# Biliary Atresia — GCMD Library living collection Also covered as: cholestasis · cirrhosis · cholangitis · portal hypertension · jaundice · ascites · Alagille syndrome · alpha-1 antitrypsin deficiency Experts: Dr. Todd Ponsky, Dr. Greg Tiao, Dr. Whit Holcomb, Dr. Em Gootee Updated: n/a · 26 episodes · 631 cited statements ## Episodes ### Foundations - [Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric...](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910) — video · 48:21 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910.md) - [Choledochal Cyst Podcast](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310) — podcast · 22:07 · [machine version](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310.md) - [Biliary Atresia with Dr. Greg Tiao](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518) — video · 11:34 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518.md) ### Diagnosis & Workup - [Biliary Atresia Part I](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039) — podcast · 31:15 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039.md) - [BOB Ped Surg 2023 - Maria Soledad Jara Valdivia, CIPESUR - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353.md) - [Update Course Rewind: MMP-7 & Biliary Atresia Diagnosis 2024](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973) — video · 6:24 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973.md) ### Medical Management - [Biliary Atresia Part II](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040) — podcast · 42:23 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040.md) ### Surgical Management - [Biliary Atresia: Update Course 2015](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911) — video · 20:34 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911.md) - [Error Traps and Culture of Safety in Biliary Atresia](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921) — video · 4:32 · [machine version](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921.md) - [Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008) — video · 2:30 · [machine version](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008.md) ### Evidence & Research - [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929) — podcast · 44:19 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929.md) - [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308) — podcast · 44:19 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308.md) - [Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405) — video · 23:20 · [machine version](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405.md) - [Quick Literature Updates Episode 9](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770.md) - [Heat 3 Winner: Shruthi Srinivas, MD - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018) — video · 1:47 · [machine version](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018.md) - [Jingying Jiang, MD - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019) — video · 6:58 · [machine version](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019.md) - [Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911.md) - [Características clínicas y pronóstico de la atresia de vías biliares con niveles bajos de metaloproteinasa 7 de la matriz sérica](https://library.globalcastmd.com/watch/caracter-sticas-cl-nicas-y-pron-stico-de-la-atresia-de-v-as-biliares-con-niveles-bajos-de-metaloproteinasa-7-de-la-matriz-s-rica-8912) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/caracter-sticas-cl-nicas-y-pron-stico-de-la-atresia-de-v-as-biliares-con-niveles-bajos-de-metaloproteinasa-7-de-la-matriz-s-rica-8912.md) - [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154) — podcast · 17:03 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154.md) - [Update Course Rewind: 2024 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md) - [Update Course Rewind: 2024 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593) — podcast · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593.md) ### Case-Based Learning - [Biliary Atresia - Robert Parry: Update Course 2014](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662) — video · 24:55 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662.md) - [Biliary Atresia-Case Presentation and Panel Discussion: Update Course 2014](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909) — video · 23:47 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909.md) - [Biliary Atresia - Clinical Practice Updates](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000) — video · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000.md) ### In-Depth Reviews - [Biliary Atresia](https://library.globalcastmd.com/watch/biliary-atresia-859) — video · 20:57 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-859.md) ### Emerging & Future Directions - [Prof. Shilpa Sharma - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004) — video · 5:46 · [machine version](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/biliary-atresia-859?t=0) Case Presentation and Differential Diagnosis (Ep 2) - [2:41](https://library.globalcastmd.com/watch/biliary-atresia-859?t=161) Diagnostic Workup and Liver Biopsy (Ep 2) - [7:51](https://library.globalcastmd.com/watch/biliary-atresia-859?t=471) Role of Cholangiography and Biopsy Interpretation (Ep 2) - [12:08](https://library.globalcastmd.com/watch/biliary-atresia-859?t=728) Surgical Technique: Extended Hilar Dissection (Ep 2) - [15:25](https://library.globalcastmd.com/watch/biliary-atresia-859?t=925) Technical Considerations: Roux Limb and Valves (Ep 2) - [16:47](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1007) Volume-Outcome Relationship and Corticosteroids (Ep 2) - [19:23](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1163) Alagille Syndrome and Closing (Ep 2) - [0:00](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=0) Case Presentation and Optimal Timing for Kasai (Ep 3) - [7:01](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=421) Contraindications and Redo Procedures (Ep 3) - [13:21](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=801) Diagnostic Workup: HIDA, Phenobarbital, and Liver Biopsy (Ep 3) - [18:21](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1101) Postoperative Steroids and Japanese Technical Refinements (Ep 3) - [0:00](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=0) Case Presentation and Initial Workup (Ep 5) - [4:15](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=255) Diagnostic Imaging and Liver Biopsy (Ep 5) - [10:28](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=628) Surgical Technique and Hilar Dissection (Ep 5) - [15:00](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=900) Operative Considerations and Variants (Ep 5) - [17:45](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1065) Outcomes, Steroids, and Centralization (Ep 5) - [0:00](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=0) Introduction and Liver Physiology (Ep 4) - [6:10](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=370) Biliary Atresia Etiology and Diagnosis (Ep 4) - [11:02](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=662) Surgical Management and Institutional Variation (Ep 4) - [19:32](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1172) Postoperative Management and Outcomes (Ep 4) - [26:40](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1600) Case Study and Diagnostic Challenges (Ep 4) - [38:19](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2299) Corticosteroid Therapy and Future Directions (Ep 4) - [0:00](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=0) MMP-7 as a Prognostic Marker in Biliary Atresia (Ep 21) - [0:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=0) Introduction (Ep 7) - [0:30](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=30) Diagnostic Error Traps (Ep 7) - [1:56](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=116) Intraoperative Error Traps (Ep 7) - [3:52](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=232) Postoperative Error Traps and Follow-up (Ep 7) - [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=0) Introduction and Overview (Ep 23) - [1:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=64) Biliary Atresia and MMP-7 Levels (Ep 23) - [5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=312) Breast Milk vs Formula in Gastroschisis (Ep 23) - [11:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=663) Transition of Care for Colorectal Conditions (Ep 23) - [0:01](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=1) Introduction and Update Course Overview (Ep 24) - [0:53](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=53) Clinical Case and Diagnostic Challenge (Ep 24) - [2:32](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=152) MMP-7 Discovery and Validation (Ep 24) - [4:26](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=266) Timing of Kasai and Clinical Outcomes (Ep 24) - [5:44](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=344) Conclusion and Key Takeaways (Ep 24) - [0:00](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=0) Case presentation and optimal age for Kasai (Ep 1) - [4:56](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=296) Age versus symptom duration debate (Ep 1) - [9:11](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=551) Upper age limit and contraindications to Kasai (Ep 1) - [13:11](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=791) Diagnostic workup: HIDA, biopsy, and cholangiography (Ep 1) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "Idiopathic neonatal hepatitis has decreased from approximately 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to improved recognition of specific etiologies" (epidemiological) [Ep 2 · 1:42](https://library.globalcastmd.com/watch/biliary-atresia-859?t=102) - "The jaundice chip microarray takes 4-6 weeks to return results, too long to guide initial biliary atresia management decisions" (clinical) [Ep 2 · 3:42](https://library.globalcastmd.com/watch/biliary-atresia-859?t=222) - "Absence of gallbladder on ultrasound does not conclusively diagnose biliary atresia" (clinical) [Ep 2 · 4:51](https://library.globalcastmd.com/watch/biliary-atresia-859?t=291) - "Presence of a gallbladder does not exclude biliary atresia because modern ultrasound can visualize small shrunken gallbladders" (clinical) [Ep 2 · 4:57](https://library.globalcastmd.com/watch/biliary-atresia-859?t=297) - "HIDA scan requires 3-5 days of phenobarbital loading, which can delay intervention into a time period potentially detrimental to Kasai outcomes" (clinical) [Ep 2 · 6:03](https://library.globalcastmd.com/watch/biliary-atresia-859?t=363) - "Cincinnati Children's Hospital does not routinely use HIDA scans for biliary atresia workup" (clinical) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/biliary-atresia-859?t=360) - "Interventional radiologists at Cincinnati perform percutaneous liver biopsies in infants as young as 3-4 weeks without complications" (clinical) [Ep 2 · 7:39](https://library.globalcastmd.com/watch/biliary-atresia-859?t=459) - "Pathognomonic biopsy findings for biliary atresia include bile duct proliferation in portal triads and bile plugs within bile ducts" (clinical) [Ep 2 · 8:23](https://library.globalcastmd.com/watch/biliary-atresia-859?t=503) - "When bile plugs are seen on biopsy, the likelihood of biliary atresia is well over 90%" (clinical) [Ep 2 · 8:34](https://library.globalcastmd.com/watch/biliary-atresia-859?t=514) - "Alagille syndrome patients do not have the same bile duct proliferation or bile duct plugs seen in biliary atresia" (clinical) [Ep 2 · 10:28](https://library.globalcastmd.com/watch/biliary-atresia-859?t=628) - "Extended Kasai dissection goes beyond portal vein bifurcation to the first bifurcation of hepatic arteries, as originally described by Kasai" (clinical) [Ep 2 · 12:26](https://library.globalcastmd.com/watch/biliary-atresia-859?t=746) - "Japanese centers may have better Kasai outcomes because they perform more extended dissections uniformly" (opinion) [Ep 2 · 12:35](https://library.globalcastmd.com/watch/biliary-atresia-859?t=755) - "Polysplenia syndrome patients with pre-duodenal portal veins are most difficult for Kasai because there is often no bile duct remnant and bile ducts are all above the portal vein" (clinical) [Ep 2 · 13:44](https://library.globalcastmd.com/watch/biliary-atresia-859?t=824) - "Mark Davenport's data from England shows cystic variant biliary atresia patients have better outcomes if intervention occurs before 30 days of age" (clinical) [Ep 2 · 14:57](https://library.globalcastmd.com/watch/biliary-atresia-859?t=897) - "Choledochal cyst patients have pigmented stool while cystic variant biliary atresia patients become acholic" (clinical) [Ep 2 · 15:14](https://library.globalcastmd.com/watch/biliary-atresia-859?t=914) - "A 20 cm Roux limb is inadequate because 5-8 cm of length is typically lost during hilar dissection at the time of liver transplantation" (clinical) [Ep 2 · 15:47](https://library.globalcastmd.com/watch/biliary-atresia-859?t=947) - "Target Roux limb length should be 30-40 cm to preserve adequate length for future transplantation" (clinical) [Ep 2 · 16:09](https://library.globalcastmd.com/watch/biliary-atresia-859?t=969) - "Anti-refluxing valves for Kasai have not been proven effective" (clinical) [Ep 2 · 16:32](https://library.globalcastmd.com/watch/biliary-atresia-859?t=992) - "UK data shows centers performing more than 5 Kasai cases per year have much better outcomes than those performing fewer, with approximately 20% difference" (epidemiological) [Ep 2 · 17:35](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1055) - "British health services centralized all Kasai procedures to three high-volume centers based on outcome data" (clinical) [Ep 2 · 17:38](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1058) - "King's College group used low-dose steroids at 2 mg/kg and showed no benefit" (clinical) [Ep 2 · 18:03](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1083) - "Klaus Peterson's German group used 10 mg/kg steroids for 5 days and showed no benefit" (clinical) [Ep 2 · 18:17](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1097) - "The Children's Network START trial enrolled approximately 70 patients in two arms and showed no improvement in bile drainage with corticosteroids" (clinical) [Ep 2 · 18:29](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1109) - "The START trial showed a slight increase in adverse events in patients who received steroids, though these were medical rather than surgical complications" (clinical) [Ep 2 · 18:42](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1122) - "A subset of biliary atresia patients have an inflammatory gene profile in which steroids might prove beneficial despite negative trial results" (opinion) [Ep 2 · 18:57](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1137) - "Cincinnati does not use MRCP for biliary atresia diagnosis because they have high-capacity pathology teams" (clinical) [Ep 2 · 19:39](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1179) - "Performing Kasai on Alagille syndrome patients will shorten their natural history and lead to earlier transplantation" (clinical) [Ep 2 · 20:12](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1212) - "For cholestatic infants where biliary atresia diagnosis is uncertain, workup includes echocardiography for pulmonic stenosis, spine X-rays for butterfly vertebrae, and ophthalmologic examination to evaluate for Alagille syndrome" (clinical) [Ep 2 · 20:21](https://library.globalcastmd.com/watch/biliary-atresia-859?t=1221) - "French registry data show significantly better 5- and 10-year native liver survival when Kasai performed before 30 days versus after 90 days, with nearly twice the survival rate" (clinical) [Ep 3 · 2:44](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=164) - "In a Michigan series, children who had Kasai after 3 months had the best drainage and long-term outcomes" (clinical) [Ep 3 · 1:03](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=63) - "Under 60 days there was a clear difference in outcomes; procedures done on weekends if approaching day 60" (clinical) [Ep 3 · 1:50](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=110) - "The critical factor determining outcome is the degree of cirrhosis developed in the liver, which varies among children and does not always correlate directly with age" (clinical) [Ep 3 · 3:24](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=204) - "Biliary atresia does not start at day zero in all patients; some may begin at day 20 and progress from there" (clinical) [Ep 3 · 3:53](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=233) - "A series from Rich Ricketts showed not statistically significant better results with Kasai performed at 76 days or older versus 0-75 days" (clinical) [Ep 3 · 4:03](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=243) - "Peter Altman from Columbia, who had the largest US series, argued Kasai should be done between 60 and 75 days" (opinion) [Ep 3 · 5:57](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=357) - "Reversal of portal flow is very concerning because patients can achieve good biliary drainage and normal bilirubin but portal hypertension continues to progress, leading to transplant need" (clinical) [Ep 3 · 9:19](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=559) - "Performing Kasai can buy time and increase the donor pool potential, even if the liver looks horrible" (clinical) [Ep 3 · 10:05](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=605) - "Transplant becomes technically easier in older children with lower risk of hepatic artery thrombosis" (clinical) [Ep 3 · 10:27](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=627) - "Hepatologists can manage biliary atresia patients