Study of Stool Color Chart
Stool Colour Chart – A Qualitative Study Page 3
Presentation of Biliary Atresia
The classic triad of BA signs include:
i. Jaundice which is conjugated and prolonged (lasting beyond second week of life)
ii.
Acholic stools
iii.
Hepatomegaly
As bile flow continues to be obstructed leading to liver dysfunction and cirrhosis, further signs may present,
e.g. splenomegaly, pruritus, failure to thrive, ascites, or coagulopathy.
Since hyperbilirubinaemia or jaundice is a very common feature in neonatal life, evident in >50 percent in term
infants and 80 percent in preterm infants, it is not until the jaundice becomes prolonged (>2 weeks in
duration) or there are other features of concern, that a serum bilirubin level would be checked, delaying
investigations and diagnosis. [2] Detecting clinical jaundice can be challenging in some infants, especially those
with darker skin tones. [3, 4] Similarly, hepatomegaly may not be picked up clinically unless the child presents
to health care services within the first few weeks of life. Meanwhile, acholic stools appear in infants with BA in
95 percent of reported cases and usually by four weeks of life. [5-7]
It has been shown acholic stools are often unrecognised as a sign of serious pathology in neonates by
caregivers and health professionals alike. [8] Having a reference for stool colour can be an inexpensive and
easy preliminary screen for BA and other neonatal cholestasis disorders.[9]
Importance of Timely Diagnosis of Biliary Atresia
If BA is diagnosed early enough, a Hepatoportoenterostomy (HPE) or Kasai Procedure can be performed to
restore bile flow towards the intestines, preserving liver function, delaying cirrhosis and the need for liver
transplant. [10] Early diagnosis and surgery (before 60 days of life), can improve survival from the operation,
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