# Chronic Pancreatitis — GCMD Library living collection

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

Updated: n/a · 10 episodes · 258 cited statements

## Episodes
### Fundamentals
- [Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440) — video · 8:32 · [machine version](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440.md)

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

### Surgical Management
- [Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973) — video · 47:20 · [machine version](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973.md)
- [Update Course Rewind: Management of Chronic Pancreatitis 2023](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546) — video · 8:30 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546.md)
- [Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540) — video · 10:19 · [machine version](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540.md)

### Evidence & Research
- [Pancreatitis in pediatric patients with pancreatic solid pseudopapillary neoplasms- a single center experience](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847.md)

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

### In-Depth Reviews
- [Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971) — video · 51:02 · [machine version](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971.md)
- [Update Course 2023 - Updates in Pancreatitis](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269) — video · 32:50 · [machine version](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269.md)
- [Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849) — video · 66:03 · [machine version](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=0) Direct pancreatic function testing: endoscopic collection protocol (Ep 1)
- [5:07](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=307) MR pancreatic function testing: quantitative fluid secretion (Ep 1)
- [10:39](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=639) Case outcome: genetic testing and enzyme therapy (Ep 1)
- [13:41](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=821) Multidisciplinary pain management: case of 13-year-old with annular pancreas (Ep 1)
- [19:50](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1190) Pain psychology integration and opioid stewardship (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=0) Introduction and Definitions: Acute Recurrent vs. Chronic Pancreatitis (Ep 2)
- [2:07](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=127) Natural History, Definitions, and Imaging Findings in Chronic Pancreatitis (Ep 2)
- [6:41](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=401) Case Presentation: 10-Year-Old with Extensive Calcifications (Ep 2)
- [10:16](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=616) Genetic Etiology and Testing in Pediatric Chronic Pancreatitis (Ep 2)
- [22:03](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1323) Penetrance, Genetic Counseling, and Combination Risk (Ep 2)
- [24:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1480) Pancreatic Function Testing: Endoscopic Collection Protocol (Ep 2)
- [29:42](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1782) MR Pancreatic Function Testing: Noninvasive Volumetric Assessment (Ep 2)
- [35:20](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2120) Case Follow-Up and Management Summary (Ep 2)
- [38:16](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2296) Multidisciplinary Pain Management: Team Composition and Case Example (Ep 2)
- [44:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2665) Psychological Intervention and Medication Management in Pain (Ep 2)
- [47:38](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2858) Closing Discussion: Communicating Psychological Care and Avoiding Stigma (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=0) Introduction and Overview of TPIAT Session (Ep 3)
- [1:30](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=90) Case Presentation: 13-Year-Old with Chronic Pancreatitis (Ep 3)
- [4:44](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=284) TPIAT Indications and Multidisciplinary Evaluation (Ep 3)
- [8:30](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=510) Endocrinology Assessment and Glucose Tolerance Testing (Ep 3)
- [13:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=794) Preoperative Pain Management Approach (Ep 3)
- [18:17](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1097) Surgical Evaluation and TPIAT Criteria (Ep 3)
- [25:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1549) Perioperative Pain Management Protocol (Ep 3)
- [26:44](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1604) Surgical Technique and Islet Isolation (Ep 3)
- [34:47](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2087) ICU Management and Early Postoperative Care (Ep 3)
- [39:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2354) Pain Management Outcomes and Weaning Strategy (Ep 3)
- [42:03](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2523) Glucose Management Protocols (Ep 3)
- [43:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2629) Summary and Closing Remarks (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=0) Introduction and Acute Pancreatitis Case (Ep 4)
- [7:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=420) Acute Pancreatitis Management Principles (Ep 4)
- [13:30](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=810) Chronic Pancreatitis and Genetics (Ep 4)
- [19:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1180) Surgical Options for Chronic Pancreatitis (Ep 4)
- [27:30](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1650) TPIAT Technical Details and Q&A (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=0) Introduction and Case Presentation (Ep 5)
- [2:00](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=120) TPIAT Goals and Outcomes (Ep 5)
- [4:13](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=253) Surgical Technique and Islet Reimplantation (Ep 5)
- [7:18](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=438) Summary and Conclusion (Ep 5)
- [0:01](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=1) Case Presentation and Initial Management Options (Ep 6)
- [1:28](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=88) Role of Genetics in Treatment Planning (Ep 6)
- [3:37](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=217) Timing of Referral and Imaging Strategies (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Solid pseudopapillary neoplasms are one of the most frequent pancreatic tumors in pediatric patients" — Lizzie Lee (epidemiological) [Ep 9 · 0:09](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=9)
- "Surgery for solid pseudopapillary neoplasms is usually curative and outcomes are excellent" — Lizzie Lee (clinical) [Ep 9 · 0:15](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=15)
- "In a single center study, 10 adolescent girls underwent surgical resection for solid pseudopapillary neoplasms" — Lizzie Lee (clinical) [Ep 9 · 0:22](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=22)
- "3 out of 10 patients developed acute recurrent or chronic pancreatitis after resection" — Lizzie Lee (clinical) [Ep 9 · 0:25](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=25)
