Symptoms of Alagille syndrome range from mild to severe. Symptoms within the first three months of life often include:
Jaundice (yellowing of skin), usually present at birth
Severe itching (caused by the buildup of bile salt in the body)
Pale, loose or clay-colored stools (this happens because there is little or no bile reaching the intestine to color the bowel movements)
Poor weight gain (due to a lack of bile needed to digest and absorb fat)
Poor growth (even with excellent nutrition, some children with Alagille syndrome are small for age)
Deficiency of vitamins A, D, E and K, which depend on bile acids for absorption; this may result in vision changes, rickets, difficulty with balance and poor clotting of the blood
Heart murmurs, due to narrowing of the blood vessels in the lung (peripheral pulmonary artery stenosis)
Other symptoms that may develop later include:
Jaundice that will not go away
Continued growth and development problems in early childhood
Enlarged liver (feels larger and harder than normal)
Hard, whitish nodules (called xanthomas) that develop in the skin due to cholesterol and fatty deposits; the nodules usually occur in spots of repeated trauma in young children, such as knees and elbows
Urine appears very dark yellow or brown (due to high levels of bilirubin in the bloodstream which pass to the kidneys)
Persistent itching