# Acute Recurrent Pancreatitis — GCMD Library living collection

Everything in the library about acute recurrent pancreatitis — built automatically from dossiers that name it.

Updated: n/a · 9 episodes · 211 cited statements

## Episodes
### Fundamentals
- [Welcome and Introductions: Pancreatic Disease](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969) — video · 6:04 · [machine version](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969.md)

### Diagnosis & Workup
- [Function Tests & Pain Management: Pancreatic Disease](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968) — video · 26:27 · [machine version](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968.md)

### Acute Management
- [Acute Pancreatitis](https://library.globalcastmd.com/watch/acute-pancreatitis-293) — podcast · 45:24 · [machine version](https://library.globalcastmd.com/watch/acute-pancreatitis-293.md)

### Surgical Management
- [Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973) — video · 47:20 · [machine version](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973.md)
- [ERCP: Pancreatic Disease](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967) — video · 9:11 · [machine version](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967.md)
- [Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540) — video · 10:19 · [machine version](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540.md)

### Case-Based Learning
- [Update Course Rewind: Management of Recurrent Pancreatitis](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663) — video · 6:37 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663.md)

### In-Depth Reviews
- [Acute and Acute Recurrent Pancreatitis: Pancreatic Disease](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970) — video · 56:45 · [machine version](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970.md)
- [Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971) — video · 51:02 · [machine version](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=0) Introduction and Series Context (Ep 7)
- [1:23](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=83) Case Presentation and Diagnostic Criteria (Ep 7)
- [4:25](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=265) Pain Management in Acute Pancreatitis (Ep 7)
- [7:02](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=422) Nutrition Management: NPO vs. Early Feeding (Ep 7)
- [14:29](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=869) Enteral vs. Parenteral Nutrition and Fat Intake (Ep 7)
- [17:29](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1049) IV Fluid Resuscitation Strategy (Ep 7)
- [21:58](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1318) Standardized Order Sets and Case Outcome (Ep 7)
- [24:50](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1490) Case Recurrence and Imaging for Complications (Ep 7)
- [28:15](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1695) CT Findings and Prognostic Markers (Ep 7)
- [31:08](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1868) Management of Complicated Pancreatitis (Ep 7)
- [36:15](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2175) Workup for Acute Recurrent Pancreatitis (Ep 7)
- [42:04](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2524) Endoscopic Necrosectomy and Closing Remarks (Ep 7)
- [0:00](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=0) Introduction to ERCP in Acute Pancreatitis and Case Presentation (Ep 2)
- [1:39](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=99) Initial CT Imaging Findings (Ep 2)
- [2:37](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=157) Clinical Course and Follow-up Ultrasound (Ep 2)
- [3:50](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=230) ERCP Findings and Therapeutic Intervention (Ep 2)
- [5:54](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=354) Follow-up ERCP and Treatment Success (Ep 2)
- [7:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=430) Poll Results Discussion and Session Conclusion (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=0) Direct pancreatic function testing: endoscopic collection protocol (Ep 3)
- [5:07](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=307) MR pancreatic function testing: quantitative fluid secretion (Ep 3)
- [10:39](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=639) Case outcome: genetic testing and enzyme therapy (Ep 3)
- [13:41](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=821) Multidisciplinary pain management: case of 13-year-old with annular pancreas (Ep 3)
- [19:50](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1190) Pain psychology integration and opioid stewardship (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=0) Welcome, Housekeeping, and Event Introduction (Ep 4)
- [3:33](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=213) Course Director Introduction and Faculty Panel Presentation (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=0) Definitions and diagnostic criteria for acute pancreatitis (Ep 5)
- [3:20](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=200) Initial imaging approach and case presentation (Ep 5)
- [6:07](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=367) Pain management and imaging modalities (Ep 5)
- [9:11](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=551) Nutritional management and evidence for early feeding (Ep 5)
- [18:20](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1100) IV fluid resuscitation strategies (Ep 5)
- [24:20](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1460) Standardized order sets and outcomes (Ep 5)
- [26:57](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1617) Complicated pancreatitis case with necrosis (Ep 5)
- [34:47](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2087) Management of necrotizing pancreatitis (Ep 5)
- [41:27](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2487) Acute recurrent pancreatitis workup (Ep 5)
- [47:32](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2852) ERCP for pancreatic duct leak (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=0) Introduction and Definitions: Acute Recurrent vs. Chronic Pancreatitis (Ep 6)
- [2:07](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=127) Natural History, Definitions, and Imaging Findings in Chronic Pancreatitis (Ep 6)
- [6:41](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=401) Case Presentation: 10-Year-Old with Extensive Calcifications (Ep 6)
- [10:16](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=616) Genetic Etiology and Testing in Pediatric Chronic Pancreatitis (Ep 6)
- [22:03](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1323) Penetrance, Genetic Counseling, and Combination Risk (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Every ERCP carries a risk of post-ERCP pancreatitis, and islet cells are lost with every pancreatitis attack" — Juan Gurria (clinical) [Ep 8 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=100)
- "PRSS1 is the most common genetic mutation in pediatric pancreatitis and is a trypsinogen activator that activates trypsin inside the pancreas" — Juan Gurria (clinical) [Ep 8 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=117)
- "Cincinnati Children's genetic panel tests 10 different genetic markers for pancreatitis" — Juan Gurria (clinical) [Ep 8 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=132)
