This document provides tips for using a PowerPoint presentation on liver embryology and biliary anomalies. It recommends: 1) Freely editing and modifying the slides. 2) Not worrying about the number of slides, as many are blank except for titles to prompt discussion. 3) Showing blank slides first to ask students what they know before presenting information. 4) Repeating this process of asking questions before providing information through multiple revisions for active learning. 5) Using the presentation also for self-study, as it provides sources in the notes.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Anatomy

3. Anatomy

4. Embryology

5. Embryology
• Liver and Biliary tree develops from liver
primordium which emerges from the
endoderm around 3rd week.
• It consists of a cranial portion and a caudal
portion
• Cranial portion forms liver and intrahepatic
biliary tract.
• Extra hepatic bile ducts and the gallbladder
arise from the caudal portion.

6. Congenital Anomalies

7. Congenital Anomalies
• Floating gall bladder
• Double gall bladder
• Absence of the cystic duct
• Low insertion of the cystic duct
• An accessory cholecystohepatic duct
• Biliary Atresia
• Choledochal cyst

8. Biliary Atresia

9. Etiology

10. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

11. Etiology
• Not known.
• Arrest of development at solid stage.
• Autoimmunity triggered by viral infection

12. Clinical Features

13. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

14. Demography

15. Demography
• 1 in 5000 – 1in 20,000
• More in Asians.

16. Symptoms & Signs

17. Symptoms & Signs
• Low birth weight
• Conjugated Jaundice
• Pale Stools
• Yellow urine
• Failure to thrive
• Bleeding tendency
• Portal hypertension
• Splenomegaly
• Oesophageal varices

18. Associated Malformations

19. Associated Malformations
• Polysplenism

20. Pathophysiology

21. Pathophysiology
• Occlusive pan ductular cholangiopathy.
• Not simply mechanical
• Inflammation +nt
• Intrahepatic bile ducts are not dilated

22. Investigations

23. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology

24. Diagnostic Studies

25. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

26. Investigations

27. Investigations
• Technitium-99m iminodiacetate(DISIDA)
scan.
• Normal alpha1 antitrypsin level.
• USG to exclude choledochal cyst.
• Liver biopsy.
• Barbiturate therapy.
• ERCP
• Surgical exploration and cholangiogram

28. Differential Diagnosis

29. Differential Diagnosis
• Prolonged Physiological jaundice
• Obstructive jaundice
– Neonatal hepatitis
– Inspissated bile syndrome
– Choledochal cyst
• Hematological disorders
– ABO/Rh incompatibility
– Spherocytosis
• Metabolic disorders
• Congenital infections

30. Differential Diagnosis
• Physiological jaundice
• Obstructive jaundice
• Hematological disorders
• Metabolic disorders
– Alpha1 antitrypsin deficiency
– Galactosemia
– Pyruvate kinase deficiency
• Congenital infections
– Syphilis
– rubella

31. Operative Therapy

32. Operative Therapy
• Kasai operation- Portoenterostomy
• Liver Transplantation

33. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

34. Get this ppt in mobile

35. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
=0
• https://www.facebook.com/doctorpradeeppa
nde/?ref=pages_you_manage