- "Every patient who developed ongoing pancreatitis had genetic risk factors like CFTR gene variants or pancreas divisum" — Lizzie Lee (clinical) [Ep 9 · 0:32](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=32)
- "Some patients with post-resection pancreatitis ultimately required completion pancreatectomy" — Lizzie Lee (clinical) [Ep 9 · 0:40](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=40)
- "Identifying genetic and anatomic risk factors before surgery may change management of patients with solid pseudopapillary neoplasms" — Lizzie Lee (opinion) [Ep 9 · 0:48](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=48)
- "85% of 1000+ pediatric pancreatitis patients at Cincinnati Children's have genetic mutations" — Juan Gurria (epidemiological) [Ep 10 · 7:23](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=443)
- "PRSS1 mutation causes autoactivation of trypsinogen, leading to aggressive early-onset pancreatitis in children as young as 1–3 years" — Juan Gurria (clinical) [Ep 10 · 8:01](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=481)
- "Hereditary pancreatitis markedly increases lifetime risk of pancreatic cancer" — Juan Gurria (clinical) [Ep 10 · 9:32](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=572)
- "Diagnosis of acute pancreatitis requires serum lipase ≥3× upper limit of normal plus imaging findings (ultrasound, MRCP, or CT)" — Juan Gurria (guideline) [Ep 10 · 5:44](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=344)
- "Most pediatric pancreatitis fluid collections are self-limited and do not require intervention" — Juan Gurria (clinical) [Ep 10 · 10:15](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=615)
- "Early necrosectomy (before 4 weeks) increases mortality; wait for walled-off necrosis to mature" — Juan Gurria (guideline) [Ep 10 · 18:40](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1120)
- "Transgastric endoscopic necrosectomy reduces major complications compared to open surgery" — Juan Gurria (clinical) [Ep 10 · 20:11](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1211)
- "Asymptomatic pseudocysts, regardless of size, do not require intervention" — Juan Gurria (guideline) [Ep 10 · 21:36](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1296)
- "Early enteral nutrition (as soon as tolerated) prevents bacterial translocation and reduces complications in acute pancreatitis" — Juan Gurria (clinical) [Ep 10 · 23:29](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1409)
- "Lactated Ringer's solution is superior to normal saline for initial resuscitation in acute pancreatitis" — Juan Gurria (clinical) [Ep 10 · 23:48](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1428)
- "~50% of pediatric patients with hereditary or anatomic pancreatitis develop chronic pancreatitis" — Juan Gurria (epidemiological) [Ep 10 · 25:18](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1518)
- "Segmental pancreatic resections in genetic pancreatitis discard islet-cell mass and leave remaining pancreas vulnerable to ongoing disease" — Juan Gurria (opinion) [Ep 10 · 28:57](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1737)
- "TPIAT is indicated for patients with refractory chronic pain, failed maximal medical/endoscopic therapy, and severe quality-of-life impairment" — Juan Gurria (guideline) [Ep 10 · 34:11](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2051)
- "The primary goal of TPIAT is pain control and quality-of-life restoration, not diabetes prevention" — Juan Gurria (opinion) [Ep 10 · 36:03](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2163)
- "Insulin independence after TPIAT is ~70% overall and approaches 92% when ≥5000 islet equivalents/kg are transplanted" — Juan Gurria (clinical) [Ep 10 · 53:03](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3183)
- "Younger age at TPIAT, higher islet yield, and absence of pre-op insulin use predict better glycemic outcomes" — Juan Gurria (clinical) [Ep 10 · 51:45](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3105)
- "Over 80% of TPIAT patients achieve sustained reduction in opioid use within 1–2 months" — Juan Gurria (clinical) [Ep 10 · 50:58](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3058)
- "Spleen-sparing TPIAT is now performed in 80% of cases without compromising islet yield or glycemic outcomes" — Juan Gurria (clinical) [Ep 10 · 43:36](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2616)
- "Pyloric botulinum toxin injection during TPIAT reduces gastroparesis and shortens length of stay" — Juan Gurria (clinical) [Ep 10 · 45:00](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2700)
- "TPIAT patients are extubated in the operating room and maintained on insulin drip to rest islet cells during engraftment" — Juan Gurria (clinical) [Ep 10 · 50:04](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3004)
- "Pseudocyst drainage should not be performed before 4 weeks; wall maturation is required to avoid spillage and infection" — Juan Gurria (guideline) [Ep 10 · 62:22](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3742)
- "Chronic pain in pediatric pancreatitis involves central sensitization and brain plasticity, requiring multidisciplinary pain management" — Juan Gurria (clinical) [Ep 10 · 26:54](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1614)
- "Medications causing pediatric pancreatitis include L-asparaginase, steroids, valproic acid, and furosemide" — Juan Gurria (clinical) [Ep 10 · 8:55](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=535)
- "Autoimmune pancreatitis can mimic chronic pancreatitis and should be ruled out before surgery; it responds to steroids" — Juan Gurria (clinical) [Ep 10 · 17:00](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1020)
- "ERCP is essential for diagnosis and treatment of pediatric pancreatitis but carries ~10% risk of post-ERCP pancreatitis" — Juan Gurria (clinical) [Ep 10 · 16:10](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=970)
- "Pancreatic trauma in children (e.g., handlebar injury) can cause ductal strictures requiring distal pancreatectomy if endoscopic therapy fails" — Juan Gurria (clinical) [Ep 10 · 31:52](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1912)
- "Islet-cell yield is reduced by frequent pancreatitis attacks, obesity, and prior segmental resections" — Juan Gurria (clinical) [Ep 10 · 36:55](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2215)
- "Portal vein thrombosis is a major complication of TPIAT; anticoagulation during surgery is mandatory" — Juan Gurria (clinical) [Ep 10 · 44:47](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2687)
- "Cincinnati Children's evaluates >100 chronic pancreatitis patients per year but performs TPIAT in only 25–30, reflecting careful patient selection" — Juan Gurria (epidemiological) [Ep 10 · 57:09](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3429)
- "Families report dramatic quality-of-life improvements after TPIAT: children return to school, sports, and normal social activities" — Juan Gurria (clinical) [Ep 10 · 56:09](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3369)
- "Acute pancreatitis in children should be managed with early aggressive fluid resuscitation in the first 12–24 hours, then reassessed to avoid fluid overload." — Juan Gurria (clinical) [Ep 4 · 3:55](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=235)