- "Genetic factors are changing the approach to pediatric chronic pancreatitis treatment" — Juan Gurria (opinion) [Ep 8 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=137)
- "Patients with more than 1 episode of acute pancreatitis or a first severe episode should undergo MRCP and genetic panel testing" — Cecilia Gigena (guideline) [Ep 8 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=146)
- "There is currently no medication to mediate trypsin activation in genetic pancreatitis" — Juan Gurria (clinical) [Ep 8 · 2:48](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=168)
- "Frey procedure requires removing the top half of the pancreas to open the duct, resulting in loss of islet cells" — Juan Gurria (clinical) [Ep 8 · 3:09](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=189)
- "In patients with PRSS1 mutation, drainage procedures only temporize attacks by draining the duct but do not fix the underlying problem, as the parenchyma continues to be attacked by the mutation" — Juan Gurria (clinical) [Ep 8 · 3:19](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=199)
- "Genetic testing is essential before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage" — Cecilia Gigena (guideline) [Ep 8 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=217)
- "There is no set number of ERCPs that defines when to consider chronic pancreatitis; sooner referral is better for evaluation" — Juan Gurria (guideline) [Ep 8 · 4:09](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=249)
- "Surgical pancreatic intervention is not offered unless medical and endoscopic management have been maximized" — Juan Gurria (guideline) [Ep 8 · 4:16](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=256)
- "If a stent is placed and the patient continues to have pancreatitis, there is no reason to continue with ERCPs" — Juan Gurria (clinical) [Ep 8 · 4:31](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=271)
- "Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT" — Cecilia Gigena (guideline) [Ep 8 · 4:37](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=277)
- "MRCP is the best non-invasive study for the pancreas, particularly with T2 sequences" — Juan Gurria (clinical) [Ep 8 · 4:58](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=298)
- "ERCP is more therapeutic than diagnostic" — Juan Gurria (clinical) [Ep 8 · 5:07](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=307)
- "Imaging approach starts with ultrasound, then CT, and MRCP with T2 sequences for better pancreatic anatomy visualization" — Cecilia Gigena (guideline) [Ep 8 · 5:11](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=311)
- "Pancreatic fluid collections should be drained only if symptomatic once the wall is mature at 4 to 6 weeks" — Juan Gurria (guideline) [Ep 8 · 5:22](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=322)
- "Asymptomatic fluid collections without gastric outlet obstruction or pain will self-resolve and do not require drainage" — Juan Gurria (clinical) [Ep 8 · 5:29](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=329)
- "Antibiotics are not needed for pancreatic fluid collections" — Juan Gurria (guideline) [Ep 8 · 5:35](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=335)
- "Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations" — Cecilia Gigena (epidemiological) [Ep 8 · 5:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=340)
- "If genetic mutations are confirmed, partial pancreatic resection (Frey procedure) should be avoided to prevent loss of pancreatic cells" — Cecilia Gigena (guideline) [Ep 8 · 5:50](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=350)
- "If endoscopic approach fails, TPIAT should be considered sooner rather than later" — Cecilia Gigena (guideline) [Ep 8 · 6:01](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=361)
- "TPIAT is one of the most complex abdominal surgical procedures performed in children" — Juan Gurria (clinical) [Ep 9 · 0:48](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=48)
- "Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis" — Juan Gurria (clinical) [Ep 9 · 0:54](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=54)
- "Patients are candidates for TPIAT when all medical and endoscopic therapy has failed" — Juan Gurria (guideline) [Ep 9 · 1:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=62)
- "TPIAT patients usually have a genetic mutation that drives the disease" (clinical) [Ep 9 · 1:08](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health" (clinical) [Ep 9 · 1:08](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "Full evaluation by the Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia and pain team" — Juan Gurria (clinical) [Ep 9 · 1:23](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=83)
- "Patients are prepared with vaccinations for potential splenectomy before surgery" — Juan Gurria (clinical) [Ep 9 · 1:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=109)
- "Pain catheters are placed in the transversus abdominis muscle by pain specialists" — Juan Gurria (clinical) [Ep 9 · 2:40](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=160)
- "Central venous catheter placement uses ultrasound for vein puncture and fluoroscopy for appropriate insertion" (clinical) [Ep 9 · 2:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=166)
- "The pancreas has often been injured for years, which makes the dissection procedure quite challenging" — Juan Gurria (clinical) [Ep 9 · 3:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=194)
- "Blood supply to the pancreas is preserved until the very last moment because hypoxia of islet cells cannot be risked" — Juan Gurria (clinical) [Ep 9 · 4:06](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=246)
- "Digestive enzymes including collagenases and neutral proteases are injected into pancreatic ducts to break down extracellular matrix" — Rita Bottino (clinical) [Ep 9 · 4:51](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Enzyme injection turns the solid pancreas organ into liquid form by releasing islet cells and exocrine cells" (clinical) [Ep 9 · 5:24](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=324)
- "Islet number correlates with good outcome" — Rita Bottino (clinical) [Ep 9 · 5:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=345)
- "Maximum infusion volume is 5 mL per bag with 3 bags maximum per patient" (clinical) [Ep 9 · 5:59](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=359)
- "Islet cells are suspended in medium with albumin, heparin, and antibiotics" — Rita Bottino (clinical) [Ep 9 · 6:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=374)
- "Islet cells are infused into the portal vein with the goal of implanting in the liver and producing insulin" — Juan Gurria (clinical) [Ep 9 · 7:15](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=435)
- "Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis" — Juan Gurria (clinical) [Ep 9 · 7:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Portal vein thrombosis could cause significant morbidity to the patient" — Juan Gurria (clinical) [Ep 9 · 7:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Patients are placed in intensive care unit to control hemodynamics and fluid shift balance" — Juan Gurria (clinical) [Ep 9 · 8:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=481)
