# Cholestasis — GCMD Library living collection

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

Updated: n/a · 5 episodes · 124 cited statements

## Episodes
### Medical Management
- [Intestinal Rehabilitation, Episode 6: Cholestasis](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734) — podcast · 15:25 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734.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)

### 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)

### In-Depth Reviews
- [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)
- [Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768) — video · 12:14 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=0) Case presentation and optimal age for Kasai procedure (Ep 1)
- [4:56](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=296) Age versus duration of symptoms and contraindications to Kasai (Ep 1)
- [8:40](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=520) Preoperative workup: HIDA scans and phenobarbital (Ep 1)
- [17:20](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1040) Role of percutaneous liver biopsy and cholangiography (Ep 1)
- [21:30](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1290) Postoperative steroids and Japanese technical modifications (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=0) Introduction and Liver Physiology Review (Ep 2)
- [4:59](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=299) Biliary Atresia Definition and Diagnostic Workup (Ep 2)
- [8:38](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=518) Pathology and Surgical Management (Ep 2)
- [13:40](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=820) Kasai Outcomes and Timing Considerations (Ep 2)
- [19:32](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1172) Postoperative Management Protocols (Ep 2)
- [26:48](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1608) Primary Care and Family Impact (Ep 2)
- [33:54](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2034) Case Study: Sandra (Ep 2)
- [39:36](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2376) Steroid Use and Future Directions (Ep 2)
- [43:05](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2585) Key Points Summary and Q&A (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=0) Case Presentation and Initial Workup of Cholestatic Infant (Ep 3)
- [3:03](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=183) Diagnostic Studies: Ultrasound, HIDA Scan, and Liver Biopsy (Ep 3)
- [7:36](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=456) Liver Biopsy Findings and Role of Cholangiography (Ep 3)
- [10:28](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=628) Surgical Technique: Extended Hilar Dissection (Ep 3)
- [13:13](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=793) Special Variants: Polysplenia and Cystic Biliary Atresia (Ep 3)
- [15:11](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=911) Operative Considerations: Roux Limb Length and Center Volume (Ep 3)
- [17:37](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1057) Postoperative Corticosteroids and Alagille Syndrome Differentiation (Ep 3)
- [0:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=5) Introduction and Definition of Cholestasis (Ep 4)
- [1:37](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=97) Epidemiology, Risk Factors, and Changing Mortality (Ep 4)
- [3:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=224) Prevention Strategies: Enteral Feeding, Sepsis Prevention, and Lipid Management (Ep 4)
- [7:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=420) Treatment of Established Cholestasis and Lipid Dosing (Ep 4)
- [9:13](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=553) Surgical Considerations: Duodenal Decompression and Biliary Drainage (Ep 4)
- [11:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=709) Long-term Monitoring and Gallbladder Considerations (Ep 4)
- [13:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=839) Summary and Conclusion (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=0) Introduction and Webinar Context (Ep 5)
- [0:44](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=44) Intestinal Growth Potential in Young Children (Ep 5)
- [2:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=138) Importance of Distal Ileum and Functional Bowel (Ep 5)
- [3:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=201) Surgical Strategy for Early Healing (Ep 5)
- [4:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=296) Enteral Nutrition Management (Ep 5)
- [8:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=515) Parenteral Nutrition and Lipid Management (Ep 5)
- [10:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=655) Summary and Conclusion (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Pathologic jaundice occurs in 1 in 2500 live births" (epidemiological) [Ep 2 · 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 with two forms: perinatal/postnatal (80-90%) and fetal/embryonic (10-20%)" (clinical) [Ep 2 · 5:01](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=301)
- "Biliary atresia incidence ranges from 1 in 5000 in Taiwan, 1 in 8-10,000 in Japan, and 1 in 18,000 in the United States and Europe" (epidemiological) [Ep 2 · 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" (epidemiological) [Ep 2 · 6:05](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=365)