medically for about a year in the absence of Kasai or transplant, though nutritional status is not optimal" (clinical) [Ep 3 · 10:41](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=641) - "If patients have signs of end-stage liver disease with profound fibrosis and reversal of portal flow, Kasai may not improve outcomes and the operation may stress them unnecessarily" (opinion) [Ep 3 · 10:56](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=656) - "The Kasai operation itself is not technically demanding with low technical risk, so if uncertain, redo procedures are reasonable" (opinion) [Ep 3 · 11:44](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=704) - "Some biliary atresia cases show a race between hepatocyte regeneration and fibrosis progression; one patient's bilirubin dropped to normal 5 months post-op" (clinical) [Ep 3 · 12:20](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=740) - "If liver biopsy is suggestive of biliary atresia, additional testing is not needed" (opinion) [Ep 3 · 14:02](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=842) - "HIDA scan with phenobarbital has high sensitivity and specificity for biliary atresia" (clinical) [Ep 3 · 15:21](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=921) - "An effective HIDA requires at least 5 days of phenobarbital at therapeutic levels" (clinical) [Ep 3 · 15:47](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=947) - "In cases where initial HIDA without adequate phenobarbital was negative, about one-third showed biliary atresia when repeated with proper phenobarbital levels" (clinical) [Ep 3 · 16:40](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1000) - "A recent paper in Gastroenterology showed a scoring system combining liver biopsy with clinical parameters had almost 100% ability to predict biliary atresia" (clinical) [Ep 3 · 17:35](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1055) - "Pathologists' understanding of what to look for in biliary atresia biopsies has improved compared to 20 years ago" (clinical) [Ep 3 · 18:01](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1081) - "Interventional radiologists can perform percutaneous liver biopsies safely and routinely" (clinical) [Ep 3 · 18:10](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1090) - "Patent gallbladder in true biliary atresia is super rare" (clinical) [Ep 3 · 18:41](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1121) - "In Milwaukee, percutaneous cholangiography combined with biopsy can quickly provide answers when successful" (clinical) [Ep 3 · 18:59](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1139) - "If percutaneous cholangiography shows contrast in the gallbladder and bowel, biliary atresia is ruled out without need for surgery" (clinical) [Ep 3 · 19:49](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1189) - "Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent" (clinical) [Ep 3 · 20:44](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1244) - "Japanese centers still recommend steroids either routinely or when drainage decreases after Kasai" (clinical) [Ep 3 · 21:46](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1306) - "Japanese surgeons now perform Kasai with wider porta dissection than Dr. Kasai originally did" (clinical) [Ep 3 · 22:15](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1335) - "Japanese technique uses more superficial sutures to avoid damaging ductules and avoids placing sutures at 10 o'clock and 3 o'clock positions where normal bile ducts bifurcate" (clinical) [Ep 3 · 22:39](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1359) - "Japanese centers claim better results with modified technique, though numbers are not statistically valid" (clinical) [Ep 3 · 23:06](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1386) - "Yamataka is attempting to show laparoscopic Kasai results are as good as open, contrary to IPEG recommendations" (clinical) [Ep 3 · 23:08](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1388) - "Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to advances in genetic diagnosis of bile acid metabolism disorders and progressive familial intrahepatic cholestasis genotyping" (epidemiological) [Ep 5 · 1:28](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=88) - "The absence of a gallbladder on ultrasound does not conclusively diagnose biliary atresia" (clinical) [Ep 5 · 4:38](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=278) - "The presence of a gallbladder on ultrasound does not exclude biliary atresia because modern ultrasound probes can visualize small shrunken gallbladders" (clinical) [Ep 5 · 4:44](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=284) - "HIDA scans require 3-5 days of phenobarbital loading, which can delay intervention into a time period potentially detrimental to Kasai outcomes" (clinical) [Ep 5 · 5:50](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=350) - "Liver biopsy showing bile plugs within a bile duct is pathognomonic for biliary atresia with >90% diagnostic likelihood" (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=495) - "Alagille syndrome patients do not have the same bile duct proliferation or bile duct plugs seen in biliary atresia" (clinical) [Ep 5 · 10:14](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=614) - "Extended hilar dissection to the first bifurcation of hepatic vessels, as originally described by Kasai, may explain better outcomes in Japan compared to the United States" (opinion) [Ep 5 · 12:13](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=733) - "Polysplenia syndrome patients with pre-duodenal portal veins are the most difficult for Kasai procedures because there is often no bile duct remnant or target" (clinical) [Ep 5 · 13:31](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=811) - "Cystic variants of biliary atresia diagnosed in utero have better outcomes if intervention occurs before 30 days of age, based on UK data from Mark Davenport" (clinical) [Ep 5 · 14:43](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=883) - "Choledochal cyst patients will have pigmented stool while cystic variant biliary atresia patients will have acholic stool, providing a simple clinical differentiation" (clinical) [Ep 5 · 15:00](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=900) - "Roux limb length of 20 cm is inadequate for future transplantation because 5-8 cm of length is typically lost during hilar dissection at transplant" (clinical) [Ep 5 · 15:30](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=930) - "Target Roux limb length should be 30-40 cm to preserve adequate length for future liver transplantation" (clinical) [Ep 5 · 15:55](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=955) - "Anti-refluxing valves for Roux limbs have not been proven effective in biliary atresia" (clinical) [Ep 5 · 16:16](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=976) - "UK data from 15 years ago showed centers performing more than 5 biliary atresia cases per year had approximately 20% better outcomes than lower-volume centers" (epidemiological) [Ep 5 · 16:53](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1013) - "The British health service centralized all Kasai procedures to three high-volume centers based on outcome data" (guideline) [Ep 5 · 17:23](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1043) - "Two European studies (King's Group using 2 mg/kg and German group using 10 mg/kg for 5 days) showed no benefit from postoperative corticosteroids in biliary atresia" (clinical) [Ep 5 · 17:49](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1069) - "The Children's Network biliary atresia consortium trial of approximately 70 patients showed no improvement in bile drainage with corticosteroids and a slight increase in adverse events" (clinical) [Ep 5 · 18:09](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1089) - "A subset of biliary atresia patients with an inflammatory gene profile might benefit from steroids despite negative trial results" (opinion) [Ep 5 · 18:39](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1119) - "Performing Kasai procedure on Alagille syndrome patients will shorten the natural history of their native liver and lead to earlier transplantation" (clinical) [Ep 5 · 19:59](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1199) - "The jaundice chip is a gene microarray that tests for PIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin, and JAG1 mutation but takes 4-6 weeks for results" (clinical) [Ep 5 · 3:11](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=191) - "Newborns produce a lot more bilirubin than adults" — Kat (clinical) [Ep 4 · 1:06](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=66) - "Pathologic jaundice occurs 1 in 2500 live births" — Kat (epidemiological) [Ep 4 · 2:24](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=144) - "Biliary atresia is a progressive, obliterative, idiopathic cholangiopathy" — Kat (clinical) [Ep 4 · 5:01](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=301) - "About 80% to 90% of babies present with perinatal or postnatal form versus 10 to 20% with a fetal or embryonic form" — Kat (epidemiological) [Ep 4 · 5:12](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=312) - "The incidence ranges from 1 in 5000 in some Asian countries like Taiwan, about 1 in 8 to 10,000 in Japan, and 1 to 18,000 in the United States and Europe" — Kat (epidemiological) [Ep 4 · 5:42](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=342) - "More females than males are affected by biliary atresia" — Kat (epidemiological) [Ep 4 · 6:05](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=365) - "There tends to be some seasonal clustering, which leads some to suspect that viruses or some sort of infectious process is a trigger for biliary atresia" — Kat (clinical) [Ep 4 · 6:09](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=369) - "Biliary atresia is lethal if untreated" — Kat (clinical) [Ep 4 · 6:10](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=370) - "If conjugated or direct bilirubin is greater than or equal to 2, the child needs to be evaluated more closely" — Kat (guideline) [Ep 4 · 7:59](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=479) - "There are babies with biliary atresia whose ultrasounds are normal" — Kat (clinical) [Ep 4 · 8:16](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=496) - "The gold standard for diagnosis is the intraoperative cholangiogram" — Kat (guideline) [Ep 4 · 8:26](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=506) - "At Children's Hospital, they pre-treat babies for 5 days of phenobarbital before the HIDA scan" — Kat (clinical) [Ep 4 · 9:31](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=571) - "Timing of the diagnosis and moving to the Kasai is extremely important, with the sweet spot being 6 to 8 weeks of age" — Kat (clinical) [Ep 4 · 15:05](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=905) - "A French study showed that 23% of their Kasai patients had their native liver 20 years post Kasai" — Kat (epidemiological) [Ep 4 · 15:50](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=950) - "In England, they increased their success with Kasai by consolidating to 3 centers performing their Kasai procedures" — Kat (epidemiological) [Ep 4 · 16:48](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1008) - "At Children's Hospital, they see 6 to 12 biliary atresia babies a year and are considered a high rate center" — Kat (epidemiological) [Ep 4 · 17:20](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1040) - "If cirrhosis is seen on liver biopsy or frozen section during intraoperative cholangiogram, they close up and proceed to transplant rather than Kasai" — Kat (clinical) [Ep 4 · 20:08](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1208) - "Getting babies to an older age for transplant through Kasai seems easier for transplant, despite some complications" — Kat (opinion) [Ep 4 · 21:10](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1270) - "Children's Hospital has a very large, if not the largest, living donor liver transplant center in the country" — Kat (clinical) [Ep 4 · 22:27](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1347) - "Most patients are put on peripheral lines rather than Broviacs for postoperative antibiotics" — Kat (clinical) [Ep 4 · 24:06](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1446) - "At Children's Hospital, babies only get intravenous antibiotics until they're taking orals, then switch to Bactrim" — Kat (clinical) [Ep 4 · 25:08](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1508) - "For babies less than 6 weeks of age, they use amoxicillin and then switch to Bactrim once they're 6 weeks of age or older" — Kat (clinical) [Ep 4 · 25:17](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1517) - "Bactrim is used at 4 to 5 mg per kg per day" — Kat (clinical) [Ep 4 · 25:28](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1528) - "Babies are put on ursodeoxycholic acid twice a day" — Kat (clinical) [Ep 4 · 25:35](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1535) - "These babies are fat soluble vitamin deficient, especially vitamin D, E, and K, and are supplemented with aqueous solutions like Aquadek or ADeck" — Kat (clinical) [Ep 4 · 25:41](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1541) - "The BARC protocol enrolled 140 babies into a randomized double-blind placebo-controlled study with steroids" — Kat (clinical) [Ep 4 · 27:22](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1642) - "Whenever a baby that's had a Kasai has an unexplained fever, ascending cholangitis is suspected" — Kat (clinical) [Ep 4 · 28:15](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1695) - "The more times a baby has an episode of ascending cholangitis, it does further damage the liver and may lead to an earlier need for transplant" — Kat (clinical) [Ep 4 · 29:36](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1776) - "Biliary atresia is the most common indication for pediatric liver transplant" — Kat (epidemiological) [Ep 4 · 31:09](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1869) - "The American Academy of Pediatrics policy statement says all jaundiced infants at 2 weeks of age should have a fractionated bilirubin done" — Kat (guideline) [Ep 4 · 32:54](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1974) - "In England, Caucasian babies' average age of diagnosis with biliary atresia was at 47 days of age, while non-white babies was 52 days of age" — Kat (epidemiological) [Ep 4 · 34:24](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2064) - "Any baby diagnosed after 100 days of age was only non-Caucasian" — Kat (epidemiological) [Ep 4 · 34:44](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2084) - "In an England study, 37% of physicians and nurses did not correctly identify a suspect stool using stool color cards" — Kat (epidemiological) [Ep 4 · 36:05](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2165) - "The 140 babies randomized between steroids and placebo in the BARC trial did not show any benefit from steroid use" — Kat (clinical) [Ep 4 · 38:41](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2321) - "Steroids did not improve outcomes with native liver survival" — Kat (clinical) [Ep 4 · 38:53](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2333) - "Studies found a more rapid drop in bilirubin level and increased jaundice clearance with steroids, but no one has found that steroids prevent or lengthen the time until a baby needs transplant" — Kat (clinical) [Ep 4 · 39:02](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2342) - "In the BARC trial, steroids were given for 14 weeks after the Kasai" — Kat (clinical) [Ep 4 · 40:29](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2429) - "In Taiwan and other Asian countries, they send stool cards home with every discharged baby" — Kat (clinical) [Ep 4 · 41:39](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2499) - "Children's Hospital will be a site using intravenous immunoglobulin following Kasai portoenterostomy in a new study" — Kat (clinical) [Ep 4 · 42:32](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2552) - "At Children's Hospital, surgeons like to see babies at the post-op two week check to ensure the incision is healing properly without infection" — Kat (clinical) [Ep 4 · 44:47](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2687) - "The GI department follows all biliary atresia babies after surgery at Children's Hospital" — Kat (clinical) [Ep 4 · 45:03](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2703) - "Bilirubin levels are obtained in the hospital before the baby leaves to see the trend" — Kat (clinical) [Ep 4 · 47:40](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2860) - "The study was a retrospective cohort study conducted in China" — Cecilia Gigena (epidemiological) [Ep 21 · 0:11](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=11) - "The study included 329 patients with biliary atresia" — Cecilia Gigena (epidemiological) [Ep 21 · 0:21](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=21) - "40 of the 329 patients had low MMP-7 levels" — Cecilia Gigena (epidemiological) [Ep 21 · 0:21](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=21) - "Patients with low MMP-7 had significantly lower 3-month jaundice clearance" — Cecilia Gigena (clinical) [Ep 21 · 0:27](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27) - "Patients with low MMP-7 had significantly lower 6-month jaundice clearance" — Cecilia Gigena (clinical) [Ep 21 · 0:27](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27) - "Patients with low MMP-7 had significantly lower 1-year native liver survival" — Cecilia Gigena (clinical) [Ep 21 · 0:27](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27) - "Measuring