• Learn about your health condition, medications, and allergies. 
• Ask your doctor questions about your health. 
• Ask your doctor if and at what age they no longer care for young adults 
• Find out what you know about your health, health care, and family medical history. 
• Both you and your parent/caregiver can  take an assessment on your readiness for transition and discuss this together and with the doctor. 
• Learn more about your health and what to do in case of an emergency. 

• Practice making a doctor’s appointment and ordering top up of medications (either by phone,online, or through an app). 
• Begin to see the doctor alone for part of the doctor’s visit to help gain independence in managing your health and health care. 
• Talk with your parent/caregiver about the age you want to transfer to an adult servce. 

• You can choose to start making your doctor’s appointments and top up your medications on your own. 
• You can also choose to see the doctor on your own and ask the doctor any questions you have on your own such that you slowly become more comfortable  and get used to navigating the healthcare system on your own. 
• Ask the doctor to talk with you about your privacy rights when you turn 21. 
• Work with your doctor to make a medical summary. Keep a copy for yourself. 
• Transition to the care of the adult service. 

• Continue to get care from your adult doctor, learn to manage your health and health care, and update your medical summary. 

• Help your teen learn about their own health condition, medications, and allergies.
• Encourage your teen to ask their doctor questions about their own health.
  • Ask your teen’s doctor if and at what age they no longer care for young adults
• Learn what your teen knows about their own health, health care, and family medical history.
• Both you and your teen can take a transition assessment questionaire and discuss this together and with the doctor.
• Help your teen learn more about their own health and what to do in case of an emergency.

• Help your teen practice making a doctor’s appointment and ordering prescription refills (either by phone, online, or through an app).
• Encourage your teen to see the doctor alone for part of the doctor’s visit to help gain independence in managing their own health and health care.
• Talk with your teen about the age they want to transfer to an adult service for adult care.

• Encourage your young adult to make doctor’s appointments, see the doctor alone, ask the doctor questions they may have, and refill medications on their own. This is to help them get used to navigating the healthcare system as they mature into becoming an adult.
• Ask the doctor to talk with your young adult about their privacy rights when they turn 21.
• Encourage your young adult to keep a copy of their medical condition with them.
• Transition to the care of the adult doctor. 
  
  

• Encourage your young adult to get care from their adult doctor, learn to manage their own health and health care, and update their medical summary. 

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Biliary atresia is a rare liver disease that affects infants, occurring when the bile ducts inside or outside the liver do not develop normally. Bile ducts are responsible for carrying bile (a digestive fluid) from the liver to the small intestine. When these ducts are absent or damaged, bile builds up in the liver, leading to liver damage, scarring, and eventually liver failure if left untreated.

Causes and Risk Factors

The exact cause of biliary atresia is unknown, but it is believed to be a combination of genetic and environmental factors. While there are no known ways to prevent biliary atresia, certain factors may increase the risk, including premature birth and certain infections during pregnancy.

Symptoms

Symptoms of biliary atresia usually appear within the first few weeks to months of life and may include:

• Jaundice (yellowing of the skin and eyes)

• Dark urine

• Pale stools

• Enlarged liver or spleen

• Poor weight gain and growth

• Irritability or fussiness

  
  

Diagnosis

Diagnosing biliary atresia typically involves several tests, including blood tests, imaging studies (such as ultrasound and MRI), and a liver biopsy. These tests help doctors assess liver function, bile flow, and the extent of liver damage.

Treatment

The primary treatment for biliary atresia is surgery called the Kasai procedure, usually performed within the first few months of life. During this procedure, the damaged bile ducts are removed, and a section of the small intestine is attached directly to the liver to allow bile drainage. While the Kasai procedure can help restore bile flow and improve symptoms, it may not always be successful, and some infants may require a liver transplant later in life.

Prognosis

The prognosis for biliary atresia varies depending on several factors, including the extent of liver damage at the time of diagnosis, the success of the Kasai procedure, and the overall health of the patient. Without treatment, biliary atresia often leads to liver failure within the first few years of life. However, with early intervention and appropriate medical care, many children with biliary atresia can lead relatively normal lives. Some may require ongoing medical management and, in some cases, a liver transplant.

Living with Biliary Atresia

Living with biliary atresia requires ongoing medical care and monitoring. Following the Kasai procedure or liver transplant, it is essential to attend regular follow-up appointments with healthcare providers. Early intervention and comprehensive care can help manage symptoms, minimize complications, and improve long-term outcomes.

Resources

1. "Biliary Atresia." National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services.

