Differential Diagnosis

The diagnosis of Alagille syndrome is primarily based on the presence of at least three out of the five main features. The differential diagnosis of each feature of the syndrome will result in a very long and tedious list. Association of butterfly vertebra and cardiac defects has been reported in patients with deletions of 22q11. Atrial septal defect associated with eye anterior chamber anomaly may be observed in Turner syndrome.

The main issue of differential diagnosis concerns diagnosis of neonatal cholestasis. The incidence of neonatal cholestasis is thought to be 1 in 2000 live births; the incidence of extrahepatic biliary atresia is between 1 in

8000, and 1 in 15,000 live births; and AGS incidence is probably between 1 in 70,000, and 1 in 100,000 live births. Complete and permanent acholic stools lasting more than 7 days suggest extrahepatic biliary atresia but may be observed in AGS. Even if biliary hypoplasia has been evidenced by microscopic examination of the biliary remnant of AGS patients, true atresia has never been observed. Moreover, it has been suggested that prognosis is worse in AGS patients who had undergone hepato-portoenterostosmy. Therefore it is important to look for extrahepatic features of AGS before surgery; conversely, cardiac abnormalities may be associated with biliary atresia, and needle liver biopsy is helpful in such situations where timing for surgery is crucial for prognosis of extrahepatic biliary atresia.[4]

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Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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