorption is low so high calorie and fat diet should be taken (best in conjunction with medicine)

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License