- "Bolus 10–20 mL/kg up to 3 L in the first 24 hours, with maintenance fluids at 1.5–2× normal rate." — Juan Gurria (guideline) [Ep 4 · 5:59](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=359)
- "Lactated Ringer's decreases inflammatory response and C-reactive protein at 24 hours compared to normal saline." — Juan Gurria (clinical) [Ep 4 · 6:32](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=392)
- "The WATERFALL trial (multi-center RCT by Enrique de Madaria) is comparing LR vs NS in acute pancreatitis, results expected in 1–2 years." — Juan Gurria (epidemiological) [Ep 4 · 8:33](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=513)
- "Aggressive fluid resuscitation in acute pancreatitis is associated with shorter length of stay, fewer severe complications, and fewer ICU admissions." — Juan Gurria (clinical) [Ep 4 · 9:07](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=547)
- "Enteral nutrition (feeding the pancreas) is significantly better than TPN or NPO in acute pancreatitis." — Juan Gurria (clinical) [Ep 4 · 9:24](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=564)
- "Nasogastric feeding is preferred over nasojejunal feeding if the patient can tolerate it." — Juan Gurria (guideline) [Ep 4 · 9:47](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=587)
- "Antibiotics are not indicated in acute pancreatitis unless there are signs of sepsis or infected pancreatitis." — Juan Gurria (guideline) [Ep 4 · 4:42](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=282)
- "The most common cause of pancreatitis in children is medication-induced; the most common risk factor is genetic." — Juan Gurria (epidemiological) [Ep 4 · 15:23](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=923)
- "PRSS1 (trypsinogen activator) is the most common genetic mutation causing pancreatitis in children and is the most aggressive." — Juan Gurria (clinical) [Ep 4 · 15:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=940)
- "Cincinnati Children's genetic panel tests 10 different markers for pancreatitis (PRSS1, CTRC, CFTR, CPA1, others)." — Juan Gurria (clinical) [Ep 4 · 15:48](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=948)
- "Up to 50% of children with genetic pancreatitis continue to have attacks despite duct drainage procedures (Frey, Puestow)." — Juan Gurria (clinical) [Ep 4 · 16:33](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=993)
- "Conventional drainage procedures (Frey, Puestow) are not recommended for children with genetic mutations because they do not address the underlying parenchymal disease." — Juan Gurria (opinion) [Ep 4 · 18:30](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1110)
- "The primary indication for TPIAT is chronic debilitating pain that is unresponsive to medical and endoscopic management." — Juan Gurria (guideline) [Ep 4 · 19:08](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1148)
- "The secondary goal of TPIAT is to preserve beta-cell function and prevent brittle diabetes." — Juan Gurria (clinical) [Ep 4 · 26:14](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1574)
- "Islet equivalent per kilogram of body weight around 5000 predicts a 50% chance of insulin independence after TPIAT." — Juan Gurria (clinical) [Ep 4 · 26:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1600)
- "20% of TPIAT patients require a small dose of insulin, and 30% remain diabetic." — Juan Gurria (epidemiological) [Ep 4 · 27:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1620)
- "TPIAT exchanges chronic pancreatitis for potential diabetes; families must understand this trade-off." — Juan Gurria (opinion) [Ep 4 · 27:05](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1625)
- "Cincinnati Children's receives over 100 TPIAT referrals per year but performs only 20–25 procedures because not all patients are candidates." — Juan Gurria (epidemiological) [Ep 4 · 15:02](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=902)
- "TPIAT requires a multidisciplinary team: surgery, GI pancreatologists, geneticists, social workers, psychologists, and pain specialists." — Juan Gurria (clinical) [Ep 4 · 24:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1480)
- "Patients with chronic pain develop hyperalgesia and central sensitization; removing the pancreas may not eliminate all pain, requiring behavioral therapy." — Juan Gurria (clinical) [Ep 4 · 25:07](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1507)
- "TPIAT operative time averages 8–10 hours: 3–4 hours for pancreatectomy, 4–4.5 hours for islet isolation, 2 hours for reconstruction." — Juan Gurria (clinical) [Ep 4 · 27:36](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1656)
- "Splenectomy is routinely performed with TPIAT to minimize ischemia time and preserve islet cells, as the pancreas and spleen share blood supply." — Juan Gurria (clinical) [Ep 4 · 29:33](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1773)
- "Islet cells are injected into the portal vein and implant in the end branches within the liver." — Juan Gurria (clinical) [Ep 4 · 29:22](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1762)
- "Extrahepatic islet implantation sites (omentum, retroperitoneum, rectus muscle, gastric submucosa) have been tried but do not work as well as intrahepatic." — Juan Gurria (clinical) [Ep 4 · 31:26](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1886)
- "Portal vein thrombosis after islet injection occurs in less than 1% of cases; portal pressure is monitored during injection." — Juan Gurria (clinical) [Ep 4 · 31:58](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1918)
- "All TPIAT patients are on insulin in the ICU post-operatively to minimize stress on newly transplanted islets and allow engraftment." — Juan Gurria (clinical) [Ep 4 · 30:20](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1820)
- "Islet cells can be lost at four points: recurrent pancreatitis, ischemia during dissection, processing/injection, and acute post-op stress." — Juan Gurria (clinical) [Ep 4 · 30:01](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1801)
- "Pyloric Botox injection during TPIAT has been shown to improve outcomes in gastroparesis, which all pancreatitis patients have." — Juan Gurria (clinical) [Ep 4 · 28:51](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1731)
- "Roux-en-Y reconstruction helps manage gastroparesis in TPIAT patients." — Juan Gurria (clinical) [Ep 4 · 28:59](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1739)
- "Patients with chronic pancreatitis have micro- and macronutrient deficiencies and often require pancreatic enzyme replacement therapy." — Juan Gurria (clinical) [Ep 4 · 21:12](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1272)
- "Exocrine function is lost before endocrine function in chronic pancreatitis; screening for endocrine dysfunction is necessary." — Juan Gurria (clinical) [Ep 4 · 21:36](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1296)
- "Walled-off necrosis should be drained only if symptomatic (gastric outlet obstruction, pain); asymptomatic collections self-resolve." — Juan Gurria (guideline) [Ep 4 · 21:48](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1308)