- "Seasonal clustering of biliary atresia cases suggests viruses or infectious processes may be triggers" (clinical) [Ep 2 · 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" (clinical) [Ep 2 · 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 closer evaluation" (guideline) [Ep 2 · 7:59](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=479)
- "Some babies with biliary atresia have normal ultrasounds" (clinical) [Ep 2 · 8:16](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=496)
- "The gold standard for biliary atresia diagnosis is the intraoperative cholangiogram" (guideline) [Ep 2 · 8:26](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=506)
- "At Children's Hospital Los Angeles, babies are pre-treated with 5 days of phenobarbital before HIDA scan" (clinical) [Ep 2 · 9:31](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=571)
- "Timing of diagnosis and Kasai procedure is extremely important, with the sweet spot being 6 to 8 weeks of age" (clinical) [Ep 2 · 15:14](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=914)
- "A French study showed 23% of Kasai patients had their native liver 20 years post-Kasai" (epidemiological) [Ep 2 · 15:50](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=950)
- "Factors affecting survival with native liver include age at Kasai, type of biliary atresia, liver histology (bridging fibrosis), and center caseload" (clinical) [Ep 2 · 16:24](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=984)
- "In England, consolidating Kasai procedures to 3 centers increased success rates" (epidemiological) [Ep 2 · 16:48](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1008)
- "At Children's Hospital Los Angeles, 6 to 12 biliary atresia cases are seen per year, considered a high rate" (epidemiological) [Ep 2 · 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, the procedure is stopped and the patient is listed for transplant" (clinical) [Ep 2 · 19:57](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1197)
- "Kasai procedures in older babies (3.5-4 months) can bridge patients to transplant at one year of age, though with complications including ascending cholangitis and frequent hospitalizations" (clinical) [Ep 2 · 20:20](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1220)
- "Bigger babies at time of transplant have easier transplant procedures" (opinion) [Ep 2 · 21:24](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1284)
- "Children's Hospital Los Angeles has a very large, possibly the largest, living donor liver transplant center in the country, offering an alternative to cadaveric transplant" (clinical) [Ep 2 · 22:27](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1347)
- "Most centers put babies on antibiotic prophylaxis postoperatively until they are eating" (clinical) [Ep 2 · 23:23](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1403)
- "Post-operative steroids for biliary atresia are unproven" (clinical) [Ep 2 · 23:48](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1428)
- "At Children's Hospital Los Angeles, peripheral IV lines are used postoperatively rather than Broviacs, and babies are not sent home on IV antibiotics" (clinical) [Ep 2 · 24:06](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1446)
- "Babies are switched from IV antibiotics to Bactrim once taking orals; babies under 6 weeks receive amoxicillin until 6 weeks of age, then switch to Bactrim at 4-5 mg/kg/day" (clinical) [Ep 2 · 25:08](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1508)
- "Babies are placed on ursodeoxycholic acid twice daily post-Kasai" (clinical) [Ep 2 · 25:35](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1535)
- "Biliary atresia babies are often deficient in fat-soluble vitamins D, E, and K, which are supplemented using aqueous solutions (Aquadek or ADeck) for better absorption" (clinical) [Ep 2 · 25:41](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1541)
- "Probiotics, herbal remedies, and omega-3 supplements have not been proven beneficial for biliary atresia" (clinical) [Ep 2 · 26:29](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1589)
- "The BARC (Biliary Atresia Research Consortium) protocol enrolled 140 babies in a randomized double-blind placebo-controlled study with steroids" (clinical) [Ep 2 · 27:01](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1621)
- "When a post-Kasai baby has unexplained fever, ascending cholangitis is suspected" (clinical) [Ep 2 · 28:15](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1695)
- "Multiple episodes of ascending cholangitis cause further liver damage and may lead to earlier need for transplant" (clinical) [Ep 2 · 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" (epidemiological) [Ep 2 · 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 states all jaundiced infants at 2 weeks of age should have a fractionated bilirubin done" (guideline) [Ep 2 · 32:54](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1974)
- "In England, Caucasian babies with biliary atresia were diagnosed at average 47 days of age, non-white babies at 52 days, and all babies diagnosed after 100 days were non-Caucasian" (epidemiological) [Ep 2 · 34:24](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2064)
- "In an English study of stool color identification, 37% of physicians and nurses did not correctly identify suspect stools using stool color cards" (epidemiological) [Ep 2 · 35:58](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2158)