- "Islet cells need to heal in a homeostatic environment" — Juan Gurria (clinical) [Ep 9 · 8:12](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=492)
- "Glucose and insulin are controlled via exogenous infusions post-operatively" — Juan Gurria (clinical) [Ep 9 · 8:18](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=498)
- "Nutrition is key in the healing of connections between the biliary tract and gastrointestinal tract" — Juan Gurria (clinical) [Ep 9 · 8:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=502)
- "Discharge criteria include well-controlled pain, full feeds via tube or by mouth, and well-controlled glucose via continuous glucose monitoring" — Juan Gurria (clinical) [Ep 9 · 8:39](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=519)
- "Lipase half-life is about 7 days and is more specific for pancreatic/intestinal pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, or salivary issues." — Maissam Abu Al Haija (clinical) [Ep 7 · 3:02](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=182)
- "Amylase rises and normalizes much quicker than lipase; in a patient presenting 2 days after symptom onset, amylase may not be the best indicator." — Maissam Abu Al Haija (clinical) [Ep 7 · 2:40](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=160)
- "Ultrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis; it is radiation-free and gives a reasonably good look at the pancreas, but is limited for evaluating complications." — Andrew Trout (clinical) [Ep 7 · 2:09](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=129)
- "The most helpful use of ultrasound in acute pancreatitis is looking for a biliary component (CBD dilation suggesting early ERCP need, or gallstones changing management), not documenting pancreatitis or looking for complications." — Maissam Abu Al Haija (clinical) [Ep 7 · 4:03](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=243)
- "There is no data on optimal pain medication in acute pancreatitis; even adult studies have not identified a superior medication." — Maissam Abu Al Haija (clinical) [Ep 7 · 6:21](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=381)
- "Opioids used in the right patient and setting in acute pancreatitis can allow earlier feeding, improve outcomes, and enable earlier discharge; providers should not be shy about using them." — Maissam Abu Al Haija (opinion) [Ep 7 · 6:27](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=387)
- "Early enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with more favorable outcomes: maintains gut barrier function, inhibits bacterial translocation, lowers incidence of systemic inflammatory response, and avoids severe complications." — Maissam Abu Al Haija (clinical) [Ep 7 · 9:03](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=543)
- "A 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, surgical intervention rate, mortality, and infections." — Maissam Abu Al Haija (host_summary) [Ep 7 · 9:32](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=572)
- "The 2007 Ekerwal study randomized 60 adult patients to eat on admission vs. NPO; early feeding did not increase abdominal pain and decreased length of stay by 2 days." — Maissam Abu Al Haija (host_summary) [Ep 7 · 13:19](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=799)
- "Cincinnati Children's replicated the early feeding approach in 38 pediatric admissions with mild pancreatitis (published late 2015); early nutrition was safe, feasible, and not associated with worse pain outcomes." — Maissam Abu Al Haija (clinical) [Ep 7 · 14:29](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=869)
- "Pilot analysis showed patients who ate the most fat had the lowest pain scores; fat intake did not increase length of stay. Patients likely self-regulate and eat more when ready." — Maissam Abu Al Haija (clinical) [Ep 7 · 15:28](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=928)
- "NG feeds vs. NJ feeds in acute pancreatitis show no difference in outcomes; duration of hospital stay and mortality are similar even in severe acute pancreatitis." — Maissam Abu Al Haija (host_summary) [Ep 7 · 12:41](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=761)
- "Aggressive IV fluid resuscitation in acute pancreatitis is associated with improved outcomes; early aggressive resuscitation (>1/3 of 72-hour fluid volume in first 24 hours) reduces mortality and incidence of SIRS and organ failure at 72 hours." — Maissam Abu Al Haija (host_summary) [Ep 7 · 18:58](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1138)
- "In the late resuscitation group, patients received more total fluid than the early resuscitation group, but outcomes were worse, indicating a critical 24-hour window for intervention." — Maissam Abu Al Haija (clinical) [Ep 7 · 19:45](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1185)
- "A small 2011 study (40 patients) and a 2023 abstract (40 patients, Spain) showed early resuscitation with lactated Ringer's (LR) vs. normal saline reduced inflammation (CRP markers) when using goal-directed management targeting urine output 3 mL/kg/hr." — Maissam Abu Al Haija (host_summary) [Ep 7 · 20:05](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1205)
- "Cincinnati Children's study of 201 patients showed 35% of NPO + low IV fluids group developed severe pancreatitis vs. 4.2% in early PO + aggressive resuscitation group." — Maissam Abu Al Haija (clinical) [Ep 7 · 24:10](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1450)
- "CT is the imaging test of choice when complicated pancreatitis is suspected; it best visualizes necrosis, fluid collections, hemorrhage, and masses." — Maissam Abu Al Haija (clinical) [Ep 7 · 5:00](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=300)
- "MRCP is useful for workup of biliary and pancreatic ductal issues but is not the first imaging modality in acute pancreatitis; edema during acute attack obscures ductal anatomy." — Maissam Abu Al Haija (clinical) [Ep 7 · 5:28](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=328)
- "For pediatric pancreatitis CT, a portal venous phase is sufficient (no multi-phase needed); oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not a deal-breaker if patient cannot tolerate it." — Andrew Trout (clinical) [Ep 7 · 28:19](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1699)
- "Absent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis." — Andrew Trout (clinical) [Ep 7 · 29:51](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1791)
- "Ranson's criteria applied to pediatric pancreatitis (studied since 2002, including Midwest/University of Cincinnati studies) initially showed promise but did not prove sufficiently sensitive and specific upon validation." — Maissam Abu Al Haija (clinical) [Ep 7 · 30:31](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1831)
- "Cincinnati Children's study proposes using white blood cell count, albumin, and lipase on admission to predict severity in ~70% of pediatric pancreatitis patients; this tool still needs optimization." — Maissam Abu Al Haija (clinical) [Ep 7 · 31:20](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1880)
- "Antibiotics should not be used in mild pancreatitis or in severe pancreatitis unless infected necrosis is suspected (e.g., fever present)." — Maissam Abu Al Haija (clinical) [Ep 7 · 32:32](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1952)