- "Chronic pancreatitis increases the risk of pancreatic cancer up to thirteenfold." — Juan Gurria (epidemiological) [Ep 4 · 22:08](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1328)
- "MRCP with T2 sequences is the best non-invasive imaging study for the pancreas." — Juan Gurria (clinical) [Ep 4 · 20:59](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1259)
- "ERCP is more therapeutic than diagnostic in pediatric pancreatitis." — Juan Gurria (opinion) [Ep 4 · 21:07](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1267)
- "Endoscopic ultrasound can confirm the diagnosis of chronic pancreatitis in children." — Juan Gurria (clinical) [Ep 4 · 20:48](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1248)
- "There is no set number of ERCPs before considering surgery, but early referral for TPIAT evaluation is better to preserve islet cell mass." — Juan Gurria (opinion) [Ep 4 · 19:56](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1196)
- "Genetic testing should be obtained even after a first severe attack of pancreatitis in children." — Juan Gurria (guideline) [Ep 4 · 15:11](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=911)
- "Up to 50% of patients with chronic pancreatitis will eventually require surgery." — Juan Gurria (epidemiological) [Ep 4 · 24:08](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1448)
- "Every ERCP carries a risk of post-ERCP pancreatitis, and islet cells are lost with every pancreatitis attack" — Juan Gurria (clinical) [Ep 6 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=100)
- "PRSS1 is the most common genetic mutation in pediatric pancreatitis and is a trypsinogen activator that activates trypsin inside the pancreas" — Juan Gurria (clinical) [Ep 6 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=117)
- "Cincinnati Children's genetic panel tests 10 different genetic markers for pancreatitis" — Juan Gurria (clinical) [Ep 6 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=132)
- "Genetic factors are changing the approach to pediatric chronic pancreatitis treatment" — Juan Gurria (opinion) [Ep 6 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=137)
- "Patients with more than 1 episode of acute pancreatitis or a first severe episode should undergo MRCP and genetic panel testing" — Cecilia Gigena (guideline) [Ep 6 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=146)
- "There is currently no medication to mediate trypsin activation in genetic pancreatitis" — Juan Gurria (clinical) [Ep 6 · 2:48](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=168)
- "Frey procedure requires removing the top half of the pancreas to open the duct, resulting in loss of islet cells" — Juan Gurria (clinical) [Ep 6 · 3:09](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=189)
- "In patients with PRSS1 mutation, drainage procedures only temporize attacks by draining the duct but do not fix the underlying problem, as the parenchyma continues to be attacked by the mutation" — Juan Gurria (clinical) [Ep 6 · 3:19](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=199)
- "Genetic testing is essential before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage" — Cecilia Gigena (guideline) [Ep 6 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=217)
- "There is no set number of ERCPs that defines when to consider chronic pancreatitis; sooner referral is better for evaluation" — Juan Gurria (guideline) [Ep 6 · 4:09](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=249)
- "Surgical pancreatic intervention is not offered unless medical and endoscopic management have been maximized" — Juan Gurria (guideline) [Ep 6 · 4:16](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=256)
- "If a stent is placed and the patient continues to have pancreatitis, there is no reason to continue with ERCPs" — Juan Gurria (clinical) [Ep 6 · 4:31](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=271)
- "Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT" — Cecilia Gigena (guideline) [Ep 6 · 4:37](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=277)
- "MRCP is the best non-invasive study for the pancreas, particularly with T2 sequences" — Juan Gurria (clinical) [Ep 6 · 4:58](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=298)
- "ERCP is more therapeutic than diagnostic" — Juan Gurria (clinical) [Ep 6 · 5:07](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=307)
- "Imaging approach starts with ultrasound, then CT, and MRCP with T2 sequences for better pancreatic anatomy visualization" — Cecilia Gigena (guideline) [Ep 6 · 5:11](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=311)
- "Pancreatic fluid collections should be drained only if symptomatic once the wall is mature at 4 to 6 weeks" — Juan Gurria (guideline) [Ep 6 · 5:22](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=322)
- "Asymptomatic fluid collections without gastric outlet obstruction or pain will self-resolve and do not require drainage" — Juan Gurria (clinical) [Ep 6 · 5:29](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=329)
- "Antibiotics are not needed for pancreatic fluid collections" — Juan Gurria (guideline) [Ep 6 · 5:35](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=335)
- "Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations" — Cecilia Gigena (epidemiological) [Ep 6 · 5:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=340)
- "If genetic mutations are confirmed, partial pancreatic resection (Frey procedure) should be avoided to prevent loss of pancreatic cells" — Cecilia Gigena (guideline) [Ep 6 · 5:50](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=350)
- "If endoscopic approach fails, TPIAT should be considered sooner rather than later" — Cecilia Gigena (guideline) [Ep 6 · 6:01](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=361)
- "Chronic pancreatitis is a chronic inflammatory condition where inflammation over time results in damage and destruction of the pancreas with replacement of healthy tissue with fibrosis" — Maisaabel Haija (clinical) [Ep 7 · 0:34](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=34)
- "Ongoing pancreatic damage affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin" (clinical) [Ep 7 · 0:54](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=54)
- "When islet cells are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes" (clinical) [Ep 7 · 1:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=85)
- "Chronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function" (clinical) [Ep 7 · 1:33](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=93)
- "Diagnosis of chronic pancreatitis mostly relies on imaging findings" — Maisaabel Haija (clinical) [Ep 7 · 1:43](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=103)
- "Diagnosis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction" — Maisaabel Haija (guideline) [Ep 7 · 1:48](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=108)
- "For CT imaging, a single phase with portal venous contrast is adequate" — Andrew Trout (guideline) [Ep 7 · 2:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=135)
- "MRI has advantages over CT in terms of soft tissue contrast with multiple different sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis" — Andrew Trout (clinical) [Ep 7 · 2:19](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=139)
