# ALL — GCMD Library living collection

Everything in the library about ALL — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 37 cited statements

## Episodes
### Acute Management
- [Update Course Rewind: Management of Acute Pancreatitis 2023](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523) — video · 6:46 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523.md)

### Case-Based Learning
- [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735) — video · 3:53 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735.md)
- [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736) — podcast · 3:53 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=0) Case Presentation: 9-Year-Old with Acute Pancreatitis (Ep 1)
- [1:11](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=71) Initial Management Decision: ICU vs Floor (Ep 1)
- [2:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=177) Fluid Resuscitation Strategy and Evidence (Ep 1)
- [4:47](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=287) Nutritional Management and Refeeding (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=0) Introduction and Course Framework (Ep 2)
- [0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=53) Case Presentation: Neutropenic Patient with Cholecystitis (Ep 2)
- [1:40](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=100) Management of Gallstone Pancreatitis (Ep 2)
- [3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=191) Summary and Key Takeaways (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=0) Introduction and Update Course Classification System (Ep 3)
- [0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=53) Case Presentation: Neutropenic Patient with Cholecystitis (Ep 3)
- [1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=99) Gallstone Pancreatitis Management Discussion (Ep 3)
- [3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=191) Summary and Closing (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Acute pancreatitis could be fatal" — Juan Gurria (clinical) [Ep 1 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=116)
- "Bolus times 2 is adequate fluid resuscitation, with 1.5 times maintenance once past the early phase of acute resuscitation" — Juan Gurria (clinical) [Ep 1 · 1:58](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=118)
- "Pancreatitis is a state of hypoxia requiring re-establishment of intravascular flow to the pancreas to prevent hypoxia, necrosis, and atrophic pancreas insufficiency" — Juan Gurria (clinical) [Ep 1 · 2:06](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=126)
- "Early fluid resuscitation is key in pancreatitis management" — Juan Gurria (clinical) [Ep 1 · 2:22](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=142)
- "Excessive fluid administration worsens outcomes in pancreatitis" — Juan Gurria (clinical) [Ep 1 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=146)
- "There is no reason to give antibiotics for pancreatitis, even in the face of necrosis or necrotizing pancreatitis, unless there are signs of sepsis or infected pancreatitis" — Juan Gurria (guideline) [Ep 1 · 2:29](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=149)
- "The North American Society of Pancreatitis, GI Pathology, and Nutrition published a position paper with guideline recommendations for pancreatitis management" — Juan Gurria (guideline) [Ep 1 · 2:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=177)
- "Early fluids lead to better outcomes in pancreatitis" — Juan Gurria (clinical) [Ep 1 · 3:07](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=187)
- "Recommended fluid bolus is 10 to 20 mL per kg, up to 3L in the first 24 hours, with reassessment at the 12-hour mark using urine output and vital signs" — Juan Gurria (guideline) [Ep 1 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=191)
- "Excessive fluid administration can flood the lungs and worsen outcomes" — Juan Gurria (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=205)
- "Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline in pancreatitis" — Juan Gurria (clinical) [Ep 1 · 3:45](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=225)
- "If albumin is low in pancreatitis patients, albumin should be given" — Juan Gurria (clinical) [Ep 1 · 3:54](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=234)
- "Enrique de Madaria conducted a multi-center worldwide RCT called the Waterfall trial comparing moderate versus aggressive fluid resuscitation in pancreatitis" — Juan Gurria (clinical) [Ep 1 · 3:58](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=238)
- "The Waterfall trial was stopped early because patients receiving too much fluid were developing organ failure" — Juan Gurria (clinical) [Ep 1 · 4:18](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=258)
- "A follow-up Waterland trial is underway to determine whether lactated Ringer's is better than normal saline, expected to be published in one to two years" — Juan Gurria (clinical) [Ep 1 · 4:27](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=267)
- "Patients with pancreatitis should be fed as soon as they are able to tolerate oral intake" — Juan Gurria (clinical) [Ep 1 · 4:47](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=287)
- "Enteral nutrition is significantly better compared to TPN or NPO in pancreatitis" — Juan Gurria (clinical) [Ep 1 · 4:51](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=291)
- "Gastric feeding is preferred over post-pyloric feeding in pancreatitis if the patient can tolerate it" — Juan Gurria (clinical) [Ep 1 · 4:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=297)
- "Some vomiting is tolerable during refeeding in pancreatitis, similar to gastroschisis management" — Juan Gurria (opinion) [Ep 1 · 5:19](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=319)
- "If nutrition is lost and the patient loses ground, outcomes will be worse, with dropping albumin and worse inflammatory reaction" — Juan Gurria (clinical) [Ep 1 · 5:26](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=326)