MMP-7 can help with prognosis in biliary atresia patients" — Cecilia Gigena (opinion) [Ep 21 · 0:40](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=40) - "MMP-7 measurement may in the future help with treatment of biliary atresia patients" — Cecilia Gigena (opinion) [Ep 21 · 0:40](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=40) - "Biliary atresia should be considered in the differential diagnosis of any newborn greater than 2 weeks of life with hyperbilirubinemia" — Jonathan Roach (clinical) [Ep 7 · 0:30](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=30) - "A direct bilirubin greater than 20% of the total or greater than 1.0 prompts further workup for biliary atresia" — Jonathan Roach (guideline) [Ep 7 · 0:40](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=40) - "Alpha one antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively" — Jonathan Roach (clinical) [Ep 7 · 0:58](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=58) - "Ultrasound findings in biliary atresia workup include abnormalities in the gallbladder and the triangular cord sign" — Jonathan Roach (clinical) [Ep 7 · 1:07](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=67) - "Liver biopsy findings suggestive of biliary atresia include bridging fibrosis, bile duct plugging, and proliferation of bile ductules" — Jonathan Roach (clinical) [Ep 7 · 1:17](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=77) - "There is no need to wait for the result of every esoteric test prior to proceeding to the operating room if workup is suggestive of biliary atresia" — Jonathan Roach (opinion) [Ep 7 · 1:41](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=101) - "Age at the time of Kasai is the primary determinant of outcome in biliary atresia patients" — Jonathan Roach (clinical) [Ep 7 · 1:50](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=110) - "Some gallbladders in biliary atresia do not have lumen, and in these patients further exploration and likely Kasai is performed" — Jonathan Roach (clinical) [Ep 7 · 2:04](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=124) - "To avoid contrast extravasation during cholangiogram, the technique involves mobilizing the gallbladder off the fossa, amputating the dome, inserting the catheter directly into the lumen, and tying off with silk ligature" — Jonathan Roach (clinical) [Ep 7 · 2:19](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=139) - "Vascular variants in biliary atresia may include a preduodenal portal vein, which is rare" — Jonathan Roach (clinical) [Ep 7 · 2:40](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=160) - "Confusing branching patterns of the hepatic artery and portal vein are more common but still rare" — Jonathan Roach (clinical) [Ep 7 · 2:43](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=163) - "It is recommended to carry out dissection to the secondary branching of the right and left hepatic arteries" — Jonathan Roach (guideline) [Ep 7 · 2:51](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=171) - "When hepatic artery branching is quite early, dissection needs to occur up to the substance of the liver" — Jonathan Roach (clinical) [Ep 7 · 2:51](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=171) - "The most reliable determinant of where the hilar plate exists is between the bifurcation of the right and left portal vein" — Jonathan Roach (clinical) [Ep 7 · 3:10](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=190) - "It is important to dissect the fibrous cone of the biliary remnants down into the bifurcation of the portal vein where small portal branches must be tied off" — Jonathan Roach (clinical) [Ep 7 · 3:19](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=199) - "The transection plane of biliary remnants should be flush with the capsule of the liver, not dissecting into the substance of the liver nor remaining too shallow into the fibrous cone" — Jonathan Roach (clinical) [Ep 7 · 3:37](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=217) - "Due to the results of the START trial, steroids are no longer routinely used in postoperative care for biliary atresia" — Jonathan Roach (guideline) [Ep 7 · 4:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=240) - "The use of antibiotics prophylactically to prevent cholangitis is a controversial topic" — Jonathan Roach (opinion) [Ep 7 · 4:08](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=248) - "The speaker's institution currently uses prophylactic antibiotics on all patients after Kasai" — Jonathan Roach (clinical) [Ep 7 · 4:15](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=255) - "Biliary atresia patients require long-term follow-up care either with the pediatric surgeon or with the pediatric hepatologist" — Jonathan Roach (guideline) [Ep 7 · 4:23](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=263) - "MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes" — Em Gootee (clinical) [Ep 23 · 1:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=85) - "MMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis" — Em Gootee (clinical) [Ep 23 · 1:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=97) - "Higher levels of MMP-7 are associated with the diagnosis of biliary atresia" — Em Gootee (clinical) [Ep 23 · 1:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=103) - "Out of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7" — Em Gootee (epidemiological) [Ep 23 · 1:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=116) - "Low levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin" — Em Gootee (clinical) [Ep 23 · 2:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=156) - "GGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain" — Em Gootee (clinical) [Ep 23 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=182) - "GGT blood test levels are used to detect diseases of the liver and bile ducts" — Em Gootee (clinical) [Ep 23 · 3:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=192) - "Biliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion" — Em Gootee (clinical) [Ep 23 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=207) - "Lower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes" — Em Gootee (clinical) [Ep 23 · 4:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=249) - "The reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown" — Em Gootee (clinical) [Ep 23 · 4:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=281) - "The gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants" — Em Gootee (epidemiological) [Ep 23 · 7:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=422) - "78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula" — Em Gootee (epidemiological) [Ep 23 · 7:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=463) - "Patients with gastroschisis who had some exposure to formula in the first 28 days of life did not have increased risk of necrotizing enterocolitis or major differences in reaching full enteral feeds" — Mike Livingston (clinical) [Ep 23 · 8:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=492) - "There were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay" — Em Gootee (clinical) [Ep 23 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=507) - "Gastroschisis patients exposed to formula seemed to have a slightly faster time getting to full feeds, likely related to timing of closure rather than feeding" — Mike Livingston (clinical) [Ep 23 · 8:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=514) - "Gastroschisis patients who received exclusive breast milk in first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure" — Mike Livingston (clinical) [Ep 23 · 8:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=533) - "The transition systematic review found 8 studies that included patient and parent responses and clinician perspectives" — Whit Holcomb (epidemiological) [Ep 23 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=766) - "The transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease" — Em Gootee (epidemiological) [Ep 23 · 12:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=775) - "There is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)" — Em Gootee (clinical) [Ep 23 · 13:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=796) - "The life course progression of anorectal malformation and Hirschsprung disease is not well understood" — Em Gootee (clinical) [Ep 23 · 13:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=810) - "Barriers and enablers of successful transition for surgical patients showed agreement with those for medical patients that guidelines were based on" — Sebastian King (clinical) [Ep 23 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822) - "Patients felt clinicians did not always understand the need for transitioning their child's care from pediatric to adult settings, including the reasons, processes, and how to make processes smooth" — Sebastian King (opinion) [Ep 23 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822) - "There was little evidence that transfer of colorectal patients happened in a timely or coordinated manner" — Whit Holcomb (clinical) [Ep 23 · 14:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=862) - "Patients felt clinicians did not always understand the significance of transfer to an adult service" — Whit Holcomb (opinion) [Ep 23 · 14:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=871) - "No models of transfer of care for colorectal conditions were identified" — Whit Holcomb (clinical) [Ep 23 · 14:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=878) - "Timely diagnosis of biliary atresia is critical to prolong native liver survival" — Greg Tiao (clinical) [Ep 24 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=53) - "The key to treating biliary atresia is making an early diagnosis" — Em Gootee (clinical) [Ep 24 · 1:11](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=71) - "MMP-7 was identified about 10 years ago as a diagnostic biomarker for biliary atresia by Georgia Bezarra's lab" — Em Gootee (clinical) [Ep 24 · 1:16](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=76) - "The sooner the Kasai is done, the more likely native liver will be saved" — Em Gootee (clinical) [Ep 24 · 1:37](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=97) - "Cincinnati Children's stopped doing HIDA scans about 25 years ago" — Greg Tiao (clinical) [Ep 24 · 2:47](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=167) - "HIDA scan adds about 5 days to the diagnostic workup" — Greg Tiao (clinical) [Ep 24 · 2:50](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=170) - "Data from a Midwest study shows that for every 10 day delay in treatment, outcomes worsen by 20%" — Em Gootee (epidemiological) [Ep 24 · 2:55](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=175) - "The Children's Network is a national consortium of about 14 centers where all cholestatic liver disease children are enrolled in a registry" — Greg Tiao (clinical) [Ep 24 · 3:17](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=197) - "Dr. Bezarra screened about 1000 proteins and found 70 or so that were elevated in the biliary atresia population, of which MMP-7 was the most clear" — Greg Tiao (clinical) [Ep 24 · 3:32](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=212) - "Within the Children's Network, biliary atresia disease frequency is low, with only 200 to 300 cases per year" — Em Gootee (epidemiological) [Ep 24 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=224) - "The incidence of biliary atresia is higher in the Far East" — Greg Tiao (epidemiological) [Ep 24 · 3:57](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=237) - "Dr. Bezarra validated MMP-7 findings in just 2 years through a study in mainland China where biliary atresia frequency is much higher" — Em Gootee (clinical) [Ep 24 · 4:01](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=241) - "In China, if biliary atresia patients don't get early Kasai, living donor liver transplant is their only option and it's not readily available, so those kids face a mortality risk" — Greg Tiao (clinical) [Ep 24 · 4:10](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=250) - "MMP-7 is now a validated biomarker for biliary atresia" — Em Gootee (clinical) [Ep 24 · 4:22](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=262) - "MMP-7 is not perfect; sensitivity is pretty good but cutoffs vary because the assay is still evolving" — Greg Tiao (clinical) [Ep 24 · 4:26](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=266) - "Cincinnati Children's commitment is to perform Kasai within 7 days of patient presentation if they have biliary atresia" — Greg Tiao (clinical) [Ep 24 · 4:44](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=284) - "Children's Network data showed that the average age of a biliary atresia patient going through Kasai in North America was around 75 days" — Em Gootee (epidemiological) [Ep 24 · 4:52](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=292) - "A European study showed that if Kasai is done before 45 days, it reduces the incidence of transplant need in that patient population" — Greg Tiao (epidemiological) [Ep 24 · 5:03](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=303) - "A Kasai portoenterostomy done before 45 days is the goal" — Greg Tiao (guideline) [Ep 24 · 5:22](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=322) - "Cincinnati Children's will do Kasai before 30 days if diagnosis can be established" — Greg Tiao (clinical) [Ep 24 · 5:27](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=327) - "More and more nurseries are screening newborns at discharge, and a direct bilirubin over 1 in the newborn period is very sensitive for biliary atresia" — Greg Tiao (clinical) [Ep 24 · 5:37](https://library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=337) - "French registry data show children who had Kasai at less than 1 month of age have nearly twice the 5- and 10-year native liver survival rate compared to those operated after 90 days" — Robert Parry (clinical) [Ep 1 · 2:32](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=152) - "In the Michigan series, children operated on after 3 months had the best drainage and long-term outcomes" (clinical) [Ep 1 · 1:03](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=63) - "The critical factor determining outcome is the degree of cirrhosis developed in the liver at the time of surgery, which does not always correlate directly with age" (clinical) [Ep 1 · 3:24](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=204) - "Rich Ricketts' series showed not statistically significant better results with Kasai performed at 76 days or older versus 0-75 days" (clinical) [Ep 1 · 4:03](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=243) - "In most biliary atresia cases, jaundice and acholic stools are present from the first week of life" (clinical) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=312) - "Peter Altman from Columbia, who had the largest US series, argued that Kasai should be performed between 60 and 75 days" (opinion) [Ep 1 · 5:57](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=357) - "Reversal of portal flow is a very concerning sign because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension" (clinical) [Ep 1 · 9:19](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=559) - "If a patient has signs of end-stage liver disease with profound fibrosis and reversed portal flow, a Kasai may not improve outcomes and the stress of surgery may be harmful" (opinion) [Ep 1 · 10:56](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=656) - "Hepatologists can manage biliary atresia patients medically for up to a year without Kasai or transplant, though nutritional status suffers" (clinical) [Ep 1 · 10:41](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=641) - "The Kasai operation itself is not technically demanding and does not carry high technical risk" (opinion) [Ep 1 · 11:44](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=704) - "Some biliary atresia patients show delayed clearance, with bilirubin remaining elevated for months post-Kasai then dropping to normal at 5 months, suggesting a race between hepatocyte regeneration and fibrosis progression" (clinical) [Ep 1 · 12:20](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=740) - "HIDA scan with phenobarbital has high sensitivity for biliary atresia, but an effective study requires at least 5 days of phenobarbital at adequate levels" — Robert Parry (clinical) [Ep 1 · 15:21](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=921) - "A recent paper in Gastroenterology showed that liver biopsy combined with other clinical parameters in a scoring system can predict biliary atresia with almost 100% accuracy" (clinical) [Ep 1 · 17:34](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1054) - "Pathologists' understanding of biliary atresia histology has improved significantly over the past 20 years" (opinion) [Ep 1 · 18:04](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1084) - "It is rare to have a patent gallbladder in true biliary atresia" (clinical) [Ep 1 · 18:41](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1121) - "Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent" (clinical) [Ep 1 · 20:44](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1244) - "Japanese centers still recommend postoperative steroids either routinely or when drainage decreases" (guideline) [Ep 1 · 21:32](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1292) - "Japanese surgeons now perform Kasai dissection much wider than Dr. Kasai originally described" (clinical) [Ep 1 · 22:15](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1335) - "Japanese technique uses more superficial sutures to avoid damaging small ductules and avoids placing sutures at 10 o'clock and 