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Introduction. Ascites of unknown origin in infants are rare and diagnostically challenging. However, it can be associated with a poor prognosis if it is not treated promptly. Case presentation. A 3-month-old boy infant was admitted to the Dr. Soetomo General Academic Hospital, Surabaya because of a 2-week history of progressive abdominal distension with massive ascites following fever onset. Laboratory parameter measurement revealed increased liver function test, hypoalbuminemia, and prolonged coagulation factor. Hepatitis markers were negative. TORCH serological examination showed non-reactive. Urinalysis, renal function test, and echocardiography were normal. The ascitic fluid analysis showed SAAG >1.1 g/dL. An abdominal ultrasound examination revealed ascites. MRCP showed hepatomegaly and ascites. A liver biopsy showed foci of polymorphonuclear and mononuclear inflammatory cell distribution among hepatocytes with no hepatic fibrosis. He was treated with antibiotics, steroids, diuretics, and albumin transfusion. There were no ascites and laboratory parameters were improved after treatment. Conclusion. Progressive and rapid hepatic inflammatory mechanisms may play a role in the development of ascites. Steroids may be considered in cases of unexplained ascites thought to be related to liver injury to prevent further liver fibrosis. [ABSTRACT FROM AUTHOR]

Background. Biliary atresia is the leading cause of liver transplantation in children. It is associated with other congenital anomalies. The presentation of biliary atresia with situs inversus is a rare case. Case presentation. A 2-month-old female presented with jaundice since 15 days of life, acolic stools, and tea-colored urine. On further evaluation, she was found to have dextrocardia and situs inversus. A liver biopsy was performed and showed hepatic fibrosis due to extrahepatic cholestasis. Abdominal ultrasound and MRCP confirmed a liver in the left hypochondrium and suggested biliary atresia. Conclusion. Although rare, every patient with biliary atresia should be screened for congenital situs inversus, which has a poor prognosis. [ABSTRACT FROM AUTHOR]

Choledochal cysts are rare congenital anomalies characterized by dilatation of the bile ducts. The most frequent subtype of choledochal cyst is type I, which has fusiform dilatation of the common bile duct and poses significant challenges in diagnosis and management, particularly, in pediatric patients. We present a case report of a child diagnosed with a Type I choledochal cyst, detailing the clinical presentation, diagnostic workup, surgical intervention, and postoperative outcome. Early recognition and appropriate surgical management are crucial for optimal outcomes in children with this rare entity. [ABSTRACT FROM AUTHOR]

Primary healthcare providers frequently fail to recognize biliary atresia because it closely mimics physiological jaundice. Early detection plays an important role in ensuring the optimal treatment of biliary atresia. Delays in referring to biliary atresia cases remain a problem around the world. The objective of this study was to analyze the knowledge of primary healthcare providers regarding prolonged jaundice as an early sign of biliary atresia. A cross-sectional study was conducted at primary health facilities using a self-administered questionnaire. The data were analyzed using the descriptive method with the assistance of IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, N.Y., USA). A total of 271 respondents participated in this study, including midwives (63.8%), nurses (24.4%), and medical doctors (8.5%). It was found that 73.8% of the respondents agreed that infants with prolonged jaundice need to undergo a serum bilirubin level assessment. However, 40.2% of the respondents believed that pale stools and dark urine in yellow infants were symptoms of physiological jaundice. Concerning the definition of prolonged jaundice, 209 (77.1%) respondents provided a response indicating a duration of more than two weeks. A total of 137 (50.6%) respondents stated that biliary atresia is a disease that must be ruled out first in cases of prolonged jaundice. Nevertheless, 86 (31.7%) and 87 (32.1%) respondents also mentioned that breastfeeding jaundice and breast milk jaundice must be considered as potential causes that need to be ruled out, respectively. These results indicated that primary healthcare providers still had limited knowledge regarding cholestasis. Education on prolonged jaundice in primary health facilities requires improvement to enhance the early detection of biliary atresia. [ABSTRACT FROM AUTHOR]

Introduction: biliary atresia (BA) is a progressive inflammation that causes obstruction and fibroobliteration of the bile ducts during the perinatal period. Biliary atresia occurs in about 1 in 5000 to 8000 live births, and 50% require liver transplantation. This study aims to iinvestigate the influence of induction and duration of illness after rhesus rotavirus (RRV) exposure to changes in the expression of cytokeratin-7 (CK-7) and cytokeratin-19 (CK-19) in mice models of AB. Methods: a total of 48 Balb/c less than a day after birth was included as model of BA. The overall sample was split randomly by using the randomization table into 4 control groups and 4 treatment groups. Groups 1,2,3, and 4 composed of 24 infant mice Balb/c (each group of 6 tails) with blue color code get a placebo (buffered saline) intraperitoneallyless than a day after birth. Groups 5, 6, 7, and 8 were composed of 24 mice Balb/c (eachgroup of 6 tails) with red color code get induction RRV 1.5 x 106 Plaque forming units (PFU) as treatment groups. Results: there are influence of the RRV induced changes in the expression of CK-7 murine model of BA day 3, 7, 14 and 21 after induction compared to the control (p<0.05). There was interaction between induction effects and duration of illness after RRV exposure to CK-7 expression in murine models of BA on days 3, 7, 14 and 21 (p<0.001). There was difference in the value of CK-19 expressions progressively between trial group and control group seen from day-3 and day 21. Conclusion: induction and duration of illness after rhesus rotavirus exposure effect on the expression of cytokeratin-7 and cytokeratin-19 mice models of biliary atresia. [ABSTRACT FROM AUTHOR]

Microflora in the gastrointestinal tract plays an important role in the hepatocyte function from the gut-liver axis. However, the effect of probiotic in innate immune response especially in Kupffer cells is still unclear. This study aimed to examine the effect of probiotic on the innate immune response in the liver. This study is a randomized posttest-only control group experimental animal study using white mice (Mus musculus BALB/c). The inclusion criteria are 10-12 weeks old, male, and weighing 30-40 mg. Samples were randomized and divided into two groups: probiotic and placebo. The probiotic group was given multispecies probiotic. Probiotic and placebo were administrated for 21 days via a gastric tube. On day 22, necropsy was performed, and liver was obtained for immunohistochemical examination at the Laboratory of Biochemistry, University of Brawijaya, Malang. Number of Kupffer cells and cells which expressing NF-κ B p105 and p65 were examined. A total of 16 mice met the inclusion criteria. A significant increase in the number of Kupffer cells (p<0.001) and NF-κ B p105 (p=0.001) was observed after administration of probiotic. No significant differences were observed in NF-kB p65 (p=0.236). Administration of probiotics affects the innate immune response (NF-κ B p105 and Kupffer cell) in the liver tissue but not in NF-κ B p65. [ABSTRACT FROM AUTHOR]