- "Multiple CT phases including non-contrast, arterial and portal venous phases markedly increase radiation dose in children and do not provide much additional diagnostic information" (clinical) [Ep 7 · 2:33](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=153)
- "Non-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases" — Andrew Trout (guideline) [Ep 7 · 2:50](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=170)
- "Arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses" (guideline) [Ep 7 · 3:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=182)
- "Key MRI sequences are 3D MRCP to characterize the duct and its relationship to the bile duct, and T1 weighted sequence to understand parenchymal health" — Andrew Trout (clinical) [Ep 7 · 3:13](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=193)
- "MRI exams can often be performed without IV contrast except for initial characterization when understanding vascular complications or fluid collections" — Andrew Trout (guideline) [Ep 7 · 3:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=205)
- "Cincinnati Children's has an in-house 10 gene pancreatitis risk panel to screen for genetic links to pancreatitis" (clinical) [Ep 7 · 3:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=236)
- "It is advised to work closely with a genetic counselor before sending genetic testing to help the family choose the test and interpret it afterwards" — Maisaabel Haija (guideline) [Ep 7 · 4:06](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=246)
- "Genetic testing plays a vital role in early diagnosis and prognosis of pancreatic diseases, potentially guiding new preventative and therapeutic interventions" (opinion) [Ep 7 · 4:17](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=257)
- "Exocrine and endocrine function need assessment because they can decline over time in chronic pancreatitis" — Maisaabel Haija (clinical) [Ep 7 · 4:32](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=272)
- "Problems related to chronic pancreatitis include macro and micronutrient deficiencies, growth problems, small intestinal bacterial overgrowth, and risk for tumors in adulthood" — Maisaabel Haija (clinical) [Ep 7 · 4:49](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=289)
- "Treatment starts with assessing disease stage, finding extent of exocrine or endocrine problems, and correcting nutrient abnormalities and growth issues" — Maisaabel Haija (guideline) [Ep 7 · 5:18](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=318)
- "For pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing" (guideline) [Ep 7 · 5:33](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=333)
- "Pancreatic enzyme replacement is reserved only for cases with documented exocrine pancreatic insufficiency" (guideline) [Ep 7 · 5:39](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=339)
- "When medical management fails and the patient continues to have symptoms, endoscopic management is considered" — Maisaabel Haija (guideline) [Ep 7 · 5:46](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=346)
- "Endoscopic therapy relies on two methods: endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP)" (clinical) [Ep 7 · 5:55](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=355)
- "ERCP is an imaging and interventional modality where the endoscopist can evaluate pancreatic or biliary ducts and treat problems with scarring or strictures" — Maisaabel Haija (clinical) [Ep 7 · 6:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=362)
- "Pain management follows a stepwise ladder approach starting with opiate-sparing medications and reserving opiates for severe pain cases" (guideline) [Ep 7 · 6:22](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=382)
- "Opiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist" (clinical) [Ep 7 · 6:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=385)
- "Multidisciplinary pain management includes a pain specialist, psychologist, and physical therapist to address all aspects of pain's impact on the patient's body" — Maisaabel Haija (guideline) [Ep 7 · 6:47](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=407)
- "Psychologists assess pain's functional and emotional impact, as chronic pain can significantly affect daily functioning" (clinical) [Ep 7 · 6:59](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=419)
- "Cognitive behavioral therapy (CBT) is incorporated in pain management at Cincinnati Children's and has been shown in other chronic conditions to be helpful in managing pain" (clinical) [Ep 7 · 7:10](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=430)
- "TPIAT is one of the most complex abdominal surgical procedures performed in children" — Juan Gurria (clinical) [Ep 8 · 0:48](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=48)
- "Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis" — Juan Gurria (clinical) [Ep 8 · 0:54](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=54)
- "Patients are candidates for TPIAT when all medical and endoscopic therapy has failed" — Juan Gurria (guideline) [Ep 8 · 1:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=62)
- "TPIAT patients usually have a genetic mutation that drives the disease" (clinical) [Ep 8 · 1:08](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health" (clinical) [Ep 8 · 1:08](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "Full evaluation by the Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia and pain team" — Juan Gurria (clinical) [Ep 8 · 1:23](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=83)
- "Patients are prepared with vaccinations for potential splenectomy before surgery" — Juan Gurria (clinical) [Ep 8 · 1:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=109)
- "Pain catheters are placed in the transversus abdominis muscle by pain specialists" — Juan Gurria (clinical) [Ep 8 · 2:40](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=160)
- "Central venous catheter placement uses ultrasound for vein puncture and fluoroscopy for appropriate insertion" (clinical) [Ep 8 · 2:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=166)
- "The pancreas has often been injured for years, which makes the dissection procedure quite challenging" — Juan Gurria (clinical) [Ep 8 · 3:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=194)
- "Blood supply to the pancreas is preserved until the very last moment because hypoxia of islet cells cannot be risked" — Juan Gurria (clinical) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=246)
- "Digestive enzymes including collagenases and neutral proteases are injected into pancreatic ducts to break down extracellular matrix" — Rita Bottino (clinical) [Ep 8 · 4:51](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Enzyme injection turns the solid pancreas organ into liquid form by releasing islet cells and exocrine cells" (clinical) [Ep 8 · 5:24](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=324)
- "Islet number correlates with good outcome" — Rita Bottino (clinical) [Ep 8 · 5:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=345)
- "Maximum infusion volume is 5 mL per bag with 3 bags maximum per patient" (clinical) [Ep 8 · 5:59](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=359)