- "The BARC trial of 140 randomized babies showed no benefit from steroid use in improving native liver survival, though steroids did produce more rapid bilirubin drop" (clinical) [Ep 2 · 38:41](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2321)
- "Multiple studies found increased jaundice clearance with steroids but none found prevention or lengthening of time until transplant" (clinical) [Ep 2 · 39:02](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2342)
- "In Taiwan and other Asian countries, stool cards are sent home with every discharged baby to help parents identify abnormal stool color" (clinical) [Ep 2 · 41:39](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2499)
- "Children's Hospital Los Angeles will be a site for a new trial using intravenous immunoglobulin following Kasai, hoping to inhibit immune-mediated bile duct injury" (clinical) [Ep 2 · 42:32](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2552)
- "The 30-30-30 rule for Kasai outcomes: 30% work great, 30% never work, 30% may work temporarily long enough to get a transplant but may fail" (host_summary) [Ep 2 · 46:43](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2803)
- "Postoperative stool color (brown or green) is more important than immediate postoperative bilirubin levels" (opinion) [Ep 2 · 48:01](https://library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2881)
- "Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to advances in diagnosing inborn errors of bile acid metabolism and genotyping of progressive familial intrahepatic cholestasis (PFIC)." (epidemiological) [Ep 3 · 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 3 · 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 even small shrunken gallbladders." (clinical) [Ep 3 · 4:44](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=284)
- "The triangular cord sign on ultrasound represents a fibrous plate above the portal vein where bile ducts were supposed to be, showing inflammatory fibrous scarring with distinct radiographic characteristics." (clinical) [Ep 3 · 5:01](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=301)
- "HIDA scans benefit from 3-5 days of phenobarbital loading, which can delay intervention into a time period potentially detrimental to Kasai outcomes." (clinical) [Ep 3 · 5:50](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=350)
- "A scoring system combining liver biopsy and clinical parameters achieves 99% accuracy in diagnosing biliary atresia." (host_summary) [Ep 3 · 2:33](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=153)
- "The jaundice chip is a gene chip microarray analysis that tests for PFIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin deficiency, and JAG1 mutation, but takes 4-6 weeks to return results, too long to guide initial biliary atresia intervention decisions." (clinical) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=191)
- "Liver biopsy findings of bile duct proliferation in portal triads and bile plugs within bile ducts are pathognomonic for biliary atresia with >90% diagnostic accuracy." (clinical) [Ep 3 · 8:10](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=490)
- "When liver biopsy is highly consistent with biliary atresia, intraoperative cholangiography becomes less necessary; some centers perform it primarily for educational purposes." (opinion) [Ep 3 · 8:30](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=510)
- "Alagille syndrome patients do not have the same degree of bile duct proliferation as biliary atresia patients and will not have the pathognomonic finding of bile duct plugs." (clinical) [Ep 3 · 10:14](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=614)
- "Extended hilar dissection in biliary atresia goes beyond the portal vein bifurcation to the first bifurcation of the hepatic arteries, as originally described by Kasai." (clinical) [Ep 3 · 12:13](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=733)
- "Japanese centers uniformly perform extended hilar dissections, which may explain their superior outcomes compared to U.S. centers." (opinion) [Ep 3 · 12:21](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=741)
- "Polysplenia syndrome patients with biliary atresia often have pre-duodenal portal veins and frequently have no bile duct remnant, making Kasai portoenterostomy difficult or impossible." (clinical) [Ep 3 · 13:31](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=811)
- "For cystic variants of biliary atresia, intervention before 30 days of age yields better outcomes, based on data from England." (host_summary) [Ep 3 · 14:43](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=883)
- "Cystic variant biliary atresia can be differentiated from choledochal cyst clinically: choledochal cyst patients have pigmented stool while cystic variant patients develop acholic stool." (clinical) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=900)
- "A Roux limb length of 20 cm is inadequate because 5-8 cm of length is typically lost during hilar dissection at the time of liver transplantation." (clinical) [Ep 3 · 15:30](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=930)
- "The recommended Roux limb length for Kasai portoenterostomy is 30-40 cm to preserve adequate length for future liver transplantation." (clinical) [Ep 3 · 15:55](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=955)