- "When antibiotics are indicated in pancreatitis, imipenem or 3rd-generation cephalosporins are good initial choices based on available evidence." — Maissam Abu Al Haija (clinical) [Ep 7 · 33:08](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1988)
- "Acute recurrent pancreatitis (ARP) is defined by the INSPPIRE group as ≥2 distinct episodes with complete pain resolution and a 1-month pain-free interval, or enzyme normalization with complete pain resolution in <1 month." — Maissam Abu Al Haija (host_summary) [Ep 7 · 34:47](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2087)
- "ARP workup includes inflammatory causes (IBD, celiac), systemic/mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing (PRSS1, SPINK1, CFTR, CTRC)." — Maissam Abu Al Haija (clinical) [Ep 7 · 35:37](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2137)
- "Aspiration of pancreatic necrosis to rule out infection carries risk of introducing infection into a sterile collection; empiric antibiotics may be started if fever is present, but aspiration is rarely performed (Cincinnati has needed one necrosectomy in 10 years)." — Jamie Nathan (clinical) [Ep 7 · 38:49](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2329)
- "Adult evidence supports endoscopic necrosectomy via EUS-guided transmural approach with good outcomes; pediatric experience is extremely limited and Cincinnati has not performed this procedure." — Tom Lynn (clinical) [Ep 7 · 41:12](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2472)
- "Secretin-enhanced MRCP has unclear added value in pediatric pancreatitis; adult literature data is 'iffy.' In acute recurrent or chronic pancreatitis patients, ducts are often dilated enough to visualize without secretin." — Andrew Trout (opinion) [Ep 7 · 42:34](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2554)
- "Cincinnati Children's prospective acute pancreatitis registry (3 years, 85 patients) found increased weight percentile for age (not BMI) during first attack predicts recurrence; abstract submitted to World Congress." — Maissam Abu Al Haija (clinical) [Ep 7 · 43:25](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2605)
- "Higher BMI predicts severe pancreatitis course in adults and some pediatric studies outside the US, but did not predict severity in Cincinnati's 85-patient sample, possibly due to wide BMI variation in both recurrence and non-recurrence groups." — Maissam Abu Al Haija (clinical) [Ep 7 · 43:58](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2638)
- "ERCP was introduced in the 1970s as a purely diagnostic modality" (clinical) [Ep 2 · 0:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "ERCP has evolved from a diagnostic to a more therapeutic modality over time" (clinical) [Ep 2 · 0:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "Advances in radiology have enabled non-invasive identification of abnormalities, contributing to ERCP's shift toward therapeutic use" (clinical) [Ep 2 · 0:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "CT provides value in complex cases and complex patients for pancreatic imaging" (clinical) [Ep 2 · 1:39](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=99)
- "Severe scoliotic curvature and spinal hardware make it difficult to get a good ultrasound" (clinical) [Ep 2 · 1:49](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=109)
- "Fluid collection replacing a large chunk of pancreas with no preserved pancreatic tissue around it indicates an area of necrosis or walled off necrosis" (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=120)
- "Once you have a lay of the land with CT, you can use ultrasound to target and look at areas of interest in complex cases" (clinical) [Ep 2 · 3:05](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=185)
- "If ultrasound findings change dramatically or you're not getting a good sense of things, you may need to go back to cross-sectional imaging (CT or MRI)" (clinical) [Ep 2 · 3:05](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=185)
- "Ultrasound is a good modality to follow patients serially over time because it's easier on patients and lacks ionizing radiation" (clinical) [Ep 2 · 3:27](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=207)
- "Spinal fusion rods make it challenging to identify and visualize normal ductal structures during ERCP" (clinical) [Ep 2 · 4:26](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=266)
- "Pancreatic sphincterotomy and pancreatic duct stent placement allow flow of pancreatic juices to the path of least resistance with hopes of resolving duct defects" (clinical) [Ep 2 · 5:30](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=330)
- "The decision to proceed with ERCP is based on clinical suspicion for pancreatic duct leak and the type of expertise available at the institution" (clinical) [Ep 2 · 6:22](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=382)
- "There is a growing number of pediatric gastroenterologists becoming skilled in performing ERCP" (clinical) [Ep 2 · 6:42](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "ERCP is invasive and has the potential to exacerbate pancreatitis" (clinical) [Ep 2 · 6:42](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "The goal of ERCP in this setting is to be therapeutic" (clinical) [Ep 2 · 6:42](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "Watchful waiting was an extension of the conservative approach already attempted in this case" (clinical) [Ep 2 · 8:19](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499)
- "Continuing conservative management was not acceptable to the family" (clinical) [Ep 2 · 8:19](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499)
- "A patient with an enlarging collection is potentially failing watchful waiting" (clinical) [Ep 2 · 8:40](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=520)
- "Cincinnati Children's has been leading the world in pediatric surgical education" — Todd Ponsky (opinion) [Ep 4 · 0:28](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=28)
- "The event will be recorded and available after 48 hours" — Todd Ponsky (clinical) [Ep 4 · 1:22](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=82)
- "A new video portal will allow users to search by keyword and watch specific segments rather than entire events" — Todd Ponsky (clinical) [Ep 4 · 1:27](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=87)
- "The Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world" — Todd Ponsky (clinical) [Ep 4 · 2:00](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=120)
- "Cincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists" — Todd Ponsky (clinical) [Ep 4 · 2:38](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=158)
- "Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's" — Todd Ponsky (host_summary) [Ep 4 · 3:06](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=186)
- "The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis" — Jamie Nathan (clinical) [Ep 4 · 3:38](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=218)
- "Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program" — Jamie Nathan (clinical) [Ep 4 · 4:05](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=245)