3 o'clock positions where bile ducts normally bifurcate" (clinical) [Ep 1 · 22:39](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1359) - "Japanese centers claim improved results with their modified technique, though numbers are not yet statistically valid" (clinical) [Ep 1 · 23:01](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1381) - "The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy" — Daniel von Allmen (clinical) [Ep 6 · 2:56](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=176) - "High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo" — Daniel von Allmen (clinical) [Ep 6 · 4:01](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=241) - "Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group" — Daniel von Allmen (clinical) [Ep 6 · 4:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=279) - "Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction" — Daniel von Allmen (clinical) [Ep 6 · 4:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=295) - "Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia" — Daniel von Allmen (clinical) [Ep 6 · 5:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=310) - "The study was powered to detect a 25% absolute treatment difference in outcomes" — Daniel von Allmen (clinical) [Ep 6 · 3:46](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=226) - "Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow" — Daniel von Allmen (clinical) [Ep 6 · 8:59](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=539) - "Washington State registry study included over 50 hospitals and analyzed clean-contaminated operations over 18 months beginning January 2011" — Whit Holcomb (clinical) [Ep 6 · 12:02](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=722) - "Overall surgical site infection rate was 4.6%, varying by procedure: 6.6% colorectal, 1.4% bariatric, 1.5% other" — Whit Holcomb (epidemiological) [Ep 6 · 13:05](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=785) - "No single antiseptic agent was associated with lower risk of surgical site infection than any other agent" — Whit Holcomb (clinical) [Ep 6 · 13:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=819) - "Isopropyl alcohol provided no benefit: 4.5% SSI rate without alcohol versus 4.6% with alcohol" — Whit Holcomb (clinical) [Ep 6 · 13:49](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=829) - "Registry data could not identify surgical site infections diagnosed after discharge, likely underestimating true SSI rate" — Whit Holcomb (clinical) [Ep 6 · 14:20](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=860) - "Recent reports show 50% or more surgical site infections are diagnosed after discharge" — Whit Holcomb (epidemiological) [Ep 6 · 14:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=880) - "Most surgical site infections occur 3 to 10 days after operation" — Whit Holcomb (clinical) [Ep 6 · 14:48](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=888) - "Chlorhexidine prep dries faster than betadine, allowing cases to start sooner" — Whit Holcomb (clinical) [Ep 6 · 18:33](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1113) - "Appendicitis pilot RCT enrolled 50 patients aged 5-15 years with non-perforated appendicitis: 26 randomized to operation, 24 to antibiotics" — Whit Holcomb (clinical) [Ep 6 · 22:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1378) - "Of 24 patients randomized to non-operative treatment, 2 underwent appendectomy during primary treatment course and 1 had appendectomy at 9 months for recurrent appendicitis" — Whit Holcomb (clinical) [Ep 6 · 23:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1394) - "An additional 6 patients in the non-operative group underwent appendectomy for recurrent abdominal pain or parental desire during 1-year follow-up, with no appendicitis found on histology" — Whit Holcomb (clinical) [Ep 6 · 23:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1412) - "Total of 9 of 24 patients (38%) initially randomized to antibiotic therapy underwent appendectomy within first year, making success rate 62%" — Whit Holcomb (clinical) [Ep 6 · 24:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1450) - "Median time to discharge was significantly shorter in surgical group than non-operative group, possibly due to stipulated 48-hour minimum hospitalization for non-operative patients" — Whit Holcomb (clinical) [Ep 6 · 24:35](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1475) - "Cost for initial inpatient stay was significantly lower in non-operative treatment group despite longer hospitalizations" — Whit Holcomb (clinical) [Ep 6 · 24:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1495) - "Immunosuppressed cancer patients with typhlitis are sometimes treated non-operatively and most resolve with antibiotics" — Whit Holcomb (clinical) [Ep 6 · 27:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1620) - "PIFCON study included 272 patients from 14 multidisciplinary intestinal rehab programs with median 33-month follow-up" — Aaron Lipskar (clinical) [Ep 6 · 32:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1952) - "Enteral autonomy was achieved in 43% of intestinal failure cohort, 13% remained PN-dependent, and 43% died or underwent transplantation" — Aaron Lipskar (epidemiological) [Ep 6 · 32:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1960) - "Necrotizing enterocolitis diagnosis, care at intestinal rehab facility without transplant center, and presence of ileocecal valve were associated with statistically significant higher rates of enteral autonomy" — Aaron Lipskar (clinical) [Ep 6 · 32:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1978) - "Residual small bowel length was a statistically significant but less impressive predictor of enteral autonomy" — Aaron Lipskar (clinical) [Ep 6 · 33:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1999) - "The protective effect of necrotizing enterocolitis on enteral autonomy goes against understanding of that inflammatory illness" — Aaron Lipskar (opinion) [Ep 6 · 33:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2035) - "A companion paper in same journal showed necrotizing enterocolitis was a poor predictor of growth outcome in infants with short bowel syndrome" — Aaron Lipskar (clinical) [Ep 6 · 35:12](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2112) - "FDA established SmartTots partnership with International Anesthesia Research Society in 2009 to study anesthesia-related neurotoxicity" — Aaron Lipskar (guideline) [Ep 6 · 37:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2239) - "SmartTots 2012 consensus statement recommended avoiding elective surgical procedures under anesthesia in children less than 3 years when possible" — Aaron Lipskar (guideline) [Ep 6 · 37:34](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2254) - "Commonly used anesthetics including propofol, etomidate, sevoflurane, isoflurane, and ketamine produce profound neurotoxic effects in laboratory animals from nematodes to nonhuman primates" — Aaron Lipskar (clinical) [Ep 6 · 38:09](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2289) - "Observational studies in children undergoing early anesthesia offer conflicting results but suggest some children may have deficits, though causation difficult to establish" — Aaron Lipskar (clinical) [Ep 6 · 38:43](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2323) - "June 2014 SmartTots statement concluded animal data sufficiently convincing that large-scale clinical studies are warranted" — Aaron Lipskar (guideline) [Ep 6 · 39:06](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2346) - "Updated recommendation is to avoid surgical procedures under anesthesia in children under 3 years unless situation is urgent or potentially harmful if not attended to" — Aaron Lipskar (guideline) [Ep 6 · 39:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2354) - "Regional anesthesia blocks can diminish amount of potentially neurotoxic medications in almost every laparoscopic, thoracoscopic, or open operation" — Aaron Lipskar (clinical) [Ep 6 · 42:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2520) - "Rule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year" — Todd Ponsky (opinion) [Ep 6 · 42:16](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2536) - "Survey of 150 parents in primary care pediatrics office found vast majority did not know anesthetic neurotoxicity was a major issue" — Aaron Lipskar (epidemiological) [Ep 6 · 43:17](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2597) - "Biliary atresia is the most common cause of end-stage liver failure in the pediatric patient population" — Rod (epidemiological) [Ep 12 · 0:12](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=12) - "Biliary atresia is the number one reason for pediatric liver transplant" — Rod (epidemiological) [Ep 12 · 0:12](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=12) - "Biliary atresia results in an obstructive cholangiopathy of the biliary system" — Greg Tiao (clinical) [Ep 12 · 0:40](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=40) - "Biliary atresia is unique to infancy" — Greg Tiao (clinical) [Ep 12 · 0:48](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=48) - "The etiology of biliary atresia is uncertain" — Greg Tiao (clinical) [Ep 12 · 0:54](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=54) - "Biliary atresia causes biliary epithelial injury that leads to biliary obstruction" — Greg Tiao (clinical) [Ep 12 · 0:56](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=56) - "Untreated biliary atresia causes progressive cholestasis, portal fibrosis, cirrhosis, portal hypertension, and can cause death by age 2 years" — Greg Tiao (clinical) [Ep 12 · 1:10](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=70) - "In the Far East, biliary atresia incidence is 1 in 8000 live births" — Greg Tiao (epidemiological) [Ep 12 · 1:37](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=97) - "In the United States, biliary atresia incidence is 1 in 15,000 live births" — Greg Tiao (epidemiological) [Ep 12 · 1:43](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=103) - "Patients with biliary atresia typically present with jaundice, acholic or pale gray stools, dark urine, and a firm palpable liver" — Greg Tiao (clinical) [Ep 12 · 2:02](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=122) - "Typical age of presentation for biliary atresia is between 1 to 2 months of age" — Greg Tiao (clinical) [Ep 12 · 2:21](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=141) - "Screening for biliary atresia can detect it at an earlier stage and has been demonstrated to improve outcomes" — Greg Tiao (clinical) [Ep 12 · 2:26](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=146) - "The most common reason for infant jaundice is physiologic jaundice of the newborn with indirect hyperbilirubinemia" — Greg Tiao (clinical) [Ep 12 · 2:46](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=166) - "Direct hyperbilirubinemia indicates a more pathologic process" — Greg Tiao (clinical) [Ep 12 · 2:58](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=178) - "Anatomic causes of direct hyperbilirubinemia include biliary atresia, choledochal cysts, and inspissated bile syndrome" — Greg Tiao (clinical) [Ep 12 · 3:25](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=205) - "Non-anatomic causes of direct hyperbilirubinemia include viral hepatitis, sepsis, PFIC syndromes, alpha-1 antitrypsin deficiency, tyrosinemia, and transport abnormalities" — Greg Tiao (clinical) [Ep 12 · 3:39](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=219) - "Matrix metalloproteinase 7 (MMP-7) is a new biochemical marker with very high diagnostic sensitivity and specificity for biliary atresia" — Greg Tiao (clinical) [Ep 12 · 5:13](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=313) - "Ultrasound is the first imaging test typically obtained for biliary atresia workup" — Greg Tiao (clinical) [Ep 12 · 5:32](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=332) - "HIDA scan is fairly sensitive but has low specificity and can delay diagnosis of biliary atresia" — Greg Tiao (clinical) [Ep 12 · 5:42](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=342) - "Liver biopsy is the gold standard for diagnosing biliary atresia" — Greg Tiao (clinical) [Ep 12 · 6:09](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=369) - "Classic biopsy findings in biliary atresia include periportal space expansion with mononuclear cells, bile duct proliferation, and bile duct plugs within proliferating periportal biliary ducts" — Greg Tiao (clinical) [Ep 12 · 6:18](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=378) - "Treatment options for biliary atresia are surgical: Kasai portoenterostomy or liver transplantation" — Greg Tiao (clinical) [Ep 12 · 6:45](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=405) - "Success rate of Kasai procedure justifies the small morbidity risks if performed before 70-75 days of age" — Greg Tiao (clinical) [Ep 12 · 7:00](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=420) - "Manifestations of cirrhosis including ascites and coagulopathy in older patients may warrant consideration for primary transplant" — Greg Tiao (clinical) [Ep 12 · 7:12](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=432) - "Intraoperative cholangiogram is required to establish anatomy and visualize patency of the common hepatic duct and intrahepatic components" — Greg Tiao (clinical) [Ep 12 · 7:34](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=454) - "The Kasai procedure involves mobilizing the gallbladder, dissecting laterally to where arteries branch, creating a triangle-like hilar plate appearance, and transecting the hilar plate proximal to Glisson's capsule" — Greg Tiao (clinical) [Ep 12 · 7:55](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=475) - "A 30-35 centimeter Roux-en-Y limb is created and brought up in a retrocolic fashion for reconstruction" — Greg Tiao (clinical) [Ep 12 · 8:34](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=514) - "The most worrisome complication of Kasai procedure is vascular injury to the portal vein or hepatic artery" — Greg Tiao (clinical) [Ep 12 · 9:04](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=544) - "During Kasai procedure, anything that appears to be a vessel should not be divided as it may be a segmental artery of importance" — Greg Tiao (clinical) [Ep 12 · 9:11](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=551) - "Other complications of Kasai include bowel obstruction and wound issues" — Greg Tiao (clinical) [Ep 12 · 9:27](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=567) - "Cholangitis is a longer-term concern but requires adequate bile flow to occur, making it paradoxically a sign of successful drainage" — Greg Tiao (clinical) [Ep 12 · 9:34](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=574) - "Most patients in the United States are discharged home within 5-7 days after Kasai procedure" — Greg Tiao (clinical) [Ep 12 · 10:01](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=601) - "Biliary atresia requires multidisciplinary care with both surgeon and gastroenterologist follow-up" — Greg Tiao (clinical) [Ep 12 · 10:06](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=606) - "Postoperative management includes prophylactic antibiotics, Actigall, and nutritional support with fat-soluble vitamins and elemental diets" — Greg Tiao (clinical) [Ep 12 · 10:14](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=614) - "A successful Kasai is defined as direct bilirubin under 2 at 3 months of age" — Greg Tiao (clinical) [Ep 12 · 10:28](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=628) - "Immediate post-operative success is indicated by pigmented stool showing the patient is draining" — Greg Tiao (clinical) [Ep 12 · 10:35](https://library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=635) - "Biliary atresia is a progressive cholangiopathy that leads to morbidity and end stage cirrhosis" — Shilpa Sharma (clinical) [Ep 17 · 1:06](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=66) - "In developing countries with delayed presentation, most infants with biliary atresia succumb to hepatopulmonary syndrome, portal hypertension, intraventricular hemorrhage, and aspiration due to massive ascites" — Shilpa Sharma (epidemiological) [Ep 17 · 1:10](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=70) - "The liver may regenerate after physiological insults and resection" — Shilpa Sharma (clinical) [Ep 17 · 1:33](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=93) - "Hepatic resection acts as a trigger for liver regeneration" — Shilpa Sharma (clinical) [Ep 17 · 1:37](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=97) - "The liver can regenerate only to a size that is proportional to its original size" — Shilpa Sharma (clinical) [Ep 17 · 1:41](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=101) - "In biliary atresia, hepatic stellate cells lead to the pro-fibrogenetic pathway involving transforming growth factor, platelet derived growth factor, and interleukins" — Shilpa Sharma (clinical) [Ep 17 · 1:53](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=113) - "With hepatic resection, hematopoietic stem cells lead to proliferation via hepatocyte growth factor receptor, epidermal growth factor receptor, and cytokines like tumor necrosis factor" — Shilpa Sharma (clinical) [Ep 17 · 2:09](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=129) - "In 2015 the team started resecting segments 2 and 3 of the liver in a non-anatomical fashion to stimulate an alternative pathway of stem cell proliferation for hepatic regeneration" — Shilpa Sharma (clinical) [Ep 17 · 2:26](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=146) - "The median age at presentation was 96 days in