- "Anti-reflux valves in Kasai portoenterostomy have not been proven effective and are no longer recommended." (clinical) [Ep 3 · 16:29](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=989)
- "UK data from 15 years ago showed that centers performing more than 5 Kasai procedures per year had significantly better outcomes (approximately 20% difference) than lower-volume centers." (host_summary) [Ep 3 · 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, and only these centers receive payment for the procedure." (host_summary) [Ep 3 · 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 steroids and German group using 10 mg/kg for 5 days) showed no benefit of postoperative corticosteroids in biliary atresia." (host_summary) [Ep 3 · 17:49](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1069)
- "The Children's Network multi-center trial with approximately 70 patients in two arms showed no improvement in bile drainage with corticosteroid use and a slight increase in adverse events (primarily medical rather than surgical complications)." (host_summary) [Ep 3 · 18:09](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1089)
- "Some biliary atresia patients have an inflammatory gene profile in which corticosteroids might prove beneficial, despite overall trial results showing no benefit." (opinion) [Ep 3 · 18:44](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1124)
- "Performing Kasai portoenterostomy on Alagille syndrome patients will shorten the natural history of their native liver and lead to earlier transplantation." (clinical) [Ep 3 · 19:59](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1199)
- "For cholestatic infants where biliary atresia diagnosis is uncertain, workup for Alagille syndrome includes echocardiography to rule out pulmonic stenosis, spine X-rays to rule out butterfly vertebrae, and ophthalmologic examination." (clinical) [Ep 3 · 20:07](https://library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1207)
- "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 done after 90 days." (host_summary) [Ep 1 · 2:32](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=152)
- "In the Michigan series, children who had Kasai after 3 months had the best drainage and long-term outcome, though patient selection bias may explain this finding." (epidemiological) [Ep 1 · 1:03](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=63)
- "Under 60 days there was a clear difference in outcomes; procedures were done emergently on weekends if approaching that deadline." (clinical) [Ep 1 · 1:50](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=110)
- "The critical factor determining outcome may be the degree of cirrhosis present at the time of Kasai, which does not always correlate directly with chronologic age." (opinion) [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 at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters." — Todd Ponsky (host_summary) [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 pale stools are present from the first week of life; timing of referral to tertiary centers varies based on pediatrician vigilance." (clinical) [Ep 1 · 5:18](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=318)
- "Peter Altman recommended performing Kasai between 60 and 75 days based on the largest U.S. series from Columbia." (host_summary) [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 finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension." — Todd Ponsky (clinical) [Ep 1 · 9:19](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=559)
- "Performing Kasai even in advanced disease may buy months of time, expanding the donor pool and making eventual transplant technically easier with lower hepatic artery thrombosis risk." (clinical) [Ep 1 · 10:05](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=605)
- "Hepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers." — Todd Ponsky (clinical) [Ep 1 · 10:41](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=641)
- "In patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition." — Todd Ponsky (opinion) [Ep 1 · 10:56](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=656)
- "The Kasai operation itself is not technically demanding or high-risk, so reoperation when uncertain about initial success is reasonable." (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 response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression." — Todd Ponsky (clinical) [Ep 1 · 12:20](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=740)
- "If a liver biopsy is suggestive of biliary atresia, additional workup tests are not needed." (opinion) [Ep 1 · 14:02](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=842)
- "HIDA scan with phenobarbital has high sensitivity and specificity for biliary atresia, requiring at least 5 days of phenobarbital at therapeutic levels." (host_summary) [Ep 1 · 15:21](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=921)
- "In the Children's National study, approximately one-third of initially negative HIDA scans converted to positive for biliary atresia when repeated with adequate phenobarbital levels." (host_summary) [Ep 1 · 16:40](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1000)
- "A recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia." — Todd Ponsky (host_summary) [Ep 1 · 17:35](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1055)