2. Bezerra, J. A. (2015). Biliary Atresia. Seminars in Pediatric Surgery, 24(5), 212–217. doi:10.1053/j.sempedsurg.2015.06.011

3. Superina, R. A., Magee, J. C., Brandt, M. L., Healey, P. J., Tiao, G., Ryckman, F. C., & Kim, H. (2006). The Anatomic Pattern of Biliary Atresia Identified at Time of Kasai Hepatoportoenterostomy and Early Postoperative Clearance of Jaundice Are Significant Predictors of Transplant-Free Survival. Annals of Surgery, 243(4), 604–614. doi:10.1097/01.sla.0000205757.76489.29

There are two types of NAFLD: NAFL and NASH. NAFL means there's extra fat in the liver, but not much inflammation or damage. NASH is more serious—it means there's fat, plus inflammation and damage to the liver. This damage can lead to scarring, which might cause cirrhosis or even liver cancer.

1. NAFLD

NAFLD is the most common liver problem in kids in the U.S. It's more likely to happen in kids who are overweight or have conditions related to being overweight, like diabetes. It's also more common in older kids and boys. Hispanic and Asian American kids tend to get it more than other groups.

Kids with NAFLD have a higher chance of getting liver problems or other health issues.

2. NASH

Most kids with NAFLD have the less serious NAFL type, but some have the more serious NASH type, which can lead to cirrhosis or liver cancer. They're also more at risk for type 2 diabetes and other problems like high blood pressure.

Causes of NAFLD

Experts are still studying the causes of NAFLD. Research suggests that certain health problems, genes, and other factors may make some children more likely to develop NAFLD. Children who are overweight, have diabetes or metabolic syndrome are more likely to develop NAFLD. Certain genes may also increase the child's chances of developing NAFLD.

Diagnosis

It is usually diagnosed using blood tests, imaging and sometimes a liver biopsy.

Treatment

Weight loss is the most effective way of treating NASH. For younger children, we recommend mantaining weight as their height increases.

References

1. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–357. doi:10.1002/hep.29367

Hepatitis B is a common virus that affects the liver, especially in places like Singapore. In Singapore, about 6% of people are carriers of hepatitis B. Most of the time, people get infected with hepatitis B when they're born or when they're very young. Often, they don't even know they have it because they don't feel sick. They might only find out when they donate blood, have a health checkup, or get screened before getting vaccinated.

How is hepatitis B transmitted, and who are at a higher risk of acquiring the infection?

• Transmitted through body secretions like blood, semen, saliva.

• Babies of hepatitis B carrier mothers are infected at the time of birth or soon after birth.

• Transmission in childhood can occur through shared utensils like toothbrushes and razors.

• Hepatitis B infections can be acquired through blood transfusions if the blood donor is not properly screened for the infection.

• HBV infections can also be acquired through acupuncture, tattooing, ear piercing, manicures and dental treatment if non-sterile instruments are used.

• Healthcare workers like doctors, dentists and nurses are at risk of finger-prick injuries which also transmit HBV infection.

• Unprotected sex promotes HBV transmission. Therefore, individuals who indulge in a promiscuous lifestyle like commerical sex-workers and homosexuals are at a higher risk of HBV infection.

Hepatitis B virus in babies and adults

A baby who acquires the hepatitis B infection manifests a different course of illness from one who is infected in adulthood. Generally, an infection contracted at birth (from mother-to-child), does not manifest in any symptoms. Following such an infection the baby has a 90% chance of becoming a hepatitis B carrier, because they are unable to eliminate the virus from their bodies.

On the other hand, an individual who acquires the infection as an adult displays symptoms of "acute liver inflammation" (acute hepatitis B). Of these patients, 1% develop a very serious clinical course known as fulminant viral hepatitis B. These patients deteriorate very rapidly during the clinical course of the illness and may go into liver failure or even die. However, newer modalities of treatment like liver transplantation exist.

Symptoms

The symptoms of acute hepatitis B include:

• Yellowing of skin and the 'whites' of the eyeball (sclera ) known as jaundice

• Joint pain

• Rash which may be itchy

• Fever

• Pain over the right upper abdomen

• Dark tea-coloured urine

• Nausea, loss of appetite and vomiting

Treatment in the acute period of the illness is essentially symptomatic relief of symptoms like itch, nausea and vomiting. It is generally advisable for patients with severe symptoms or deep jaundice to be admitted to hospital for observation because of the potentially severe consequences (fulminant hepatitis ) which may prove to be fatal, albeit rarely. This enables rapid intervention, which may be lifesaving, to be instituted if required. The patient is advised bedrest, and avoidance of alcohol and traditional Chinese remedies which could exacerbate his condition.