- "Outcomes are dramatically better when the gut is fed in pancreatitis patients" — Juan Gurria (clinical) [Ep 1 · 5:34](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=334)
- "Vitals are the main consideration for deciding whether a pancreatitis patient should go to the floor or ICU" (host_summary) [Ep 1 · 5:48](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=348)
- "Fluid resuscitation is key in pancreatitis management" — Cecilia Gigena (host_summary) [Ep 1 · 5:55](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=355)
- "Patients should be reassessed at the 12 and 24 hour mark to avoid fluid overload" — Cecilia Gigena (host_summary) [Ep 1 · 5:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=357)
- "Current publications suggest lactated Ringer's is better in reducing inflammatory response in pancreatitis" (host_summary) [Ep 1 · 6:07](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=367)
- "It is important to feed pancreatitis patients as soon as possible, specifically aiming to feed in the stomach" (host_summary) [Ep 1 · 6:17](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=377)
- "The patient is a 16-year-old currently undergoing treatment for acute lymphoblastic leukemia (ALL) who presents with right upper quadrant pain, neutropenia, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis." — Em Gootee (host_summary) [Ep 2 · 0:56](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=56)
- "In this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests." — Em Gootee (host_summary) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=80)
- "The patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy." — Luke Neff (clinical) [Ep 2 · 1:31](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=91)
- "Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas." — Em Gootee (host_summary) [Ep 2 · 1:49](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=109)
- "From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away in gallstone pancreatitis." — Jeff Ponsky (clinical) [Ep 2 · 2:13](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=133)
- "When symptoms are improving in gallstone pancreatitis (biochemical normalization is not required), the approach is to proceed to cholecystectomy with intraoperative cholangiogram and coordinate with ERCP availability in case it might be needed." (clinical) [Ep 2 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=145)
- "Studies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy." — David Vitale (clinical) [Ep 2 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=158)
- "Most stones can be cleared, some stones pass spontaneously, and good clinical judgment with local resources must be factored into management decisions." — Luke Neff (opinion) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=179)
- "In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs." — Em Gootee (host_summary) [Ep 2 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=191)
- "For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention." — Em Gootee (host_summary) [Ep 2 · 3:22](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=202)
- "The timing of cholecystectomy in gallstone pancreatitis should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed." — Em Gootee (host_summary) [Ep 2 · 3:33](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=213)
- "The 12th annual update course in pediatric surgery introduced a new classification system with three categories: Green Circle for established practice, Blue Square for promising newer practice, and Black Diamond for early adopter practice only." — Em Gaudi (host_summary) [Ep 3 · 0:08](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=8)
- "A 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis." — David Vitale (clinical) [Ep 3 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=53)
- "Over 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient." — David Vitale (opinion) [Ep 3 · 1:18](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=78)
- "Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy." — David Vitale (clinical) [Ep 3 · 1:27](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=87)
- "Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas." — Luke Neff (clinical) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=99)
- "Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week." — Luke Neff (opinion) [Ep 3 · 2:07](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=127)
- "From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis." — Luke Neff (clinical) [Ep 3 · 2:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=135)
- "When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed." — David Vitale (clinical) [Ep 3 · 2:24](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=144)
- "Studies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy." — Luke Neff (clinical) [Ep 3 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=158)
- "If amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted." — Luke Neff (clinical) [Ep 3 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=158)
- "Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment." — David Vitale (clinical) [Ep 3 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=179)
- "Local resources and what is available must be factored into management decisions for biliary stones." — David Vitale (opinion) [Ep 3 · 3:07](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=187)
- "In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs." — Em Gaudi (host_summary) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=191)
- "For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention." — Em Gaudi (host_summary) [Ep 3 · 3:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=205)
- "The timing of cholecystectomy in gallstone pancreatitis should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed." — Em Gaudi (host_summary) [Ep 3 · 3:35](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=215)

## Changelog
- Sep 12: 3 items added automatically

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