- "Ken Goldschneider is director of pain management at Cincinnati Children's, professor of clinical pediatrics and anesthesia, and plays a central role in pain management for patients with pancreatic diseases" — Jamie Nathan (clinical) [Ep 4 · 4:23](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=263)
- "Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center" — Jamie Nathan (clinical) [Ep 4 · 4:40](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=280)
- "Tom Lynn is a gastroenterologist who manages the vast majority or all endoscopic needs for children with pancreatic disorders, director of endoscopy for the Pancreas Care Center, and co-director of endoscopy for the division of gastroenterology" — Jamie Nathan (clinical) [Ep 4 · 4:54](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=294)
- "Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine" — Jamie Nathan (clinical) [Ep 4 · 5:17](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=317)
- "Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event" — Jamie Nathan (clinical) [Ep 4 · 5:33](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=333)
- "Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event" — Jamie Nathan (clinical) [Ep 4 · 5:47](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=347)
- "Direct pancreatic function testing means obtaining function directly from the pancreas, not relying on stool testing for fecal elastase." (clinical) [Ep 3 · 0:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=5)
- "Endoscopic pancreatic function testing replaced the duodenal-tube (drilling) method by the end of the 1990s/early 2000s." (clinical) [Ep 3 · 2:07](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=127)
- "Dr. Conwell and colleagues at Tyler Stevens launched endoscopic function testing, showing comparable results to duodenal-tube testing for bicarbonate and lipase measurement." (clinical) [Ep 3 · 2:13](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=133)
- "Endoscopic collection became the standard because duodenal-tube testing requires the patient to be awake, placement of two tubes, and interventional radiology." (clinical) [Ep 3 · 2:39](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=159)
- "The Cincinnati protocol uses secretin 0.2 mcg/kg or CCK 0.04 mcg/kg at time zero, then collects duodenal aspirates every 5 minutes for three samples using an ERCP tapered catheter." (clinical) [Ep 3 · 3:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=185)
- "The lab at Cincinnati Children's Hospital measures activities for four enzymes: trypsin, amylase, lipase, and chemotrypsin." (clinical) [Ep 3 · 3:46](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=226)
- "Pancreatic function can be abnormal if checked around an acute attack." (clinical) [Ep 3 · 4:25](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=265)
- "Exocrine pancreatic maturation occurs over the first 2 to 3 years of life." (clinical) [Ep 3 · 4:33](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=273)
- "MR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract." — Andrew Trout (clinical) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=318)
- "The delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation." — Andrew Trout (clinical) [Ep 3 · 6:27](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=387)
- "MR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume." — Andrew Trout (clinical) [Ep 3 · 7:38](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=458)
- "Phantom studies have proven that MR can accurately quantitate fluid volume." — Andrew Trout (clinical) [Ep 3 · 8:13](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=493)
- "Preliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing." — Andrew Trout (clinical) [Ep 3 · 8:28](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=508)
- "Qualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency." — Andrew Trout (opinion) [Ep 3 · 8:49](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=529)
- "In chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct." — Andrew Trout (opinion) [Ep 3 · 9:41](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=581)
- "Low-fat diet, pancreatic enzyme replacement therapy (PERT), antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes." (clinical) [Ep 3 · 12:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=725)
- "The case patient was PRSS1-positive on genetic testing." (clinical) [Ep 3 · 12:43](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=763)
- "The case patient had low fecal elastase on two occasions and endoscopic PFTs showed low amylase and lipase, borderline low trypsin and chemotrypsin." (clinical) [Ep 3 · 12:47](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=767)
- "The case patient had normal hemoglobin A1C and normal mixed meal test for endocrine function." (clinical) [Ep 3 · 13:01](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=781)
- "The case patient showed evidence of ductal changes on ERCP, confirming chronic pancreatitis based on imaging and ERCP findings." (clinical) [Ep 3 · 13:09](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=789)
- "The case patient has been pain-free on PERT treatment for several months with catch-up growth." (clinical) [Ep 3 · 13:17](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=797)
- "The multidisciplinary pain consult at Cincinnati comprises three disciplines: pain physician (medical/psychosocial assessment, medication, interventional management), psychologist (100% of the time, not optional), and nurses." — Goldschneider (clinical) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=900)
- "Cognitive-behavioral therapy is the standard, state-of-the-art therapy for pain management." — Goldschneider (guideline) [Ep 3 · 18:16](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1096)
- "The 13-year-old pain case had extensive psychiatric disabilities: bipolar disorder, attention deficit disorder, oppositional defiant disorder." — Goldschneider (clinical) [Ep 3 · 16:37](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=997)
- "The 13-year-old's recurrent pancreatitis episodes were timed almost specifically with visits to his father, when he went off all medical regimen (diet, enzyme therapy)." — Goldschneider (clinical) [Ep 3 · 17:23](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1043)
- "Topiramate was used for the 13-year-old's migraines and may have a role for visceral hyperalgesia where the gut has become sensitized by repeated inflammatory processes." — Goldschneider (clinical) [Ep 3 · 20:02](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1202)
- "Low-dose methadone was used for about 2 years in the 13-year-old case, and weaning off was not a problem when the time was right." — Goldschneider (clinical) [Ep 3 · 20:22](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1222)
- "In Ohio, informed consent is required for the use of opioids for chronic purposes in minors (law about a year old at time of recording)." — Goldschneider (guideline) [Ep 3 · 21:28](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1288)
- "The 13-year-old's pain resolved for a couple of years without any surgical or endoscopic intervention, came off all pain medications, returned to school, and surgery was deferred indefinitely." — Goldschneider (clinical) [Ep 3 · 22:21](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1341)