- "Pathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago." — Todd Ponsky (opinion) [Ep 1 · 18:01](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1081)
- "Interventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test." — Todd Ponsky (clinical) [Ep 1 · 18:10](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1090)
- "A patent gallbladder is extremely rare in true biliary atresia." (clinical) [Ep 1 · 18:42](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1122)
- "In Milwaukee, percutaneous cholangiography is combined with liver biopsy when a gallbladder is present, with one surgical complication in 46 attempts." (host_summary) [Ep 1 · 18:59](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1139)
- "Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent, with at least one reported case of near-abortion for a normal fetus." (clinical) [Ep 1 · 20:44](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1244)
- "Japanese surgeons still recommend postoperative steroids either routinely or when bile drainage decreases, despite studies questioning their efficacy." (host_summary) [Ep 1 · 21:42](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1302)
- "Yamataka's group at Juntendo University performs Kasai dissection much wider than the classic technique, uses more superficial sutures to avoid ductule damage, and avoids sutures at 10 and 3 o'clock positions where bile ducts bifurcate, claiming improved results." (host_summary) [Ep 1 · 22:15](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1335)
- "Japanese surgeons are attempting to refute IPEG's recommendation against laparoscopic Kasai by demonstrating equivalent results with laparoscopic technique." (host_summary) [Ep 1 · 23:08](https://library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1388)
- "Cincinnati Children's Hospital institutionally defined cholestasis as conjugated bilirubin greater than 3 mg/dL or 50 micromoles/L sustained for 2 weeks and not associated with a septic event." — Paul Wales (guideline) [Ep 4 · 1:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=69)
- "A 2021 JPN publication defined cholestasis as conjugated bilirubin around 2 mg/dL or 34 micromoles/L for 2 weeks, not associated with a septic event." — Paul Wales (guideline) [Ep 4 · 1:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=80)
- "Advanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL." — Cecilia Gigena (host_summary) [Ep 4 · 1:48](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=108)
- "As treatment has improved with different lipid emulsions and nutrition approaches, cholestasis has become more an indicator of underlying diseases to address rather than a primary morbidity/mortality factor." — Michael Helmrath (opinion) [Ep 4 · 1:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=117)
- "Historically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%." — Cecilia Gigena (host_summary) [Ep 4 · 2:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=156)
- "In young children, intestinal failure-associated liver disease presents as cholestatic liver disease, whereas in adolescents and adults it tends to be steatosis (fatty deposition)." — Paul Wales (clinical) [Ep 4 · 2:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=177)
- "Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components." — Cecilia Gigena (host_summary) [Ep 4 · 3:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=199)
- "Prematurity is not modifiable by the clinical team, but lack of enteral feeding, sepsis, and TPN components are modifiable risk factors." — Paul Wales (clinical) [Ep 4 · 3:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=210)
- "Prevention of cholestasis requires aggressive introduction of enteral feeding to establish enterohepatic circulation and surgical procedures to optimize anatomy for feed delivery." — Paul Wales (clinical) [Ep 4 · 4:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=249)
- "Limiting intravenous fat to 1 g/kg/day can help prevent cholestasis." — Michael Helmrath (clinical) [Ep 4 · 5:12](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=312)
- "New lipid emulsions including Omegaven (used first in the US) and SMOF (used in Europe and Canada, now prevalent in the US for 3-4 years) can reverse or prevent cholestasis." — Michael Helmrath (clinical) [Ep 4 · 5:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=320)
- "SMOF lipid emulsion is composed of soybean oil, medium chain triglycerides, olive oil, and fish oil." — Ellen [last name unclear] (host_summary) [Ep 4 · 6:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=364)
- "A major advantage of SMOF is the ability to provide more calories from fat (as much as 2-2.5 g/kg) while supporting healthy growth." — Michael Helmrath (clinical) [Ep 4 · 6:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=375)
- "Patients on SMOF lipid emulsions can still develop cholestasis due to other factors beyond lipid composition." — Ellen [last name unclear] (host_summary) [Ep 4 · 6:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=401)
- "Two strategies for reversing cholestasis are dose restriction and change of lipid composition." — Paul Wales (clinical) [Ep 4 · 7:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=420)
