In typical cases of biliary atresia, the infant is born at term and most have no abnormalities and normal fecal color. Jaundice is usually gradually revealed 2 to 3 weeks after birth, and in some cases it appears in the first few days after birth when it is misdiagnosed as physiologic jaundice. The stool becomes brownish-yellow and pale yellowish-beige, and later becomes bile-free clay-like grayish-white. However, a slight yellowish color may occasionally appear in the more advanced stages of the disease. The darker urine stains the diapers yellow. The skin becomes golden yellow or even brown and may scratch due to itching. Sometimes lipomatous fibromas may appear, but they are uncommon. Individual cases may develop pestle fingers or be accompanied by cyanosis. The liver is enlarged and hard spleen is rarely felt in the early stages. If an enlarged spleen is felt in the first few weeks, it may be an intrahepatic cause of portal hypertension as the disease progresses. In the early stages of the disease the infant is still in good general condition, but there are varying degrees of malnutrition, and the mother often narrates that the infant appears excited and restless when underweight for length and weight. Later in the disease, various fat-soluble vitamin deficiencies may occur, and vitamin D deficiency may be associated with rickets crossties and broad epiphyses. Due to altered hemodynamic status, partial arteriovenous short-circuiting and reduced peripheral vascular resistance high row heart murmurs may be heard in the precordial region and lung fields.