- "Islet cells are suspended in medium with albumin, heparin, and antibiotics" — Rita Bottino (clinical) [Ep 8 · 6:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=374)
- "Islet cells are infused into the portal vein with the goal of implanting in the liver and producing insulin" — Juan Gurria (clinical) [Ep 8 · 7:15](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=435)
- "Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis" — Juan Gurria (clinical) [Ep 8 · 7:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Portal vein thrombosis could cause significant morbidity to the patient" — Juan Gurria (clinical) [Ep 8 · 7:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Patients are placed in intensive care unit to control hemodynamics and fluid shift balance" — Juan Gurria (clinical) [Ep 8 · 8:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=481)
- "Islet cells need to heal in a homeostatic environment" — Juan Gurria (clinical) [Ep 8 · 8:12](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=492)
- "Glucose and insulin are controlled via exogenous infusions post-operatively" — Juan Gurria (clinical) [Ep 8 · 8:18](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=498)
- "Nutrition is key in the healing of connections between the biliary tract and gastrointestinal tract" — Juan Gurria (clinical) [Ep 8 · 8:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=502)
- "Discharge criteria include well-controlled pain, full feeds via tube or by mouth, and well-controlled glucose via continuous glucose monitoring" — Juan Gurria (clinical) [Ep 8 · 8:39](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=519)
- "Up to 50% of patients with chronic pancreatitis will eventually require surgery" — Juan Gurria (epidemiological) [Ep 5 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=100)
- "Most of the pancreatic parenchyma is in the head and the uncinate process" — Juan Gurria (clinical) [Ep 5 · 1:28](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=88)
- "Patients with PRSS1 mutation will get recurrent attacks if only the pancreatic head is removed" — Juan Gurria (clinical) [Ep 5 · 1:33](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=93)
- "Patients with chronic pancreatitis always have micro and macronutrient deficiencies" — Juan Gurria (clinical) [Ep 5 · 2:18](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=138)
- "Patients with chronic pancreatitis sometimes need pancreatic enzyme replacement therapy" — Juan Gurria (clinical) [Ep 5 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=153)
- "You lose first your exocrine and then your endocrine function in chronic pancreatitis" — Juan Gurria (clinical) [Ep 5 · 2:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=160)
- "All TPIAT patients have enzyme replacement therapy" — Juan Gurria (clinical) [Ep 5 · 3:06](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=186)
- "With islet cell count of 5000, there is 50% chance of not requiring insulin" — Juan Gurria (clinical) [Ep 5 · 3:23](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=203)
- "20% chance of requiring a small dose of insulin after TPIAT" — Juan Gurria (clinical) [Ep 5 · 3:36](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=216)
- "30% of TPIAT patients are still diabetics" — Juan Gurria (clinical) [Ep 5 · 3:40](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=220)
- "TPIAT surgery takes on average 8 to 10 hours" — Juan Gurria (clinical) [Ep 5 · 4:25](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=265)
- "Pancreas removal takes 3 to 4 hours" — Juan Gurria (clinical) [Ep 5 · 4:51](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=291)
- "Islet cell isolation takes 4 to 4.5 hours" — Juan Gurria (clinical) [Ep 5 · 5:35](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=335)
- "Islet cells are injected into the portal vein inside the liver" — Juan Gurria (clinical) [Ep 5 · 5:39](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=339)
- "All patients are on insulin in the ICU post-TPIAT to avoid stressing the cells" — Juan Gurria (clinical) [Ep 5 · 6:12](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=372)
- "Islet cells implant in the end branches of the portal vein inside the liver" — Juan Gurria (clinical) [Ep 5 · 6:27](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=387)
- "Extrahepatic reimplantation of islet cells does not work as well as intrahepatic" — Juan Gurria (clinical) [Ep 5 · 6:34](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=394)
- "Extrahepatic islet cells have good glucagon reaction for hypoglycemia compared to intrahepatic" — Juan Gurria (clinical) [Ep 5 · 6:43](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=403)
- "The best site for islet cell reimplantation is the liver" — Juan Gurria (clinical) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=411)
- "Risk for portal vein thrombosis after islet injection is very low, less than 1%" — Juan Gurria (clinical) [Ep 5 · 6:54](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=414)
- "The duodenum is taken right at D1 post pyloric during TPIAT" — Juan Gurria (clinical) [Ep 5 · 7:05](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=425)
- "Duodenum-sparing is difficult due to shared blood supply with pancreas" — Juan Gurria (clinical) [Ep 5 · 7:10](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=430)
- "Direct pancreatic function testing means obtaining function directly from the pancreas, not relying on stool testing for fecal elastase." (clinical) [Ep 1 · 0:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=5)
- "Endoscopic pancreatic function testing replaced the duodenal-tube (drilling) method by the end of the 1990s/early 2000s." (clinical) [Ep 1 · 2:07](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=127)
- "Dr. Conwell and colleagues at Tyler Stevens launched endoscopic function testing, showing comparable results to duodenal-tube testing for bicarbonate and lipase measurement." (clinical) [Ep 1 · 2:13](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=133)
- "Endoscopic collection became the standard because duodenal-tube testing requires the patient to be awake, placement of two tubes, and interventional radiology." (clinical) [Ep 1 · 2:39](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=159)
- "The Cincinnati protocol uses secretin 0.2 mcg/kg or CCK 0.04 mcg/kg at time zero, then collects duodenal aspirates every 5 minutes for three samples using an ERCP tapered catheter." (clinical) [Ep 1 · 3:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=185)
- "The lab at Cincinnati Children's Hospital measures activities for four enzymes: trypsin, amylase, lipase, and chemotrypsin." (clinical) [Ep 1 · 3:46](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=226)
- "Pancreatic function can be abnormal if checked around an acute attack." (clinical) [Ep 1 · 4:25](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=265)
- "Exocrine pancreatic maturation occurs over the first 2 to 3 years of life." (clinical) [Ep 1 · 4:33](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=273)
- "MR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract." — Andrew Trout (clinical) [Ep 1 · 5:18](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=318)
- "The delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation." — Andrew Trout (clinical) [Ep 1 · 6:27](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=387)
