Biliary Atresia

What is Biliary Atresia?

Biliary atresia is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder. This congenital condition occurs when the bile ducts inside or outside the liver do not develop normally. It is not known why the biliary system fails to develop normally. In babies with biliary atresia, bile flow from the liver to the gallbladder is blocked. This can lead to liver damage and cirrhosis of the liver, which is deadly if not treated.


Newborns with this condition may appear normal at birth. However, jaundice develops by the second or third week of life. The infant may gain weight normally for the first month, but then will lose weight and become irritable, and have worsening jaundice. 

Other symptoms may include:

  • Dark urine

  • Enlarged spleen

  • Floating stools

  • Foul-smelling stools

  • Pale or clay-colored stools

  • Slow or no weight gain

  • Slow growth

Stool Color Guide

Poop comes in all colors (and all smells and textures) including many shades of brown, green, or yellow. In general, these colors are normal. However, in some instances, poop color can provide important clues as to problems with the gastrointestinal tract or liver.


Physical exam is performed to feel for an enlarged liver. Other tests include:

  • Abdominal x-ray

  • Abdominal ultrasound

  • Blood tests to check total and direct bilirubin levels

  • Hepatobiliary iminodiacetic acid (HIDA) scan, also called cholescintigraphy, to help determine if the bile ducts and gallbladder are working properly

  • Liver biopsy to determine severity of cirrhosis or to rule out other causes of jaundice

  • X-ray of the bile ducts (cholangiogram)


An operation called the Kasai procedure is done to connect the liver to the small intestine, going around the abnormal ducts. It is most successful if done before the baby is 8 weeks old. However, a liver transplant may still be needed.

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