Different Phases of Chronic Hepatitis B

A chronic hepatitis B carrier goes through 3 phases, especially if the infection is acquired at birth. This is the usual scenario amongst carriers in Singapore:

• High viral replicative ( immune-tolerant ) phase which is usually seen in patients less than 20 year old. There is rapid viral replication but the patient is well and has no symptoms. Blood tests and liver samples indicate minimal liver inflammation.

  
  

• Low viral replicative (immune-elimination ) phase which occurs in patients between 20 to 40 years old. In this phase, the body's immune system attempts to rid itself of the hepatitis B virus, and this is reflected by abnormal blood tests that indicates active liver inflammation. The carrier may complain of lethargy. Occasionally, if this phase occurs in older patients, especially if more than 60 years, the clinical course is more serious and can cause severe liver dysfunction and death.

  
  

• Non-replicative ( latent infection ) phase occurs in carriers above the age of 40 years. This phase is characterised by the continuous presence of the hepatitis B virus with a low replicative rate. There may be however, evidence of liver damage which later progresses on to liver cancer. The patient in this last phase may present for the first time with swelling of legs and abdomen, progressive mental deterioration and vomiting or passing out of blood in the stools.

Hepatitis B - How to prevent?

Hepatitis B is best prevented by vaccination. The following groups who are at highest risk for contracting hepatitis B should be vaccinated:

• Individuals requiring repeated transfusions of blood and blood products

• Patients who have natural or acquired immune deficiency e.g. HIV, or cancer patients.

• Patients with kidney failure who require dialysis.

• Healthcare workers.

• Intravenous drug abusers, homosexuals and commercial sex workers

• Individuals living in areas where the prevalence of chronic hepatitis B is high e.g. Southeast Asia.

• Offspring of women who are hepatitis B carriers.

• Spouses and other sexual contacts of hepatitis B carriers.

• Laboratory workers dealing with blood or serum samples.

Side-effects of vaccines are rare and include local soreness at the injection site, mild fever, malaise but extremely infrequently may cause swelling of the lymph nodes (glands in the neck, groin, armpits ), and abnormalities of the nervous system.

The vaccine is administered at time 0,1 and 6 months. However, before one gets vaccinated, one should check oneself for the immune status. Only those who are non-immune to hepatitis B and not carriers should be vaccinated.

Hepatitis B - Treatments

Although we would expect the number of hepatitis B carriers to decrease in time, largely due to widespread screening and immunisation efforts, there still exists a significant proportion of our population who are carriers. The treatment of these carriers include:

• Diagnosis and evaluation

• Supportive therapy

• Surveillance for liver cancer

I) Diagnosis and evaluation

Blood tests, ultrasonography of the liver and liver tissue sampling ( liver biopsy ) are used to assess the severity and stage of the illness. In suitable patients, appropriate treatment e.g. interferon may be instituted.

i) General Advice

• A carrier should avoid donating blood, blood products, organs and sperm.

• A carrier should inform his doctor, dentist or phlebotomist (health care worker who takes a patient's blood) of his hepatitis B status.

• Household contacts / sexual partners should be screened and immunised against hepatitis B if they are not immune.

• A carrier should not share his toothbrush / shaving equipment.

• A female carrier who delivers should have her child immunised at birth.

• Diet: Generally a normal nutritious diet should be recommended to healthy carriers. However, once a patient manifests signs of liver cirrhosis/failure, restriction in water and salt needs to be enforced.

• Exercise: A regular exercise programme is beneficial for asymptomatic carriers but patients with severe liver impairment should avoid strenuous jogging and heavy weight lifting.

• Drugs and Alcohol: drugs which may potentially damage the liver should be avoided if possible. Hepatitis B carriers should not take alcohol in excessive quantities. Care must be taken when self medicating. If in doubt, consult your doctor.

II) Supportive therapy

The aim of specific therapy is to reduce infectivity, stop the progression of the disease and ultimately prevent complications like cirrhosis ( 'liver failure with hardening' ) and cancer. These are basically 2 groups of drugs that are used by liver specialists, namely:

• Those that boost the immune system to eliminate the hepatitis B virus e.g. interferon

• Those that suppress viral replication ( anti-viral agents ) like entecavir

III) Monitoring of hepatitis B carriers

Hepatitis B carriers should be followed up regularly at intervals depending on the stage of the disease. Besides monitoring the disease activity or progression, the patient is screened for liver cancer

Taken from https://www.singhealth.com.sg/patient-care/conditions-treatments/hepatitis-b