- "MR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume." — Andrew Trout (clinical) [Ep 1 · 7:38](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=458)
- "Phantom studies have proven that MR can accurately quantitate fluid volume." — Andrew Trout (clinical) [Ep 1 · 8:13](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=493)
- "Preliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing." — Andrew Trout (clinical) [Ep 1 · 8:28](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=508)
- "Qualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency." — Andrew Trout (opinion) [Ep 1 · 8:49](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=529)
- "In chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct." — Andrew Trout (opinion) [Ep 1 · 9:41](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=581)
- "Low-fat diet, pancreatic enzyme replacement therapy (PERT), antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes." (clinical) [Ep 1 · 12:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=725)
- "The case patient was PRSS1-positive on genetic testing." (clinical) [Ep 1 · 12:43](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=763)
- "The case patient had low fecal elastase on two occasions and endoscopic PFTs showed low amylase and lipase, borderline low trypsin and chemotrypsin." (clinical) [Ep 1 · 12:47](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=767)
- "The case patient had normal hemoglobin A1C and normal mixed meal test for endocrine function." (clinical) [Ep 1 · 13:01](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=781)
- "The case patient showed evidence of ductal changes on ERCP, confirming chronic pancreatitis based on imaging and ERCP findings." (clinical) [Ep 1 · 13:09](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=789)
- "The case patient has been pain-free on PERT treatment for several months with catch-up growth." (clinical) [Ep 1 · 13:17](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=797)
- "The multidisciplinary pain consult at Cincinnati comprises three disciplines: pain physician (medical/psychosocial assessment, medication, interventional management), psychologist (100% of the time, not optional), and nurses." — Goldschneider (clinical) [Ep 1 · 15:00](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=900)
- "Cognitive-behavioral therapy is the standard, state-of-the-art therapy for pain management." — Goldschneider (guideline) [Ep 1 · 18:16](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1096)
- "The 13-year-old pain case had extensive psychiatric disabilities: bipolar disorder, attention deficit disorder, oppositional defiant disorder." — Goldschneider (clinical) [Ep 1 · 16:37](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=997)
- "The 13-year-old's recurrent pancreatitis episodes were timed almost specifically with visits to his father, when he went off all medical regimen (diet, enzyme therapy)." — Goldschneider (clinical) [Ep 1 · 17:23](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1043)
- "Topiramate was used for the 13-year-old's migraines and may have a role for visceral hyperalgesia where the gut has become sensitized by repeated inflammatory processes." — Goldschneider (clinical) [Ep 1 · 20:02](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1202)
- "Low-dose methadone was used for about 2 years in the 13-year-old case, and weaning off was not a problem when the time was right." — Goldschneider (clinical) [Ep 1 · 20:22](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1222)
- "In Ohio, informed consent is required for the use of opioids for chronic purposes in minors (law about a year old at time of recording)." — Goldschneider (guideline) [Ep 1 · 21:28](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1288)
- "The 13-year-old's pain resolved for a couple of years without any surgical or endoscopic intervention, came off all pain medications, returned to school, and surgery was deferred indefinitely." — Goldschneider (clinical) [Ep 1 · 22:21](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1341)
- "Discussing the neurobiology and neuropsychology of pain with families—using anecdotes like the paper-cut example (opening a lottery ticket vs. a bad report card)—helps destigmatize psychology referral." — Goldschneider (opinion) [Ep 1 · 24:04](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1444)
- "TPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work." — Joe Palermo (guideline) [Ep 3 · 5:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=328)
- "The main indication for TPIAT is chronic pain, not the transplant outcome; the primary goal is pain relief and full function, with insulin independence being secondary." — Jamie (opinion) [Ep 3 · 20:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1231)
- "TPIAT criteria include diagnosis of acute recurrent pancreatitis or chronic pancreatitis, chronic pain of greater than 6 months duration with either daily opioid use or severely impaired quality of life, absence of reversible cause, failure of medical or endoscopic intervention, and adequate beta cell function." — Jamie (guideline) [Ep 3 · 23:20](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1400)
- "Contraindications to islet autotransplantation include pre-existing insulin dependent diabetes mellitus, liver disease with portal hypertension or portal vein thrombosis." — Jamie (guideline) [Ep 3 · 23:59](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1439)
- "Patients with central sensitization of pain, functional pain disorders, drug seeking behavior, or severe psychosocial maladaptation do not do as well after TPIAT." — Jamie (clinical) [Ep 3 · 24:35](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1475)
- "Prior ductal drainage procedures and distal pancreatectomy compromise islet yield." — Jamie (clinical) [Ep 3 · 29:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1781)
- "Surgical drainage procedures are avoided in patients anticipated to require future TPIAT, particularly those with genetic etiologies." — Jamie (guideline) [Ep 3 · 29:50](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1790)
- "Portal vein pressures exceeding 25 centimeters of water pressure are associated with higher risk of portal vein thrombosis post TPIAT." — Jamie (clinical) [Ep 3 · 31:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1905)
- "Tight glucose control between 80 and 120 is critical postoperatively to protect from toxic hyperglycemia, as islets do not resume function immediately and rely on diffusion of nutrients and oxygen until neovascularization occurs over weeks to months." — Jamie (clinical) [Ep 3 · 32:43](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1963)
- "Up to 85-90% of TPIAT patients can achieve opioid independence, with most improvement occurring over the first several months." — Jamie (epidemiological) [Ep 3 · 36:56](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2216)
- "In children, 40% of TPIAT patients achieve insulin independence (typically over the first 12 months), 30% have partial graft function requiring basal insulin only, and 30% require basal-bolus insulin." — Jamie (epidemiological) [Ep 3 · 37:37](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2257)