- "Conventional intralipid (soybean-based) produces prostaglandins and eicosanoids that are pro-inflammatory when metabolized." — Paul Wales (clinical) [Ep 4 · 7:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=428)
- "SMOF lipid promotes bile flow, is hepatoprotective, and can be delivered at conventional dose to achieve somatic growth and provide neurologic nutrients while protecting the liver." — Paul Wales (clinical) [Ep 4 · 7:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=439)
- "SMOF lipid does not contain enough arachidonic acid, so dose restriction of SMOF can lead to essential fatty acid deficiency." — Paul Wales (clinical) [Ep 4 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=465)
- "When SMOF is delivered at conventional dosing, no patients develop essential fatty acid deficiency." — Paul Wales (clinical) [Ep 4 · 7:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=477)
- "Conventional dosing for lipids is settling around 2.5 g/kg/day, but nutrition guidelines for preterm infants and babies state 3-4 g/kg/day." — Paul Wales (guideline) [Ep 4 · 8:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=486)
- "A bilirubin of 2 mg/dL is not advanced liver disease, is not dangerous, and is usually transient; Dr. Wales would not change lipid emulsion at this threshold." — Paul Wales (opinion) [Ep 4 · 8:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=532)
- "When refeeding a cholestatic liver after proximal jejunostomy takedown, direct bilirubin typically rises in the first week as bile acid pool is reintroduced and the liver becomes more active in bile salt production." — Michael Helmrath (clinical) [Ep 4 · 9:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=578)
- "GGT, AST, and ALT will go up in the first week or two after anastomosis takedown surgery, then slowly come down over several weeks." — Michael Helmrath (clinical) [Ep 4 · 10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=604)
- "When direct bilirubin rises after refeeding, the main differential to rule out is urinary tract infection or gram-negative infection; extensive imaging such as ultrasounds is not needed." — Michael Helmrath (clinical) [Ep 4 · 10:23](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=623)
- "It is important to provide proximal drainage of the duodenum in high-risk intestinal failure patients; Dr. Helmrath places a lake drain for this purpose." — Michael Helmrath (clinical) [Ep 4 · 10:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=646)
- "Ongoing cholestasis with proximal blockage puts pressure in the biliary system at a much higher level and speeds up the cholestatic process." — Michael Helmrath (clinical) [Ep 4 · 11:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=678)
- "G-tubes do not decompress the duodenum." — Michael Helmrath (clinical) [Ep 4 · 11:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=691)
- "A lake drain helps identify proximal bowel and leaves the bowel at appropriate size to make future anastomosis easier without large size mismatch." — Ellen [last name unclear] (host_summary) [Ep 4 · 11:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=696)
- "During secondary surgical or autologous reconstruction procedures, a liver biopsy is commonly taken to provide an up-to-date microscopic snapshot." — Paul Wales (clinical) [Ep 4 · 12:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=731)
- "Prophylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it." — Cecilia Gigena (host_summary) [Ep 4 · 12:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=744)
- "Liver function and biochemistry are followed routinely as inpatient and at outpatient clinic visits." — Paul Wales (clinical) [Ep 4 · 12:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=773)
- "Elastography (FibroScan) is available for monitoring but is good for mild/no fibrosis or very advanced fibrosis; it is not as sensitive for patients with intermediate fibrosis." — Paul Wales (clinical) [Ep 4 · 13:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=780)
- "Follow-up visit frequency for children on TPN at home ranges from every 1-4 months depending on patient stability; actively adapting patients may be seen more frequently due to rapid changes being made." — Paul Wales (clinical) [Ep 4 · 13:31](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-6-cholestasis-6734?t=811)
- "Young infants, babies, and young children have tremendous gut growth potential, with the gut growing for the first several years of life." — Paul Well (clinical) [Ep 5 · 0:49](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=49)
- "A term baby will have 160 centimeters of small bowel, and by age 5 years it almost triples to about 425 to 450 centimeters." — Paul Well (clinical) [Ep 5 · 1:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=77)
- "Residual bowel should be discussed as a percentage of what is normal for a child of that age, not in absolute centimeters." — Paul Well (clinical) [Ep 5 · 1:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=62)
- "You can have as low as 10% expected gut length and still achieve enteral autonomy if you have the majority of your colon in continuity." — Paul Well (clinical) [Ep 5 · 1:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=111)
- "The more important factor than the ileocecal valve is the presence or absence of the distal small bowel (ileum) and right colon that can act as a site for bile reclamation and enterohepatic circulation." — Michael Helmrath (clinical) [Ep 5 · 2:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=150)