one group and 89 days in the other" — Shilpa Sharma (epidemiological) [Ep 17 · 3:16](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=196) - "Serum bilirubin levels were significantly different between both groups at 1 month and 3 month postoperative period" — Shilpa Sharma (clinical) [Ep 17 · 3:26](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=206) - "APRI was significantly different between groups on day 7" — Shilpa Sharma (clinical) [Ep 17 · 3:35](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=215) - "Mortality was 56% in the study group (Kasai plus resection) compared to 93% in the control group (Kasai alone)" — Shilpa Sharma (clinical) [Ep 17 · 3:41](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=221) - "Jaundice-free percentage was 91% in the study group compared to 25% in the control group" — Shilpa Sharma (clinical) [Ep 17 · 3:49](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=229) - "Resection of a part of the liver may trigger an alternative path of stem cell proliferation for hepatic regeneration with reduced fibrosis and improved survival" — Shilpa Sharma (opinion) [Ep 17 · 3:58](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=238) - "The study resected the left liver (segments 2 and 3) to leave enough liver to regenerate" — Cecilia (clinical) [Ep 17 · 5:08](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=308) - "Patients in the study presented late, after 80 days of life" — Cecilia (epidemiological) [Ep 17 · 5:32](https://library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=332) - "Dr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia" (clinical) [Ep 18 · 0:04](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=4) - "Dr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca" (clinical) [Ep 18 · 0:20](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=20) - "Dr. Dariusz Patkowski presented thoracoscopic approach for long gap esophageal atresia using internal traction technique with slipknots" — Rennie (clinical) [Ep 18 · 0:39](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=39) - "Dr. Johanna Gerardo presented an epidemiological study of pediatric robotic surgery at their institution" — Rennie (epidemiological) [Ep 18 · 0:53](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=53) - "Dr. Dariusz Patkowski was the predominant winner of the heat" — Todd (clinical) [Ep 18 · 1:30](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=90) - "The thoracoscopic procedure for long gap esophageal atresia is beneficial to learn how to do" — Todd (opinion) [Ep 18 · 1:30](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=90) - "A claim was made that resecting liver cuts mortality down by 50% in biliary atresia, but the judge expressed uncertainty about the data" — Todd (clinical) [Ep 18 · 1:49](https://library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=109) - "Dr. Mina Yeina discussed lipid nanoparticle delivery of microRNA 148A and attenuation of intestinal inflammation during NEC" (clinical) [Ep 19 · 0:04](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=4) - "Dr. Joseph Davidson presented on sexual function and fertility outcomes in Hirschsprung's disease patients" (clinical) [Ep 19 · 0:20](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=20) - "Dr. Shruthi Srinivas presented outcomes from colonic pull-through for cloacal atrophy" (clinical) [Ep 19 · 0:25](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=25) - "Dr. Kala presented on single-cell guided prenatal derivation of fetal organoids" (clinical) [Ep 19 · 0:31](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=31) - "Dr. Zheng presented on clinical characteristics and MMP-7 levels for biliary atresia" (clinical) [Ep 19 · 0:40](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=40) - "Dr. Shruthi Srinivas won Heat 3 with her presentation on outcomes from colonic pull-through for cloacal atrophy, differentiated by colon length, in a multi-institutional study" (clinical) [Ep 19 · 1:15](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=75) - "The competition between the second and third presentations was very tight" (opinion) [Ep 19 · 0:50](https://library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=50) - "Biliary atresia is a severe liver disease characterized by fibro-inflammatory destruction of bile ducts" — Zhang Jing (clinical) [Ep 20 · 0:42](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=42) - "MMP-7 can help precisely discriminate BA from other cholestatic diseases at a cutoff value of around 20 ng/mL" — Zhang Jing (clinical) [Ep 20 · 0:48](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=48) - "5 to 10% of BA patients have false negative MMP-7 levels" — Zhang Jing (epidemiological) [Ep 20 · 1:00](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=60) - "329 BA patients who underwent Kasai procedure from 2020 to 2022 were reviewed" — Zhang Jing (clinical) [Ep 20 · 1:24](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=84) - "Patients were divided into low and high MMP-7 groups based on preoperative MMP-7 levels of 20-25 ng/mL" — Zhang Jing (clinical) [Ep 20 · 1:34](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=94) - "The median MMP-7 level for low MMP-7 group was 20.19 ng/mL compared with 66.55 ng/mL for the high MMP-7 group" — Zhang Jing (clinical) [Ep 20 · 2:03](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=123) - "Preoperative gamma-GT and direct bilirubin in the low MMP-7 group were significantly lower than those in the high MMP-7 group" — Zhang Jing (clinical) [Ep 20 · 2:16](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=136) - "Fibrosis stages were significantly different between the two groups" — Zhang Jing (clinical) [Ep 20 · 2:26](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=146) - "Three-month jaundice clearance rate was 46.91% for the high MMP-7 group and 29.73% for the low MMP-7 group" — Zhang Jing (clinical) [Ep 20 · 2:34](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=154) - "Six-month jaundice clearance rate was 54.51% for the high MMP-7 group and 32.14% for the low MMP-7 group" — Zhang Jing (clinical) [Ep 20 · 2:50](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=170) - "90 patients in the low MMP-7 group and 112 patients in the high MMP-7 group died or underwent liver transplantation by latest follow-up" — Zhang Jing (clinical) [Ep 20 · 3:03](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=183) - "One-year native liver survival rate was 29.63% for the low MMP-7 group and 53.02% for the high MMP-7 group" — Zhang Jing (clinical) [Ep 20 · 3:16](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=196) - "Around 10% of BA patients have low MMP-7 levels" — Zhang Jing (epidemiological) [Ep 20 · 3:29](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=209) - "Low gamma-GT levels correlated with more severe liver injury and poor outcomes in previous study" — Zhang Jing (clinical) [Ep 20 · 3:41](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=221) - "BA patients in the low MMP-7 group had a lower jaundice clearance rate and native liver survival rate" — Zhang Jing (clinical) [Ep 20 · 3:50](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=230) - "Follow-up period ranged from 3 months to 3 years" — Zhang Jing (clinical) [Ep 20 · 4:11](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=251) - "Some patients lost follow-up within 3 months and were excluded from final analysis" — Zhang Jing (clinical) [Ep 20 · 4:11](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=251) - "Patients did not take MMP-7 measurements post-Kasai procedure" — Zhang Jing (clinical) [Ep 20 · 4:30](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=270) - "MMP-7 measurement is based on ELISA method" — Zhang Jing (clinical) [Ep 20 · 5:26](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=326) - "MMP-7 testing costs about 1000 RMB per measurement in China" — Zhang Jing (clinical) [Ep 20 · 5:44](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=344) - "MMP-7 testing is not very popular in every hospital in China, just in some institutions" — Zhang Jing (epidemiological) [Ep 20 · 5:36](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=336) - "Kasai procedure is still the first line treatment for biliary atresia" — Zhang Jing (guideline) [Ep 20 · 6:14](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=374) - "Some BA patients could not achieve jaundice clearance and could not live long with their native liver" — Zhang Jing (clinical) [Ep 20 · 6:14](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=374) - "Patients with low MMP-7 might someday go directly for liver transplantation if the mechanism is clearly understood" — Zhang Jing (opinion) [Ep 20 · 6:34](https://library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=394) - "Cross-training occurs at Cincinnati Children's with interventional radiologists teaching pediatric surgery fellows ultrasound guidance for vascular access" (clinical) [Ep 25 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53) - "Hybrid OR collaboration can occur in regular OR by bringing in an ultrasound machine without requiring a dedicated hybrid OR" (clinical) [Ep 25 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62) - "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images stacked together to create a CT" (clinical) [Ep 25 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85) - "ChatGPT can screen thousands of articles in systematic review based on title and abstract with explanation column for decision rationale" (clinical) [Ep 25 · 2:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140) - "Jenny AI can provide relevant answers, cite supporting papers, and format citations according to preferred style" (clinical) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=207) - "Double lumen endotracheal tube deflates the lung on the side of cryoablation for thoracoscopic guidance" (clinical) [Ep 25 · 4:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275) - "Cryoanalgesia targets T3 to T8 with 2-minute freeze cycles per interspace" (clinical) [Ep 25 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286) - "Subpleural injection with 0.25% marcaine with epinephrine works immediately versus 8-10 hour delay with cryo nerve block" (clinical) [Ep 25 · 4:56](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296) - "Double lumen endotracheal tube reduces risk of pneumothorax during cryoanalgesia" (clinical) [Ep 25 · 5:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=309) - "Cryoanalgesia blocks fail when surgeons use single lumen tube and perform block too far anteriorly" (clinical) [Ep 25 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313) - "Majority of centers still do VA ECMO primarily for CDH babies" (epidemiological) [Ep 25 · 6:34](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=394) - "Michigan SER Protocol showed survival was equivalent between ECMO and comfort care groups for severe unilateral CDH based on prenatal criteria" (clinical) [Ep 25 · 6:43](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403) - "With biovalrudin ECMO management, surgical repair can proceed after 8 hours once levels are stable" (clinical) [Ep 25 · 7:26](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446) - "Early repair while on ECMO is safe with optimal window between 8 to 24 hours" (clinical) [Ep 25 · 7:49](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=469) - "CO2 laser operates in spectrum of 920 to 1400 nm which is well absorbed by water" (clinical) [Ep 25 · 8:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494) - "CO2 laser circumcision using sleeve technique with dorsal slit and cyanoacrylate adhesive had 3% complication rate in 56 cases" (clinical) [Ep 25 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510) - "CO2 laser frenulectomy in 47 patients showed low pain profile with no suture required" (clinical) [Ep 25 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520) - "Autofluorescence in randomized controlled trial from France reduced rates of hypoparathyroidism and hypocalcemia following thyroidectomy" (clinical) [Ep 25 · 9:37](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577) - "Parathyroids naturally autofluoresce at specific wavelength without injection" (clinical) [Ep 25 · 9:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593) - "Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it" (clinical) [Ep 25 · 10:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607) - "Surgery-first pathway for pediatric cholelithiasis reduces resource utilization including MRCP" (clinical) [Ep 25 · 11:33](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=693) - "ERCP causes pancreatitis 10% of the time regardless of operator skill" (clinical) [Ep 25 · 12:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722) - "Stone clearance rate reflected by negative intraoperative cholangiogram was 86% with surgery-first approach" (clinical) [Ep 25 · 12:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734) - "Success rate was in the 90s with simple flushing or catheter manipulation of common bile duct or reaming the sphincter" (clinical) [Ep 25 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745) - "Every 10 day delay in biliary atresia treatment worsens outcomes by 20% according to Midwest study data" (epidemiological) [Ep 25 · 13:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821) - "MMP-7 sensitivity is pretty good but cutoffs vary between teams because the assay is still evolving" (clinical) [Ep 25 · 13:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838) - "Cincinnati Children's commitment is Kasai procedure within 7 days of biliary atresia patient presentation" (guideline) [Ep 25 · 14:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=861) - "REBOA can be performed in pediatric patients but is rarely done with no clear survival advantage over laparotomy" (clinical) [Ep 25 · 15:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948) - "Patients presenting with wounds as initial presentation for pilonidal tend to not always reach full healing with minimally invasive approach" (clinical) [Ep 25 · 16:23](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983) - "US Army clinic with captive patient population implementing weekly shaving protocol observed dramatic improvement and significantly reduced need for surgical intervention in pilonidal disease" (clinical) [Ep 25 · 16:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000) - "Clipping is probably the easiest and simplest approach for pilonidal disease hair removal when parent or active caregiver is involved, recommended once weekly" (clinical) [Ep 25 · 17:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037) - "The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy" — Daniel von Allmen (clinical) [Ep 10 · 2:56](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=176) - "High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo" — Daniel von Allmen (clinical) [Ep 10 · 4:01](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=241) - "Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group" — Daniel von Allmen (clinical) [Ep 10 · 4:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=279) - "Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction" — Daniel von Allmen (clinical) [Ep 10 · 4:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=295) - "Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia" — Daniel von Allmen (clinical) [Ep 10 · 5:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=310) - "The study was powered to detect a 25% absolute treatment difference in outcomes" — Daniel von Allmen (clinical) [Ep 10 · 3:46](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=226) - "Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow" — Daniel von Allmen (clinical) [Ep 10 · 8:59](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=539) - "Washington State registry study included over 50 hospitals and analyzed clean-contaminated operations over 18 months beginning January 2011" — Whit Holcomb (clinical) [Ep 10 · 12:02](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=722) - "Overall surgical site infection rate was 4.6%, varying by procedure: 6.6% colorectal, 1.4% bariatric, 1.5% other" — Whit Holcomb (epidemiological) [Ep 10 · 13:05](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=785) - "No single antiseptic agent was associated with lower risk of surgical site infection than any other agent" — Whit Holcomb (clinical) [Ep 10 · 13:39](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=819) - "Isopropyl alcohol provided no benefit: 4.5% SSI rate without alcohol versus 4.6% with alcohol" — Whit Holcomb (clinical) [Ep 10 · 13:49](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=829) - "Registry data could not identify surgical site infections diagnosed after discharge, likely underestimating true SSI rate" — Whit Holcomb (clinical) [Ep 10 · 14:20](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=860) - "Recent reports show 50% or more surgical site infections are diagnosed after discharge" — Whit Holcomb (epidemiological) [Ep 10 · 14:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=880) - "Most surgical site infections occur 3 to 10 days after operation" — Whit Holcomb (clinical) [Ep 10 · 14:48](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=888) - "Chlorhexidine prep dries faster than betadine, allowing cases to start sooner" — Whit Holcomb (clinical) [Ep 10 · 18:33](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1113) - "Appendicitis pilot RCT enrolled 50 patients aged 5-15 years with non-perforated appendicitis: 26 randomized to operation, 24 to antibiotics" — Whit Holcomb (clinical) [Ep 10 · 22:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1378) - "Of 24 patients randomized to non-operative treatment, 2 underwent appendectomy during primary treatment