Shilpa Sharma
16 statements · 1 topic
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In developing countries with delayed presentation, advanced cirrhosis, and hepatic failure, most infants with biliary atresia succumb to hepatopulmonary syndrome, portal hypertension, intraventricular hemorrhage, and aspiration due to massive ascites.
epidemiological ·
Biliary Atresia
In hepatic resection, hematopoietic stem cells lead to proliferation with the help of hepatocyte growth factor receptor, epidermal growth factor receptor, and cytokines like tumor necrosis factor.
clinical ·
Biliary Atresia
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Shilpa's statements about Biliary Atresia 16 statements
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Statement
Biliary atresia is a progressive cholangiopathy that leads to morbidity and end stage cirrhosis.
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In developing countries with delayed presentation, advanced cirrhosis, and hepatic failure, most infants with biliary atresia succumb to hepatopulmonary syndrome, portal hypertension, intraventricular hemorrhage, and aspiration due to massive ascites.
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The liver may regenerate after physiological insults and resection, with hepatic resection acting as a trigger for regeneration.
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The liver, however, can regenerate only to a size that is proportional to its original size.
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In biliary atresia, hepatic stellate cells activate and lead to a pro-fibrogenic pathway involving transforming growth factor, platelet derived growth factor, and interleukins.
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In hepatic resection, hematopoietic stem cells lead to proliferation with the help of hepatocyte growth factor receptor, epidermal growth factor receptor, and cytokines like tumor necrosis factor.
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Starting in 2015, the team began resecting segments 2 and 3 of the liver in a non-anatomical fashion to stimulate an alternative pathway of stem cell proliferation for hepatic regeneration.
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The study compared outcomes of segmentectomy combined with Kasai procedure versus Kasai alone, measuring bilirubin and APRI at preoperative, day 7, and 1st, 3rd, 6th, and 12th month time points.
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The median age at presentation was similar in both groups: 96 days in one group and 89 days in the other.
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Serum bilirubin levels were significantly different between the Kasai-plus-resection group and Kasai-alone group at 1 month and 3 months postoperatively.
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APRI (AST to Platelet Ratio Index) was significantly different between groups on postoperative day 7.
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Mortality was lower in the study group (Kasai plus resection) at 56% compared to 93% in the control group (Kasai alone).
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The jaundice-free percentage was 91% in the study group compared to 25% in the control group.
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Resection of a part of the liver may trigger an alternative pathway of stem cell proliferation for hepatic regeneration with reduced fibrosis and improved survival.
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