- "Discussing the neurobiology and neuropsychology of pain with families—using anecdotes like the paper-cut example (opening a lottery ticket vs. a bad report card)—helps destigmatize psychology referral." — Goldschneider (opinion) [Ep 3 · 24:04](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1444)
- "TPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work." — Joe Palermo (guideline) [Ep 1 · 5:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=328)
- "The main indication for TPIAT is chronic pain, not the transplant outcome; the primary goal is pain relief and full function, with insulin independence being secondary." — Jamie (opinion) [Ep 1 · 20:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1231)
- "TPIAT criteria include diagnosis of acute recurrent pancreatitis or chronic pancreatitis, chronic pain of greater than 6 months duration with either daily opioid use or severely impaired quality of life, absence of reversible cause, failure of medical or endoscopic intervention, and adequate beta cell function." — Jamie (guideline) [Ep 1 · 23:20](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1400)
- "Contraindications to islet autotransplantation include pre-existing insulin dependent diabetes mellitus, liver disease with portal hypertension or portal vein thrombosis." — Jamie (guideline) [Ep 1 · 23:59](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1439)
- "Patients with central sensitization of pain, functional pain disorders, drug seeking behavior, or severe psychosocial maladaptation do not do as well after TPIAT." — Jamie (clinical) [Ep 1 · 24:35](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1475)
- "Prior ductal drainage procedures and distal pancreatectomy compromise islet yield." — Jamie (clinical) [Ep 1 · 29:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1781)
- "Surgical drainage procedures are avoided in patients anticipated to require future TPIAT, particularly those with genetic etiologies." — Jamie (guideline) [Ep 1 · 29:50](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1790)
- "Portal vein pressures exceeding 25 centimeters of water pressure are associated with higher risk of portal vein thrombosis post TPIAT." — Jamie (clinical) [Ep 1 · 31:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1905)
- "Tight glucose control between 80 and 120 is critical postoperatively to protect from toxic hyperglycemia, as islets do not resume function immediately and rely on diffusion of nutrients and oxygen until neovascularization occurs over weeks to months." — Jamie (clinical) [Ep 1 · 32:43](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1963)
- "Up to 85-90% of TPIAT patients can achieve opioid independence, with most improvement occurring over the first several months." — Jamie (epidemiological) [Ep 1 · 36:56](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2216)
- "In children, 40% of TPIAT patients achieve insulin independence (typically over the first 12 months), 30% have partial graft function requiring basal insulin only, and 30% require basal-bolus insulin." — Jamie (epidemiological) [Ep 1 · 37:37](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2257)
- "Data from Minnesota shows the best outcomes in patients under 12 years old, with up to 55% insulin independence rate." — Jamie (epidemiological) [Ep 1 · 37:57](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2277)
- "Higher replicatory capacity of islets in younger children and possible islet neogenesis of ductal origin may explain better outcomes in younger patients." — Jamie (clinical) [Ep 1 · 38:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2294)
- "Islet function has been shown to be durable in children for as long as 10 years post TPIAT and is especially good for patients under 21 or with a short history of pancreatic disease." — Jamie (epidemiological) [Ep 1 · 38:26](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2306)
- "All TPIAT patients have delayed gastric emptying that resolves in several weeks, typically by 3-5 weeks." — Jamie (clinical) [Ep 1 · 30:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1841)
- "Complications occur in 15-20% of TPIAT cases, including bleeding (5-7%), abscesses, wound infections, bowel obstructions, portal vein thrombosis, and anastomotic leaks." — Jamie (epidemiological) [Ep 1 · 36:16](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2176)
- "Type 3C diabetes describes a pancreatic form of diabetes that is insulin deficient (unlike type 1 autoimmune or type 2 insulin resistant), must meet ADA criteria for diabetes, has negative islet antibodies, and requires insulin therapy not oral hypoglycemic agents." — Deb Elder (clinical) [Ep 1 · 11:05](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=665)
- "A normal peak insulin response to oral glucose tolerance load is typically at 30 minutes; a delayed peak at 60 minutes with blood sugar rising to 150 indicates subtle abnormalities in insulin secretion." — Deb Elder (clinical) [Ep 1 · 12:21](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=741)
- "Brittle diabetes, describing unpredictable extreme highs and lows, is reported in less than 1% of type 1 diabetes patients, and recent studies comparing total pancreatectomy patients with type 1 patients show no difference in complications." — Deb Elder (epidemiological) [Ep 1 · 21:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1293)
- "Tramadol is useful for mild to moderate pain because it does not generally slow gut motility as much as conventional opioids." — Ken Goldschneider (clinical) [Ep 1 · 16:42](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1002)
- "Sensitization in both the enteric and central nervous system from repeated inflammatory insults can lead to pain when all enzymes are normal, which is treated with neuropathic medications like tricyclic antidepressants and gabapentin, not opioids." — Ken Goldschneider (clinical) [Ep 1 · 17:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1053)
- "Splenectomy is performed routinely for TPIAT; attempts to preserve the spleen risk warm ischemia to islets during dissection and potential splenic infarction if relying only on short gastric vessels." — Jamie (clinical) [Ep 1 · 27:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1642)
- "Significant thrombocytosis occurs after TPIAT, likely not just related to splenectomy but possibly due to increased thrombopoietin levels produced by hepatocytes." — Jamie (clinical) [Ep 1 · 35:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2149)
- "Insulin independence is dependent on the number of islet equivalents transplanted, and there is a relationship between islet yield and severity of chronic pancreatitic changes by imaging or histopathology." — Jamie (clinical) [Ep 1 · 29:19](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1759)
- "Heparin anticoagulation is maintained intraoperatively and for one week postoperatively to prevent portal vein thrombosis from islet infusion." — Jamie (guideline) [Ep 1 · 31:38](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1898)
- "Dexamethasone infusion is used for the first 2 days postoperatively to decrease the instant blood mediated inflammatory response which has a potentially detrimental effect on islets." — Jamie (guideline) [Ep 1 · 33:17](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1997)
- "Acetaminophen is not used postoperatively because some continuous glucose monitoring systems will read falsely with it." — Ken Goldschneider (clinical) [Ep 1 · 34:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2071)