course and 1 had appendectomy at 9 months for recurrent appendicitis" — Whit Holcomb (clinical) [Ep 10 · 23:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1394) - "An additional 6 patients in the non-operative group underwent appendectomy for recurrent abdominal pain or parental desire during 1-year follow-up, with no appendicitis found on histology" — Whit Holcomb (clinical) [Ep 10 · 23:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1412) - "Total of 9 of 24 patients (38%) initially randomized to antibiotic therapy underwent appendectomy within first year, making success rate 62%" — Whit Holcomb (clinical) [Ep 10 · 24:10](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1450) - "Median time to discharge was significantly shorter in surgical group than non-operative group, possibly due to stipulated 48-hour minimum hospitalization for non-operative patients" — Whit Holcomb (clinical) [Ep 10 · 24:35](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1475) - "Cost for initial inpatient stay was significantly lower in non-operative treatment group despite longer hospitalizations" — Whit Holcomb (clinical) [Ep 10 · 24:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1495) - "Immunosuppressed cancer patients with typhlitis are sometimes treated non-operatively and most resolve with antibiotics" — Whit Holcomb (clinical) [Ep 10 · 27:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1620) - "PIFCON study included 272 patients from 14 multidisciplinary intestinal rehab programs with median 33-month follow-up" — Aaron Lipskar (clinical) [Ep 10 · 32:32](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1952) - "Enteral autonomy was achieved in 43% of intestinal failure cohort, 13% remained PN-dependent, and 43% died or underwent transplantation" — Aaron Lipskar (epidemiological) [Ep 10 · 32:40](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1960) - "Necrotizing enterocolitis diagnosis, care at intestinal rehab facility without transplant center, and presence of ileocecal valve were associated with statistically significant higher rates of enteral autonomy" — Aaron Lipskar (clinical) [Ep 10 · 32:58](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1978) - "Residual small bowel length was a statistically significant but less impressive predictor of enteral autonomy" — Aaron Lipskar (clinical) [Ep 10 · 33:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1999) - "The protective effect of necrotizing enterocolitis on enteral autonomy goes against understanding of that inflammatory illness" — Aaron Lipskar (opinion) [Ep 10 · 33:55](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2035) - "A companion paper in same journal showed necrotizing enterocolitis was a poor predictor of growth outcome in infants with short bowel syndrome" — Aaron Lipskar (clinical) [Ep 10 · 35:12](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2112) - "FDA established SmartTots partnership with International Anesthesia Research Society in 2009 to study anesthesia-related neurotoxicity" — Aaron Lipskar (guideline) [Ep 10 · 37:19](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2239) - "SmartTots 2012 consensus statement recommended avoiding elective surgical procedures under anesthesia in children less than 3 years when possible" — Aaron Lipskar (guideline) [Ep 10 · 37:34](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2254) - "Commonly used anesthetics including propofol, etomidate, sevoflurane, isoflurane, and ketamine produce profound neurotoxic effects in laboratory animals from nematodes to nonhuman primates" — Aaron Lipskar (clinical) [Ep 10 · 38:09](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2289) - "Observational studies in children undergoing early anesthesia offer conflicting results but suggest some children may have deficits, though causation difficult to establish" — Aaron Lipskar (clinical) [Ep 10 · 38:43](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2323) - "June 2014 SmartTots statement concluded animal data sufficiently convincing that large-scale clinical studies are warranted" — Aaron Lipskar (guideline) [Ep 10 · 39:06](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2346) - "Updated recommendation is to avoid surgical procedures under anesthesia in children under 3 years unless situation is urgent or potentially harmful if not attended to" — Aaron Lipskar (guideline) [Ep 10 · 39:14](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2354) - "Regional anesthesia blocks can diminish amount of potentially neurotoxic medications in almost every laparoscopic, thoracoscopic, or open operation" — Aaron Lipskar (clinical) [Ep 10 · 42:00](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2520) - "Rule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year" — Todd Ponsky (opinion) [Ep 10 · 42:16](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2536) - "Survey of 150 parents in primary care pediatrics office found vast majority did not know anesthetic neurotoxicity was a major issue" — Aaron Lipskar (epidemiological) [Ep 10 · 43:17](https://library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2597) - "In the US and Europe, alpha-1 antitrypsin deficiency is the most common cause of neonatal cholestasis in the differential diagnosis" — Jorge Bezerra (epidemiological) [Ep 8 · 3:22](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=202) - "By two weeks of age, if the baby still has jaundice, the pediatrician needs to fractionate the bilirubin; if the direct or conjugated fraction is elevated, think about pathologic jaundice" — Jorge Bezerra (guideline) [Ep 8 · 4:16](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=256) - "The Taiwanese published in the Journal of Pediatrics in 2006 that they send all their kids home with stool color cards" — Alex Bondoc (clinical) [Ep 8 · 6:13](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=373) - "MMP7 was identified as a serum marker of epithelial injury in biliary atresia through large-scale proteomic analysis of 30 children with biliary atresia in 2017" — Alex Bondoc (clinical) [Ep 8 · 9:59](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=599) - "MMP7 using a cutoff value of 52-53 nanograms per ml demonstrated a sensitivity of diagnosing biliary atresia of about 98% with a specificity of about 95% in 135 consecutive infants in China" — Alex Bondoc (clinical) [Ep 8 · 10:40](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=640) - "The MMP7 assay is run every other day and is a six-hour assay" — Jorge Bezerra (clinical) [Ep 8 · 12:51](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=771) - "MMP7 has the potential to eliminate a lot of other testing and eliminate things like a liver biopsy if confidence grows in its impact" — Alex Bondoc (opinion) [Ep 8 · 13:10](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=790) - "Cutoff values for MMP7 changed depending on reports from Asia, with much lower cutoff levels reported from Taiwan and China" — Jorge Bezerra (clinical) [Ep 8 · 12:20](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=740) - "A combination of blood tests and laparoscopy can diagnose biliary atresia promptly and accurately" — Alex Bondoc (clinical) [Ep 8 · 14:44](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=884) - "Nearly all patients with biliary atresia have a hard liver, whereas hepatitis and Alagille syndrome patients have livers that are not as hard" — Yamataka (clinical) [Ep 8 · 17:57](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1077) - "Bile duct proliferation and portal edema may not appear on very early liver biopsies and may delay diagnosis by up to 30 days" — Alex Bondoc (clinical) [Ep 8 · 17:09](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1029) - "In Yamataka's series, 16 cases were not typical biliary atresia on laparoscopy, and all 16 were confirmed not to be biliary atresia, including 8 cases of Alagille syndrome" — Yamataka (clinical) [Ep 8 · 19:13](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1153) - "If you do a Kasai operation on Alagille patients, you just shorten that patient's natural liver life and convert those patients to needing transplant at a much earlier age" (clinical) [Ep 8 · 18:24](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1104) - "Infants coming to surgery for other matters who later turned out to have biliary atresia in the first week of life all had normal livers, so you can't diagnose early biliary atresia on liver biopsy" — Mark Davenport (clinical) [Ep 8 · 22:18](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1338) - "Liver histology looking at inflammation and fibrosis has not shown great discrimination for prognosis in babies coming to surgery before 100 days" — Mark Davenport (clinical) [Ep 8 · 23:08](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1388) - "Liver biopsy has additional value to quantify inflammation and use that information to personalize treatment" — Jorge Bezerra (opinion) [Ep 8 · 24:04](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1444) - "The key differential for a prenatally detected cyst is between cystic biliary atresia and a choledochal cyst" — Mark Davenport (clinical) [Ep 8 · 24:57](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1497) - "If the baby is not jaundiced and not raising conjugated bilirubin, then it's not cystic biliary atresia and you can wait to do the laparotomy" — Mark Davenport (clinical) [Ep 8 · 25:51](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1551) - "Cystic biliary atresia patients get to surgery earlier, potentially because of prenatal diagnosis and heightened level of suspicion" — Alex Bondoc (clinical) [Ep 8 · 26:20](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1580) - "Biliary atresia leads to liver cirrhosis without early treatment" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=0) - "The diagnosis of BA can be challenging as its histopathologic features overlap with those of other pediatric cholestatic liver diseases" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=20) - "The most helpful hallmark of BA on histology is portal fibrosis and bile duct proliferation" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:40](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=40) - "A similar pattern to BA can be found in other causes of cholestasis such as familiar intrahepatic cholestasis, neonatal hepatitis, and Alagille syndrome" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:50](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=50) - "During cirrhosis, biliary epithelial structure express immunohistochemical markers of immaturity such as CD56" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 1:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=70) - "639 biopsies were performed between 2013 and 2019" — Maria Soledad Jara Valdivia (epidemiological) [Ep 15 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=180) - "Final groups were distributed as: group BA equals 30 patients, group NC equals 28 patients, group C no BA equals 31" — Maria Soledad Jara Valdivia (epidemiological) [Ep 15 · 3:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=185) - "CD56 plus had sensitivity of 74% for BA versus 16% and 9% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=200) - "CD56 plus had specificity of 87.7% for BA versus 61% and 50% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=215) - "The PPV was 76% for BA versus 18% and 9% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=225) - "The NPV was 80% for BA versus 57% and 50% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=235) - "The AUC was 0.81" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=245) - "The labeling quantile from 6 to 25% had a higher sensitivity and adequate specificity" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=250) - "CD56 in more than 5% of the ductular epithelial cells has a sensitivity of 74.2% versus 16.1% and 9.68% in non-BA groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=270) - "CD56 has specificity of 87.7% and LHR+ of 6.04 compared to 0.42 and 0.20 in non BA group to diagnose biliary atresia" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=285) - "An NPV of 86.2% shows that if CD56 is negative, biliary atresia is unlikely" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=295) - "CD56 IHC stain is helpful as a complementary test in liver biopsies to rule out biliary atresia as an etiology for neonates presenting with cholestasis" — Maria Soledad Jara Valdivia (opinion) [Ep 15 · 5:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=305) - "Patients with a transanastomotic tube had a 2.72 times higher risk of developing a stricture post-operatively after esophageal atresia with tracheoesophageal fistula repair" (clinical) [Ep 16 · 1:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70) - "The Midwest Pediatric Surgery Consortium study examined every patient who had a laparoscopic pyloric myotomy to identify patent processus vaginalis and followed them annually" (clinical) [Ep 16 · 1:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=90) - "Of 526 patients enrolled in the PPV study, 283 had a patent processus vaginalis (bilateral, right, or left)" (epidemiological) [Ep 16 · 2:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=120) - "Of 208 patients with at least one year follow-up, only three underwent inguinal hernia repair, all within the first year" (clinical) [Ep 16 · 2:13](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133) - "Most patent processus vaginalis do not turn into inguinal hernias based on four-year interim analysis data" (clinical) [Ep 16 · 2:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=155) - "Liver transplantation for biliary atresia can be performed as initial treatment (primary) or after failed Kasai hepatoportoenterostomy (salvage)" (clinical) [Ep 16 · 2:45](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=165) - "The current standard in the US for biliary atresia is Kasai first and liver transplant only if that fails" (guideline) [Ep 16 · 3:05](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=185) - "Children who had an early salvage liver transplant (before age one) and children who had a primary liver transplant had similar outcomes" (clinical) [Ep 16 · 3:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=210) - "Children who had a late salvage liver transplant had improved graft survival compared to other groups" (clinical) [Ep 16 · 3:45](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=225) - "Some children who undergo the Kasai procedure will never end up needing a liver transplant" (clinical) [Ep 16 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=240) - "Social risk screening in pediatrics involves screening for risk factors including food and housing insecurity, financial strain, and unsafe environments" (clinical) [Ep 16 · 4:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=270) - "There is low concordance between screening results showing who might need resources and who is actually asking for more resources" (epidemiological) [Ep 16 · 5:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=300) - "Families may feel uncomfortable with social risk screening and may think there might be downstream repercussions based on their answers" (opinion) [Ep 16 · 5:15](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=315) - "There may be racial biases in screening practices, with non-white patients potentially being asked social risk questions more often" (epidemiological) [Ep 16 · 5:28](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=328) - "Current social risk screening protocols may not be effective and may actually lead to more inequities" (opinion) [Ep 16 · 4:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=290) - "The Update Course has approximately 2000 people signed up" (epidemiological) [Ep 11 · 0:00](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=0) - "MMP7 could be used to distinguish biliary atresia from other cholestatic diseases" — Rod Gerardo (clinical) [Ep 11 · 3:47](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227) - "Intraoperative ICG can be used to determine biliary flow or identify a transaction" — Rod Gerardo (clinical) [Ep 11 · 3:47](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227) - "26% of respondents use ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it" (epidemiological) [Ep 11 · 4:45](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=285) - "MMP7 testing is often a send-out test at non-freestanding children's hospitals" — Rod Gerardo (clinical) [Ep 11 · 5:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348) - "Children with biliary atresia presenting at five weeks have limited time to achieve best outcomes" — Rod Gerardo (clinical) [Ep 11 · 5:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348) - "For pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading" — Rod Gerardo (guideline) [Ep 11 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510) - "There is currently no great definition of what constitutes massive transfusion protocol in pediatric patients" — Rod Gerardo (clinical) [Ep 11 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510) - "Balanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion" — Rod Gerardo (clinical) [Ep 11 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510) - "Hypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each" — Rod Gerardo (epidemiological) [Ep 11 · 10:35](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=635) - "Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions" (clinical) [Ep 11 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650) - "There are case reports showing mucosal sloughing with phenol use" (clinical) [Ep 11 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650) - "Deflux, used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse" (clinical) [Ep 