- "The distal ileum produces hormones and incretins including GLP-2, GLP-1, and PYY." — Michael Helmrath (clinical) [Ep 5 · 2:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=163)
- "The importance is not the ileocecal valve itself but the distal ileum and proximal colon where bilioenteric circulation occurs and where hormones and peptides that help intestinal growth and absorption are produced." (host_summary) [Ep 5 · 3:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=181)
- "The surgical strategy at the first operation should provide a pathway forward that allows early interval feeding." — Michael Helmrath (clinical) [Ep 5 · 3:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=209)
- "It is sometimes better to stage reconstruction with the plan to restore bowel continuity under more controlled conditions." — Michael Helmrath (opinion) [Ep 5 · 3:38](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=218)
- "In situations of overwhelming intestinal loss, the strategy is to provide proximal control that allows feeding to occur without the enteral stream going through, and to leave questionable bowel segments that have potential to heal and can make a huge difference in the child's lifetime." — Michael Helmrath (clinical) [Ep 5 · 3:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=233)
- "As long as you can divert proximally and the baby is stable, you can leave questionable bowel for potential use at later secondary reconstructive procedures." (clinical) [Ep 5 · 4:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=266)
- "The overarching principle is to deliver adequate nutrition to have normal growth within normal parameters, ideally enterally." — Paul Well (clinical) [Ep 5 · 5:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=308)
- "As much as possible, the goal is to establish normal feeding behavior, recognizing that enteral nutrition is more than just nutrition." — Paul Well (clinical) [Ep 5 · 5:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=328)
- "If a patient needs tube support from the beginning, bolus feeding should be tried rather than defaulting to continuous feeding." — Paul Well (clinical) [Ep 5 · 5:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=352)
- "If the child fails a gastric approach (both bolus and continuous), the strategy is to feed beyond the stomach and decompress the stomach through an NG tube." — Paul Well (clinical) [Ep 5 · 6:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=375)
- "Breast milk is the formula of choice, not only for its nutritional benefits but for all the other beneficial components within breast milk." — Paul Well (clinical) [Ep 5 · 6:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=402)
- "Starting at the single amino acid level for protein is the generalized preference, ensuring patients are not having high stool output, high fluid losses, wound breakdown, rashes, or emesis." — Michael Helmrath (clinical) [Ep 5 · 7:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=448)
- "Long-chain fat is the preferred fat module rather than MCT fat, especially in the setting of short bowel syndrome." — Paul Well (clinical) [Ep 5 · 7:57](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=477)
- "Long-chain fat is a much stronger stimulus for GLP-2 release compared to MCT, which is important when trying to drive intestinal adaptation." — Paul Well (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=495)
- "Not every child needs to be on SMOF lipids." — Paul Well (opinion) [Ep 5 · 9:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=540)
- "For preterm babies, SMOF is not the ideal lipid emulsion but is the best currently available." — Paul Well (clinical) [Ep 5 · 9:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=543)
- "SMOF lipids do not have enough arachidonic acid, which is important for brain development." — Paul Well (clinical) [Ep 5 · 9:16](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=556)
- "Two strategies exist to treat cholestasis: reduce the total amount of fat, or change the composition to introduce SMOF lipids or Omegaven." (clinical) [Ep 5 · 9:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=574)
- "Lipid restrictions that reduce lipid dose to 1 g per kg per day can reverse cholestasis but result in reduced calorie delivery that can impair growth and potentially impact neurocognitive development." (clinical) [Ep 5 · 9:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=590)
- "Omegaven is essentially pure fish oil with omega-3 and is dosed at 1 g/kg, so babies take a calorie hit." (clinical) [Ep 5 · 10:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=607)
- "SMOF lipids are a better choice as they are a more well-balanced emulsion with an omega-3 and omega-6 ratio of 2.5 to 1, are less inflammatory than Intralipid, and promote bile flow." (clinical) [Ep 5 · 10:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=628)
- "SMOF lipids should not be restricted and can be given at no less than 2 or 2.5 g per kg per day." (clinical) [Ep 5 · 10:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-webinar-2023-top-5-key-takeaways-8768?t=628)

## Changelog
- Sep 8: 1 item no longer name cholestasis
- Sep 7: 6 items added automatically

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