- "The expectation is to wean patients off opioids postoperatively because there is no pancreas to have acute inflammatory disorders, and visceral hyperalgesia from sensitization should not be treated with opioids." — Ken Goldschneider (opinion) [Ep 1 · 41:34](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2494)
- "Acute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis." — Abu Haija (host_summary) [Ep 5 · 0:55](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=55)
- "Lipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease." — Abu Haija (clinical) [Ep 5 · 4:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=271)
- "Amylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic." — Abu Haija (clinical) [Ep 5 · 4:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=271)
- "Ultrasound should be the initial imaging modality for suspected uncomplicated acute pancreatitis because it is radiation-free and provides a reasonably good look at the pancreas." — Andrew Trout (clinical) [Ep 5 · 3:43](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=223)
- "The primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications." — Abu Haija (clinical) [Ep 5 · 5:54](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=354)
- "CT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound." — Abu Haija (clinical) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=411)
- "MRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves." — Abu Haija (clinical) [Ep 5 · 7:19](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=439)
- "There is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery." — Abu Haija (clinical) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=492)
- "Early enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response." — Abu Haija (clinical) [Ep 5 · 10:16](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=616)
- "A 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality." — Abu Haija (host_summary) [Ep 5 · 10:53](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=653)
- "In a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events." — Abu Haija (host_summary) [Ep 5 · 15:21](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=921)
- "In a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients." — Abu Haija (clinical) [Ep 5 · 16:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=991)
- "Pilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately." — Abu Haija (clinical) [Ep 5 · 17:30](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1050)
- "There is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion." — Abu Haija (opinion) [Ep 5 · 17:17](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1037)
- "Nasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater." — Abu Haija (clinical) [Ep 5 · 14:43](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=883)
- "Adult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours." — Abu Haija (host_summary) [Ep 5 · 20:10](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1210)
- "A 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline." — Abu Haija (host_summary) [Ep 5 · 21:22](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1282)
- "In a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group." — Abu Haija (clinical) [Ep 5 · 26:09](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1569)
- "Prophylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis." — Abu Haija (clinical) [Ep 5 · 35:22](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2122)
- "When antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence." — Abu Haija (clinical) [Ep 5 · 35:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2131)
- "Acute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month." — Abu Haija (host_summary) [Ep 5 · 37:19](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2239)
- "Comprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC." — Abu Haija (clinical) [Ep 5 · 38:00](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2280)
- "In pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients." — Abu Haija (clinical) [Ep 5 · 46:01](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2761)
- "Ranson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002." — Abu Haija (clinical) [Ep 5 · 31:03](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1863)
- "A prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization." — Abu Haija (clinical) [Ep 5 · 31:54](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1914)
- "For CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients unless evaluating for masses." — Andrew Trout (clinical) [Ep 5 · 33:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2011)
- "Oral contrast is helpful in CT for pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but the exam can provide substantial information without it if the patient cannot tolerate oral contrast." — Andrew Trout (clinical) [Ep 5 · 33:50](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2030)
- "Aspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis." — Todd Ponsky (clinical) [Ep 5 · 41:39](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2499)
- "In adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited." — Tom Lin (clinical) [Ep 5 · 43:34](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2614)
- "The added value of secretin-enhanced MRCP in pediatric pancreatitis is not well established; even adult literature shows limited evidence, though it may improve visualization of ductal anomalies in select cases." — Andrew Trout (opinion) [Ep 5 · 45:01](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2701)
- "ERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes." — Tom Lin (host_summary) [Ep 5 · 47:34](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2854)
- "For pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing." — Tom Lin (clinical) [Ep 5 · 53:05](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=3185)
- "Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes." — Joe Palermo (host_summary) [Ep 6 · 2:54](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=174)
- "Acute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes." — Joe Palermo (host_summary) [Ep 6 · 3:12](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=192)
- "Chronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP." — Joe Palermo (host_summary) [Ep 6 · 3:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=217)
- "Chronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency." — Joe Palermo (host_summary) [Ep 6 · 4:30](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=270)
- "Patients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss." — Joe Palermo (clinical) [Ep 6 · 5:48](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=348)
- "In adults, up to 70% of chronic pancreatitis cases are caused by alcohol." — Joe Palermo (host_summary) [Ep 6 · 11:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "In the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes." — Joe Palermo (epidemiological) [Ep 6 · 11:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "PRSS1 (cationic trypsinogen gene) is a gain-of-function gene causing hereditary pancreatitis, autosomal dominant, with 80% penetrance for acute pancreatitis, 50% for chronic pancreatitis, and more than 40% risk of pancreatic cancer." (host_summary) [Ep 6 · 12:29](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=749)