11 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650) - "3% sotradecol is used as an alternative sclerotherapy agent" — Rod Gerardo (clinical) [Ep 11 · 11:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=708) - "D50 from the code cart is easier to acquire than 3% saline in some operating rooms" — Rod Gerardo (clinical) [Ep 11 · 11:56](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=716) - "50% of respondents always use sutureless closure for large abdominal wall defects, 39% use it in select patients, and only 11% do not use it" (epidemiological) [Ep 11 · 12:23](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743) - "ERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics" — Rod Gerardo (clinical) [Ep 11 · 16:14](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974) - "ERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols" — Rod Gerardo (clinical) [Ep 11 · 16:14](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974) - "ERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice" — Rod Gerardo (opinion) [Ep 11 · 16:42](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1002) - "ERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy" — Rod Gerardo (opinion) [Ep 11 · 17:55](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1075) - "Surgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways" — Rod Gerardo (clinical) [Ep 11 · 19:09](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149) - "Surgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay" — Rod Gerardo (clinical) [Ep 11 · 19:09](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149) - "Starting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation" — Rod Gerardo (opinion) [Ep 11 · 19:42](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1182) - "For pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system" — Rod Gerardo (clinical) [Ep 11 · 21:18](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1278) - "Multiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding" — Rod Gerardo (clinical) [Ep 11 · 21:38](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1298) - "Most institutions are either addressing social determinants of health or working on it, with few saying no" (epidemiological) [Ep 11 · 21:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1310) - "Biliary atresia is the leading cause for liver transplant in the U.S." — Rae Hanke (epidemiological) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=0) - "At 50 days of age, physiologic jaundice from the newborn period would have resolved" — Greg Tiao (clinical) [Ep 13 · 6:37](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=397) - "A high GGT is more consistent with an obstructive process and helps eliminate some of the PFIC syndromes" — Greg Tiao (clinical) [Ep 13 · 6:06](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=366) - "Infants with yellow stool initially that becomes clay-colored have better prognosis than those with clay-colored stool immediately after meconium" — Atsuyuki Yamataka (clinical) [Ep 13 · 7:32](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=452) - "The triangular cord sign on ultrasound is not consistently reliable or discriminatory for biliary atresia diagnosis" — Mark Davenport (clinical) [Ep 13 · 8:35](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=515) - "Percutaneous liver biopsy can diagnose biliary atresia in approaching 90% of 50-day-old babies" — Mark Davenport (clinical) [Ep 13 · 15:04](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=904) - "NASSGN guidelines recommend against obtaining HIDA scan because phenobarbital loading delays treatment by 5-6 days, pushing closer to the window where Kasai efficacy deteriorates" — Greg Tiao (guideline) [Ep 13 · 13:46](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=826) - "HIDA scan is helpful when trying to rule out biliary atresia rather than rule it in" — Greg Tiao (opinion) [Ep 13 · 13:46](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=826) - "King's College Hospital uses ERCP for about 10% of biliary atresia cases when biopsy is not fully diagnostic" — Mark Davenport (clinical) [Ep 13 · 15:17](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=917) - "Pathognomonic finding for biliary atresia is bile duct plugs in proliferating bile ducts" — Mark Davenport (clinical) [Ep 13 · 15:47](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=947) - "Significant fibrosis on biopsy is a piece of information that reflects disease progression and may guide management decisions" — Greg Tiao (clinical) [Ep 13 · 16:28](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=988) - "ERCP requires general anesthesia in infants, so the benefit over exploration is technical rather than avoiding anesthesia" — Greg Tiao (clinical) [Ep 13 · 17:38](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1058) - "Liver exteriorization during Kasai can create denser, more vascularized adhesions that complicate future liver transplantation" — Greg Tiao (clinical) [Ep 13 · 20:26](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1226) - "Exteriorizing the liver with a small incision can cause kinking of the hepatic vein" — Atsuyuki Yamataka (clinical) [Ep 13 · 21:41](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1301) - "IPEG placed a moratorium on laparoscopic Kasai because of poor outcomes" — Todd Ponsky (guideline) [Ep 13 · 22:55](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1375) - "Recent data shows liver function might be worse in the midterm follow-up for patients who had laparoscopic Kasai compared to open surgery" — Atsuyuki Yamataka (clinical) [Ep 13 · 23:17](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1397) - "Laparoscopic Kasai is only recommended for surgeons doing it in a prospective trial or who have demonstrated equivalent outcomes; it is not yet recommended for the masses" — Todd Ponsky (guideline) [Ep 13 · 23:44](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1424) - "Peterson ran a prospective randomized trial of laparoscopic Kasai and stopped it" — Greg Tiao (clinical) [Ep 13 · 24:31](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1471) - "The only chance a biliary atresia patient has to avoid early transplant is a well-done Kasai" — Greg Tiao (opinion) [Ep 13 · 24:31](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1471) - "Even in the best hands, long-term drainage rate after Kasai is only 70-75%" — Greg Tiao (clinical) [Ep 13 · 24:31](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1471) - "Damaging hepatic artery branches during Kasai can exacerbate the underlying liver disease process" — Greg Tiao (clinical) [Ep 13 · 25:50](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550) - "The hilar plate should be transected at the level of Glisson's capsule, leaving it intact, not cutting into the liver parenchyma" — Greg Tiao (clinical) [Ep 13 · 25:50](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550) - "In the Children's Network, about one-third of centers cut into the liver during Kasai; the rest transect at 1-2 mm of fibrous remnant" — Greg Tiao (clinical) [Ep 13 · 25:50](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550) - "Pro-coring of the liver has never achieved good results in the literature" — Mark Davenport (clinical) [Ep 13 · 28:21](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1701) - "Standard Roux limb length for Kasai is 40-45 centimeters" — Mark Davenport (clinical) [Ep 13 · 29:48](https://library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1788) - "American Academy of Pediatrics recommends fractionation of bilirubin for any baby with persistent jaundice beyond two weeks of age, with referral to pediatric gastroenterologist if direct bilirubin is elevated" — Jorge Bezerra (guideline) [Ep 14 · 1:50](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=110) - "Matrix metalloprotein A7 (MMP7) serum level predicts biliary atresia with positive predictive value of 96% and negative predictive value of 98% in prospective validation study from Wuhan, China" — Jorge Bezerra (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=223) - "In START trial, jaundice clearance at six months was 48% in placebo arm versus 58% in steroid arm for all patients, a 10% difference that did not reach statistical significance" — Mark Davenport (clinical) [Ep 14 · 7:14](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=434) - "In START trial subset analysis of patients under 70 days old, jaundice clearance was 57% in placebo versus 72% in steroid arm, a 15% difference without statistical significance due to insufficient numbers" — Mark Davenport (clinical) [Ep 14 · 8:10](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=490) - "START trial was properly designed randomized trial with 110 patients in each arm, adequately powered as designed" — Greg Tiao (clinical) [Ep 14 · 9:56](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=596) - "King's College initial low-dose steroid trial (2 mg/kg/day) showed no difference in jaundice clearance but statistically significant lower bilirubin at one month in steroid group" — Mark Davenport (clinical) [Ep 14 · 10:20](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=620) - "King's College high-dose steroid protocol (5 mg/kg/day) in open-label prospective study showed 52% clearance in controls versus 67% in steroid group, reaching statistical significance with larger numbers" — Mark Davenport (clinical) [Ep 14 · 11:00](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=660) - "Japanese protocol uses prednisolone 4 mg/kg/day for 3 days after CRP normalizes, then tapers (3-2-1-0.5 mg/kg each for 3 days), with return to higher dose if stool becomes pale" — Yamataka Atsuyuki (clinical) [Ep 14 · 11:15](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=675) - "Cincinnati protocol reserves steroids for specific subsets: patients under 30 days who don't drain, or cystic variant patients who don't respond appropriately, rather than empiric use" — Greg Tiao (clinical) [Ep 14 · 12:31](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=751) - "Molecular profiling identified two biliary atresia phenotypes: inflammatory subtype that may respond to steroids, and fibrotic subtype that may not" — Greg Tiao (clinical) [Ep 14 · 13:40](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=820) - "START trial documented that serious adverse events occurred earlier in steroid group compared to placebo while patients were receiving steroids, but no difference in frequency after steroid discontinuation" — Jorge Bezerra (clinical) [Ep 14 · 16:30](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=990) - "King's College protocol starts steroids on day 4 when oral feeds begin, uses ranitidine for GI protection" — Mark Davenport (clinical) [Ep 14 · 18:04](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1084) - "Japanese centers wait 4-7 days until CRP decreases and white blood count normalizes before starting steroids, which may reduce serious side effects" — Yamataka Atsuyuki (opinion) [Ep 14 · 18:45](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1125) - "Early cholangitis is bad prognostic sign for long-term native liver survival" — Yamataka Atsuyuki (clinical) [Ep 14 · 19:08](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1148) - "King's College uses IV tazocin-gentamicin for 5 days postoperatively, then oral cephalosporin for one month" — Mark Davenport (clinical) [Ep 14 · 19:34](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1174) - "Cincinnati uses cephalosporin in immediate postoperative period, then switches to Bactrim or amoxicillin for at least 3 months (treatment dose for 2 weeks, then prophylaxis for 6 months)" — Greg Tiao (clinical) [Ep 14 · 19:48](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1188) - "Aggressive nutrition with supplementation via NG tube if needed to maintain positive anabolic balance is key to outcomes" — Jorge Bezerra (clinical) [Ep 14 · 20:12](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1212) - "For patients presenting at 100+ days with ultrasound showing heterogeneous liver surface and ascites (unequivocal cirrhosis), consider primary transplant rather than Kasai" — Mark Davenport (clinical) [Ep 14 · 21:20](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1280) - "Primary transplant rate in England and Wales is approximately 5%, mainly for delayed presentation patients" — Mark Davenport (epidemiological) [Ep 14 · 22:20](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1340) - "In King's College 100+ day cohort from 2001, 40% achieved 5-year native liver survival, including pre-transplant era patients" — Mark Davenport (clinical) [Ep 14 · 22:40](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1360) - "Timing of acholic stool onset (not chronological age) is important prognostic factor - patient with acholic stool from birth at 100 days has worse prognosis than patient with yellow stool for first month who becomes acholic at day 30" — Yamataka Atsuyuki (clinical) [Ep 14 · 23:12](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1392) - "Cystic biliary atresia with visible bile ducts on cholangiogram has better prognosis" — Yamataka Atsuyuki (clinical) [Ep 14 · 24:03](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1443) - "Cincinnati makes clinical assessment including preoperative biopsy; significant fibrosis on biopsy may lead to primary transplant decision" — Greg Tiao (clinical) [Ep 14 · 24:14](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1454) - "At King's College with high-dose steroids, 100% of babies who underwent Kasai before 30 days cleared jaundice in last 10 years" — Mark Davenport (clinical) [Ep 14 · 25:41](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1541) - "Age at Kasai is not significantly related to outcome; duration of acholic stool is more strongly related to outcome" — Yamataka Atsuyuki (opinion) [Ep 14 · 26:19](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1579) - "Cholangitis requires early recognition and treatment; families instructed to see pediatrician immediately for fever, not wait at home" — Greg Tiao (clinical) [Ep 14 · 27:21](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1641) - "Cincinnati uses short course of steroids for cholangitis that doesn't respond to antibiotics after several days" — Greg Tiao (clinical) [Ep 14 · 28:15](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1695) - "King's College does not use steroids for cholangitis treatment and does not perform revision Kasai in early phase/infancy" — Mark Davenport (clinical) [Ep 14 · 28:48](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1728) - "Cincinnati offers revision Kasai only to highly selected patients who previously cleared jaundice and normalized bilirubin, then became acholic after cholangitis - can salvage native liver for 5-10+ years in some cases" — Greg Tiao (clinical) [Ep 14 · 29:07](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1747) - "For patients who never clear jaundice, focus is nutrition and liver transplant evaluation; nutritional support is key driver in determining post-transplant complications" — Jorge Bezerra (clinical) [Ep 14 · 30:23](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1823) - "Patients should be referred to transplant center by 3 months post-Kasai if bilirubin hasn't gone below 2, to allow time for evaluation before developing synthetic dysfunction" — Greg Tiao (clinical) [Ep 14 · 31:22](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1882) - "CMV IgM-positive biliary atresia represents approximately 10% of cases in Western Europe and North America, higher prevalence in China and Japan" — Mark Davenport (epidemiological) [Ep 14 · 34:12](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2052) - "CMV-positive patients are older at time of Kasai, have different histology, and historically cleared jaundice in less than 10% without antiviral treatment" — Mark Davenport (clinical) [Ep 14 · 34:50](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2090) - "Treatment with ganciclovir or oral valganciclovir changed outcomes in CMV-positive patients to 7 out of 9 (approximately 70%) clearing jaundice" — Mark Davenport (clinical) [Ep 14 · 35:30](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2130) - "CMV PCR levels show inverse relationship with AST and age - highest levels in younger babies, lower levels as population ages, suggesting body clears virus naturally over time" — Mark Davenport (clinical) [Ep 14 · 36:10](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2170) - "Substantial number of patients who initially improve after Kasai ultimately need liver transplantation due to progressive fibrosis despite controlled cholestasis" — Jorge Bezerra (clinical) [Ep 14 · 38:22](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2302) - "Increasing proportion of King's College patients are transplanted with modestly elevated or normal bilirubins due to uncontrolled fibrotic progression causing ascites and portal hypertension" — Mark Davenport (clinical) [Ep 14 · 39:10](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2350) - "Colchicine randomized placebo-controlled trial showed no difference in long-term fibrosis levels or clinical outcomes" — Mark Davenport (clinical) [Ep 14 · 39:50](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2390) - "Animal model studies identified therapeutic targets that showed remarkable decrease in collagen deposition and hepatic fibrosis when tested" — Jorge Bezerra (clinical) [Ep 14 · 41:29](https://library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2489) - "Choledochal cyst is a congenital cystic dilation of the biliary tree" — Alex Bondoc (clinical) [Ep 9 · 0:29](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=29) - "In the Western world, the incidence is about 1 in 100,000" — Alex Bondoc (epidemiological) [Ep 9 