INTENSIVE NURSING PRACTICUM - Pediatric Ward (BMC)

CASE STUDY 7: Hepatic Disorder (Biliary Atresia)

CLIENT PROFILE. This is a 4 week old female who presents to the office with parental
reports of increasing jaundice over the last week. Her parents report that 2 weeks ago,
she began to have yellowing of her eyes with subsequent yellowing of her skin when she
was diagnosed with physiologic jaundice. After persistent jaundice for 5 days, her
parents changed her from breast-feeding to a commercial formula. Since the jaundice
appears to be worsening, her parents decided to bring her in for re-evaluation. Her stools
have been pale in color for the past 10 days along with darker urine.

She was born by spontaneous vaginal delivery to a G2P1 A+ mother at 39 weeks with
Apgar scores of 9 and 9 and 1 and 5 minutes. There were no complications noted at
birth, the nursery, or at discharge home. The patient was not jaundiced at discharge or
when seen at initial office visits. Her highest bilirubin previously was 12.0 and her blood
type is A+.

PHYSICAL ASSESSMENT. VS Normal. Weight and height are at the 60th percentile. She
is awake, alert, in no acute distress and is easily comforted by her mother during the
exam. Her skin is jaundiced, most notably in the cephalic and truncal areas, with scleral
icterus. Her liver is slightly enlarged without nodularity. No splenomegaly is noted. The
remainder of her exam is normal.

LABORATORY EXAMINATIONS. Examinations reveal a total bilirubin of 15 mg/dL,

direct bilirubin of 12.3 mg/dL, ALT 45 U/L, AST 52 U/L, and an alkaline phosphatase of
2007 U/L. The patient undergoes a DISIDA scan after 5 days of phenobarbital therapy.
The scan showed normal uptake by the liver but no excretion of the isotope (i.e., no bile
flow) into the bowel even after 24 hours. She is referred to the surgical service for
evaluation. She is then scheduled for a laparotomy with intraoperative cholangiogram,
wedge liver biopsy and possible Kasai procedure

ACTIVITIES:
1. Make your own disease study of Biliary Atresia with pathophysiology (diagram
format)
2. Formulate your health teachings related to the condition
4. Look for a journal related to the case

Prepared by:

Mark Joseph V. Liwanag, RN, MSN

Clinical Instructor – Pediatric Ward (BMC)