- "SPINK1 (trypsin inhibitor gene) is a modifier gene, autosomal recessive, but heterozygous patients can also develop disease." (host_summary) [Ep 6 · 13:32](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=812)
- "Severe CFTR mutations (e.g., delta 508) cause exocrine pancreatic insufficiency; patients who are pancreatic sufficient with CF mutations are at risk for pancreatitis and chronic pancreatitis." (host_summary) [Ep 6 · 13:59](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=839)
- "CTRC gene has been shown through functional studies to be linked to development of chronic pancreatitis and acute recurrent pancreatitis." (host_summary) [Ep 6 · 14:35](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=875)
- "In a local cohort of 50 patients (34 ARP, 16 CP), 55% of ARP patients and 68% of CP patients tested positive for mutations in CFTR, PRSS1, CTRC, or SPINK1." (epidemiological) [Ep 6 · 14:52](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=892)
- "Chronic pancreatitis patients were diagnosed earlier with the first attack, had more additional attacks, and were more likely to be exocrine insufficient compared to ARP patients." (epidemiological) [Ep 6 · 15:45](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=945)
- "CFTR gene was more commonly found in chronic pancreatitis patients compared to acute recurrent patients, and patients were more likely to have two genes affected than one." (epidemiological) [Ep 6 · 15:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=956)
- "Six additional genes beyond the original four (PRSS1, SPINK1, CFTR, CTRC) are now known to be associated with ARP and CP." (host_summary) [Ep 6 · 16:17](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=977)
- "A next-generation sequencing pancreas panel covering 10 genes will launch in October at Cincinnati Children's, offering efficient, low-cost testing with faster turnaround than whole exome sequencing." (clinical) [Ep 6 · 16:42](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1002)
- "PRSS1 penetrance is incomplete: half of patients with the gene develop chronic pancreatitis, not all." (host_summary) [Ep 6 · 19:31](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1171)
- "Heterozygous CFTR (one gene copy) increases the risk for chronic pancreatitis in children." (clinical) [Ep 6 · 19:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1196)
- "Combination of SPINK1 and CFTR mutations confers an approximately 800-fold relative risk of chronic pancreatitis." (epidemiological) [Ep 6 · 20:18](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1218)
- "The CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations." — Joe Palermo (clinical) [Ep 6 · 20:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1256)
- "Some patients with pancreas divisum do not develop pancreatitis, suggesting a two-hit or multi-hit hypothesis where additional risk factors (e.g., genetic mutations) increase disease propensity." (opinion) [Ep 6 · 23:07](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1387)
- "Direct pancreatic function testing means directly obtaining pancreatic function from the pancreas, not relying on stool testing like fecal elastase." (guideline) [Ep 6 · 24:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1480)
- "The endoscopic pancreatic function test protocol uses secretin (0.2 mcg/kg) or CCK (0.4 mcg/kg) at time zero, then collects duodenal aspirates via ERCP catheter every 5 minutes for three samples." (clinical) [Ep 6 · 27:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1660)
- "Samples are sent to Women's Children's Hospital lab to measure activities of trypsin, amylase, lipase, and chymotrypsin." (clinical) [Ep 6 · 28:21](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1701)
- "Pancreatic function can be abnormal if checked around an acute attack." (clinical) [Ep 6 · 29:08](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1748)
- "Pancreatic enzyme maturation occurs over the first 2 to 3 years of life." (clinical) [Ep 6 · 29:14](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1754)
- "MR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract." — Andrew Trout (clinical) [Ep 6 · 29:42](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1782)
- "In the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation." — Andrew Trout (clinical) [Ep 6 · 31:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1862)
- "MRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid." — Andrew Trout (clinical) [Ep 6 · 32:13](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1933)
- "Correlation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients." — Andrew Trout (clinical) [Ep 6 · 32:43](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1963)
- "Qualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency." — Andrew Trout (opinion) [Ep 6 · 33:24](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2004)
- "In chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment." — Andrew Trout (opinion) [Ep 6 · 34:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2055)
- "Low-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes." — Joe Palermo (host_summary) [Ep 6 · 36:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2200)
- "Pancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks." — Joe Palermo (clinical) [Ep 6 · 37:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2222)
- "The multidisciplinary pain team comprises a pain physician (medical/psychosocial assessment, medication, interventional procedures), a psychologist (cognitive behavioral therapy, school reintegration, family intervention), and a nurse." — Goldschneider (clinical) [Ep 6 · 39:31](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2371)
- "Psychology involvement is 100% of the time in the pain clinic, not optional, to address pain coping, functional and emotional impact, and school reintegration." — Goldschneider (clinical) [Ep 6 · 40:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2402)
- "Cognitive behavioral therapy is the standard, state-of-the-art therapy for pain management." — Goldschneider (host_summary) [Ep 6 · 42:51](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2571)
- "Opioids are a tool requiring risk assessment, mitigation, informed consent (mandated by Ohio law for chronic use in minors), controlled substance agreements, prescription history tracking, and use of the lowest effective dose." — Goldschneider (clinical) [Ep 6 · 45:38](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2738)
- "In the case of a 13-year-old with annular pancreas and chronic pancreatitis, multidisciplinary pain management (topiramate for migraines, low-dose methadone for 2 years, psychology, family intervention) resulted in pain resolution, return to school and activities, and indefinite deferral of Whipple surgery." — Goldschneider (clinical) [Ep 6 · 46:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2816)

## Changelog
- Sep 7: Published again automatically — condition is back above threshold
- Sep 7: 6 items added automatically
- Sep 7: 1 item no longer name acute recurrent pancreatitis
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 4 items added automatically

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