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36) - "In Asia, specifically Eastern Asia, incidence is 1 in 13,000" — Alex Bondoc (epidemiological) [Ep 9 · 0:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=50) - "Choledochal cysts are three to four times more likely in females than in males" — Alex Bondoc (epidemiological) [Ep 9 · 0:58](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=58) - "There are some genes that have been identified in limited studies, possibly including PKD1 for type 5 choledochal cysts" — Alex Bondoc (clinical) [Ep 9 · 0:58](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=58) - "For types 1 and 4, etiology is likely embryologic, relating to the pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel" — Alex Bondoc (clinical) [Ep 9 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70) - "Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes" — Alex Bondoc (clinical) [Ep 9 · 1:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=100) - "Type 1 is a dilation of the extrahepatic common bile duct only, either fusiform or saccular" — Alex Bondoc (clinical) [Ep 9 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125) - "Type 2 is a small diverticulum off of the common bile duct" — Alex Bondoc (clinical) [Ep 9 · 2:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=145) - "Type 3 is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum" — Alex Bondoc (clinical) [Ep 9 · 2:35](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=155) - "Type 4a is multiple cysts in both the intra- and extrahepatic biliary tree; type 4b is multiple cysts in the extrahepatic biliary tree only" — Alex Bondoc (clinical) [Ep 9 · 2:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=165) - "Type 5 is intrahepatic only and diffusely throughout, called Caroli's disease" — Alex Bondoc (clinical) [Ep 9 · 3:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=180) - "In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes" — Alex Bondoc (clinical) [Ep 9 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205) - "In children, patients often present with symptoms consistent with cholangitis, such as jaundice or fever, and can have a palpable right upper quadrant mass" — Alex Bondoc (clinical) [Ep 9 · 3:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=225) - "Charcot's triad (jaundice, fever, palpable RUQ mass) is incredibly uncommon as a presentation" — Alex Bondoc (clinical) [Ep 9 · 4:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=245) - "Giant cysts that children are born with can perforate and present with biliary ascites" — Alex Bondoc (clinical) [Ep 9 · 4:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=260) - "Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds" — Alex Bondoc (clinical) [Ep 9 · 4:35](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=275) - "If a cyst was diagnosed prenatally and was larger than 4.5 cm at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention" — Alex Bondoc (clinical) [Ep 9 · 4:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=285) - "Differential diagnosis for a one-year-old with jaundice includes choledocholithiasis, cholelithiasis, gallstone pancreatitis, choledochal cyst, and biliary atresia (though the child is a little old for biliary atresia)" — Alex Bondoc (clinical) [Ep 9 · 5:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312) - "Physical exam should look for jaundice or scleral icterus and a palpable abdominal mass in younger children" — Alex Bondoc (clinical) [Ep 9 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346) - "Labs to check include liver function tests with total, direct, and indirect bilirubin levels, plus or minus a CBC to look for evidence of cholangitis or infection" — Alex Bondoc (clinical) [Ep 9 · 6:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=365) - "The major initial screening imaging test is an abdominal ultrasound" — Alex Bondoc (clinical) [Ep 9 · 6:22](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=382) - "A liver biopsy is not typically needed if the patient is older and you have reliable ultrasound imaging, but becomes critical in a neonate or newborn to rule out cystic biliary atresia" — Alex Bondoc (clinical) [Ep 9 · 6:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=385) - "CT scan is commonly used because of the ease with which you can scan young children" — Alex Bondoc (clinical) [Ep 9 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407) - "MRCP is useful if there are questions about anatomic details, specifically hilar or intrahepatic disease, to understand how extensive the cystic change is and to identify variant biliary anatomy (present in 15-20% of patients)" — Alex Bondoc (clinical) [Ep 9 · 7:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=425) - "ERCP can be both diagnostic and therapeutic depending on what is seen on prior scans and the type of choledochal cyst" — Alex Bondoc (clinical) [Ep 9 · 7:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=460) - "There are no non-surgical treatment options for choledochal cysts" — Alex Bondoc (clinical) [Ep 9 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480) - "The anomalous anatomy related to the cyst puts the patient at risk for episodes of cholangitis due to biliary stasis and superinfection, which can be life-threatening" — Alex Bondoc (clinical) [Ep 9 · 8:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=490) - "For type 1 and type 4 cysts with pancreaticobiliary malunion, there is about an 8% lifetime risk of hepatobiliary malignancy, most specifically cholangiocarcinoma and gallbladder cancer" — Alex Bondoc (clinical) [Ep 9 · 8:30](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=510) - "Studies estimate lifetime malignancy risk anywhere from 6% to 30%" — Alex Bondoc (epidemiological) [Ep 9 · 9:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=540) - "Even after surgical resection of these cysts, some studies suggest there is still about a 4% lifetime risk of malignancy, requiring lifelong surveillance" — Alex Bondoc (clinical) [Ep 9 · 9:08](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=548) - "If a patient presents actively infected with pancreatitis, cholangitis, or in some acute way, cool them off and treat the underlying process, then schedule surgery after sufficient recovery" — Alex Bondoc (clinical) [Ep 9 · 9:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556) - "For incidentally found lesions, schedule surgery sooner than later when it makes sense for the family schedule, but not waiting too long" — Alex Bondoc (opinion) [Ep 9 · 9:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=590) - "Surgical goals for type 1 and type 4 are to remove as much of the duct as possible, taking the duct all the way down behind or into the head of the pancreas to where it tapers, so as not to leave remnant cyst" — Alex Bondoc (clinical) [Ep 9 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673) - "For type 1 and type 4 cysts, reconstruction of the biliary drainage system often includes a Roux-en-Y hepaticojejunostomy, but a hepaticoduodenostomy is also an option" — Alex Bondoc (clinical) [Ep 9 · 11:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=710) - "Type 2 can be simply removal of the diverticulum at its neck with repair of the common bile duct" — Alex Bondoc (clinical) [Ep 9 · 12:15](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=735) - "Type 3 can be treated with ERCP and sphincterotomy if it is a limited choledochocele, or transduodenal resection if it involves the duodenal wall" — Alex Bondoc (clinical) [Ep 9 · 12:30](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=750) - "Biopsy of the mucosa of the choledochocele is important because if it is biliary epithelium constantly exposed to intestinal secretions, it could become malignant" — Alex Bondoc (clinical) [Ep 9 · 12:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=770) - "Type 5 management depends on how diffuse the disease is: if limited to an anatomic part of the liver, resection may be possible; if diffuse throughout with inadequate functional liver remnant, transplantation may be necessary" — Alex Bondoc (clinical) [Ep 9 · 13:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=790) - "In a younger child (less than 2 years), a transverse or right subcostal incision is preferred; in older children, an upper midline incision is also viable" — Alex Bondoc (clinical) [Ep 9 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799) - "Intraoperative cholangiogram through the gallbladder helps understand where the tapering of the distal cyst occurs to avoid leaving remnant cyst" — Alex Bondoc (clinical) [Ep 9 · 14:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=880) - "Roux-en-Y limb is constructed about 15 to 20 cm distal from the ligament of Treitz, brought retrocolic, and hepaticojejunostomy is performed with interrupted 5-0 or 6-0 Maxon suture" — Alex Bondoc (clinical) [Ep 9 · 15:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=950) - "For type 2 cyst, resect the neck and repair the common bile duct with interrupted absorbable suture; T-tube is not typically left" — Alex Bondoc (clinical) [Ep 9 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007) - "Type 3 cyst can be approached endoscopically with ERCP and sphincterotomy, or transduodenally if large and obstructing, sometimes with preoperative stents" — Alex Bondoc (clinical) [Ep 9 · 17:30](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1050) - "Type 5 (Caroli's disease) management depends on extent: if limited to one hemi-liver with adequate remnant and preserved biliary outflow, liver resection is possible; if diffuse, liver transplantation may be necessary" — Alex Bondoc (clinical) [Ep 9 · 18:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1090) - "Postoperatively, place drains to assess for biliary leaks from the hepatoenteric anastomosis and remove them once the patient is tolerating a regular diet" — Alex Bondoc (clinical) [Ep 9 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125) - "Institutionally, patients are placed on a choleretic like Actigall and cholangitis prophylaxis with daily Bactrim for 3 to 6 months after surgery" — Alex Bondoc (clinical) [Ep 9 · 19:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1160) - "Short-term to long-term surgical complications can include anastomotic stricture, small bowel obstruction, reflux gastritis, and recurrent cholangitis" — Alex Bondoc (clinical) [Ep 9 · 19:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1190) - "Lifelong follow-up is needed because of the possibility of developing future malignancy even after resection of the cyst" — Alex Bondoc (clinical) [Ep 9 · 20:15](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1215) - "Cross-training occurs at Cincinnati Children's with interventional radiologists teaching pediatric surgery fellows ultrasound guidance for vascular access" (clinical) [Ep 26 · 2:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=120) - "You don't have to have a hybrid OR to do surgical-IR collaboration; it can occur in regular OR by bringing in an ultrasound machine" (clinical) [Ep 26 · 2:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=140) - "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked to create a CT" (clinical) [Ep 26 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=180) - "ChatGPT can screen thousands of articles in systematic review by analyzing Excel sheets and providing explanations for inclusion/exclusion decisions" (clinical) [Ep 26 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=280) - "Jenny AI provides suggestions for research writing, cites supporting papers, and formats citations according to preferred style" (clinical) [Ep 26 · 5:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=330) - "Cryoanalgesia temporarily freezes nerves to alleviate pain during chest wall surgery" (clinical) [Ep 26 · 7:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=430) - "Double lumen endotracheal tube deflates the lung on the side of cryoablation and surgeon uses thoracoscope to guide cryoprobe through axillary incisions" (clinical) [Ep 26 · 7:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=450) - "Cryoanalgesia targets nerves from T3 to T8 with two-minute freeze cycles" (clinical) [Ep 26 · 7:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=475) - "Subpleural injection with quarter percent marcaine with epinephrine works immediately as opposed to eight to ten hour delay with cryo nerve block" (clinical) [Ep 26 · 8:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=490) - "Double lumen endotracheal tube helps reduce risk of pneumothorax during cryoanalgesia" (clinical) [Ep 26 · 8:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=515) - "Sphere Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, showing survival was equivalent between groups" (clinical) [Ep 26 · 10:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=620) - "If you had good prenatal counseling with parents, you should pursue ECMO for every unilateral isolated CDH" (opinion) [Ep 26 · 10:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=655) - "With bivalirudin anticoagulation, you can operate after eight hours of putting patient on ECMO as long as levels are stable" (clinical) [Ep 26 · 11:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=690) - "Early repair while on ECMO is safe with optimal window between eight to 24 hours" (clinical) [Ep 26 · 11:50](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=710) - "CO2 laser emits infrared light in spectrum of 920 to 1,400 nanometers which is well absorbed by water" (clinical) [Ep 26 · 12:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=730) - "In 56 circumcision cases using CO2 laser with sleeve technique and cyanoacrylate adhesive, complication rate was only three percent" (clinical) [Ep 26 · 12:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=755) - "Autofluorescence has shown to reduce rates of hyperparathyroidism and hypocalcemia following thyroidectomy in randomized control trial from France" (clinical) [Ep 26 · 13:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=810) - "Parathyroids naturally autofluorescence at specific wavelength without injection" (clinical) [Ep 26 · 13:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=835) - "Fluobeam system showed hypocalcemia rates about half with use versus not using it" (clinical) [Ep 26 · 14:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=850) - "Surgery-first pathway reduces resource utilization including MRCP in pediatric biliary stone cases" (clinical) [Ep 26 · 14:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=880) - "ERCP causes pancreatitis 10% of the time regardless of operator skill" (clinical) [Ep 26 · 15:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=900) - "With surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%" (clinical) [Ep 26 · 15:15](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=915) - "MMP7 was identified about 10 years ago as diagnostic biomarker for biliary atresia" (clinical) [Ep 26 · 15:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=945) - "Data from Midwest study shows every 10-day delay in biliary atresia treatment worsens outcomes by 20%" (epidemiological) [Ep 26 · 16:05](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=965) - "MMP7 is now validated biomarker for biliary atresia with good sensitivity, though cutoffs vary as assay is still evolving" (clinical) [Ep 26 · 16:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=985) - "Cincinnati Children's commitment is to perform Kasai procedure within seven days of biliary atresia diagnosis" (clinical) [Ep 26 · 16:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1005) - "REBOA is procedure where catheter is inserted through femoral artery into aorta and balloon is inflated to stop blood flow, buying time for surgical intervention" (clinical) [Ep 26 · 17:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1030) - "REBOA seems to take longer than opening abdomen or chest if just needing to cross-clamp aorta" (opinion) [Ep 26 · 17:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1055) - "Most surgeons favor laparotomy over REBOA for quickly treating shock in controlled environment" (opinion) [Ep 26 · 17:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1065) - "Patients presenting with wounds as initial presentation for pilonidal tend to not always get to finish line fully healed with minimally invasive approach" (clinical) [Ep 26 · 18:05](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1085) - "Joan Armstrong's U.S. Army clinic implemented weekly shaving protocol in captive patient population and observed dramatic improvement, significantly reducing need for surgical intervention in pilonidal disease" (clinical) [Ep 26 · 18:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1100) - "If not pushing hair removal and meticulous hygiene, will probably end up operating on some pilonidal patients that might not need operation" (opinion) [Ep 26 · 18:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1125) ## Changelog - Aug 31: 31 doctors auto-found from episode dossiers - Aug 30: 25 doctors auto-found from episode dossiers - Aug 30: 20 doctors auto-found from episode dossiers - Aug 30: Members-only episodes removed from this collection - Aug 29: 34 doctors auto-found from episode dossiers - Aug 29: Checked against source: collection - Aug 29: Checked against source: collection - Aug 29: 33 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 37 items, 26 dossiers, summaries for 3 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 27 items, 26 dossiers, summaries for 1 audience(s) - Aug 29: Collection generated from campaign corpus: 27 items, 26 dossiers, summaries for 3 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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