- "Data from Minnesota shows the best outcomes in patients under 12 years old, with up to 55% insulin independence rate." — Jamie (epidemiological) [Ep 3 · 37:57](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2277)
- "Higher replicatory capacity of islets in younger children and possible islet neogenesis of ductal origin may explain better outcomes in younger patients." — Jamie (clinical) [Ep 3 · 38:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2294)
- "Islet function has been shown to be durable in children for as long as 10 years post TPIAT and is especially good for patients under 21 or with a short history of pancreatic disease." — Jamie (epidemiological) [Ep 3 · 38:26](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2306)
- "All TPIAT patients have delayed gastric emptying that resolves in several weeks, typically by 3-5 weeks." — Jamie (clinical) [Ep 3 · 30:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1841)
- "Complications occur in 15-20% of TPIAT cases, including bleeding (5-7%), abscesses, wound infections, bowel obstructions, portal vein thrombosis, and anastomotic leaks." — Jamie (epidemiological) [Ep 3 · 36:16](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2176)
- "Type 3C diabetes describes a pancreatic form of diabetes that is insulin deficient (unlike type 1 autoimmune or type 2 insulin resistant), must meet ADA criteria for diabetes, has negative islet antibodies, and requires insulin therapy not oral hypoglycemic agents." — Deb Elder (clinical) [Ep 3 · 11:05](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=665)
- "A normal peak insulin response to oral glucose tolerance load is typically at 30 minutes; a delayed peak at 60 minutes with blood sugar rising to 150 indicates subtle abnormalities in insulin secretion." — Deb Elder (clinical) [Ep 3 · 12:21](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=741)
- "Brittle diabetes, describing unpredictable extreme highs and lows, is reported in less than 1% of type 1 diabetes patients, and recent studies comparing total pancreatectomy patients with type 1 patients show no difference in complications." — Deb Elder (epidemiological) [Ep 3 · 21:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1293)
- "Tramadol is useful for mild to moderate pain because it does not generally slow gut motility as much as conventional opioids." — Ken Goldschneider (clinical) [Ep 3 · 16:42](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1002)
- "Sensitization in both the enteric and central nervous system from repeated inflammatory insults can lead to pain when all enzymes are normal, which is treated with neuropathic medications like tricyclic antidepressants and gabapentin, not opioids." — Ken Goldschneider (clinical) [Ep 3 · 17:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1053)
- "Splenectomy is performed routinely for TPIAT; attempts to preserve the spleen risk warm ischemia to islets during dissection and potential splenic infarction if relying only on short gastric vessels." — Jamie (clinical) [Ep 3 · 27:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1642)
- "Significant thrombocytosis occurs after TPIAT, likely not just related to splenectomy but possibly due to increased thrombopoietin levels produced by hepatocytes." — Jamie (clinical) [Ep 3 · 35:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2149)
- "Insulin independence is dependent on the number of islet equivalents transplanted, and there is a relationship between islet yield and severity of chronic pancreatitic changes by imaging or histopathology." — Jamie (clinical) [Ep 3 · 29:19](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1759)
- "Heparin anticoagulation is maintained intraoperatively and for one week postoperatively to prevent portal vein thrombosis from islet infusion." — Jamie (guideline) [Ep 3 · 31:38](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1898)
- "Dexamethasone infusion is used for the first 2 days postoperatively to decrease the instant blood mediated inflammatory response which has a potentially detrimental effect on islets." — Jamie (guideline) [Ep 3 · 33:17](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1997)
- "Acetaminophen is not used postoperatively because some continuous glucose monitoring systems will read falsely with it." — Ken Goldschneider (clinical) [Ep 3 · 34:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2071)
- "The expectation is to wean patients off opioids postoperatively because there is no pancreas to have acute inflammatory disorders, and visceral hyperalgesia from sensitization should not be treated with opioids." — Ken Goldschneider (opinion) [Ep 3 · 41:34](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2494)
- "Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes." — Joe Palermo (host_summary) [Ep 2 · 2:54](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=174)
- "Acute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes." — Joe Palermo (host_summary) [Ep 2 · 3:12](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=192)
- "Chronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP." — Joe Palermo (host_summary) [Ep 2 · 3:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=217)
- "Chronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency." — Joe Palermo (host_summary) [Ep 2 · 4:30](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=270)
- "Patients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss." — Joe Palermo (clinical) [Ep 2 · 5:48](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=348)
- "In adults, up to 70% of chronic pancreatitis cases are caused by alcohol." — Joe Palermo (host_summary) [Ep 2 · 11:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "In the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes." — Joe Palermo (epidemiological) [Ep 2 · 11:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "PRSS1 (cationic trypsinogen gene) is a gain-of-function gene causing hereditary pancreatitis, autosomal dominant, with 80% penetrance for acute pancreatitis, 50% for chronic pancreatitis, and more than 40% risk of pancreatic cancer." (host_summary) [Ep 2 · 12:29](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=749)
- "SPINK1 (trypsin inhibitor gene) is a modifier gene, autosomal recessive, but heterozygous patients can also develop disease." (host_summary) [Ep 2 · 13:32](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=812)
- "Severe CFTR mutations (e.g., delta 508) cause exocrine pancreatic insufficiency; patients who are pancreatic sufficient with CF mutations are at risk for pancreatitis and chronic pancreatitis." (host_summary) [Ep 2 · 13:59](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=839)
- "CTRC gene has been shown through functional studies to be linked to development of chronic pancreatitis and acute recurrent pancreatitis." (host_summary) [Ep 2 · 14:35](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=875)
- "In a local cohort of 50 patients (34 ARP, 16 CP), 55% of ARP patients and 68% of CP patients tested positive for mutations in CFTR, PRSS1, CTRC, or SPINK1." (epidemiological) [Ep 2 · 14:52](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=892)
- "Chronic pancreatitis patients were diagnosed earlier with the first attack, had more additional attacks, and were more likely to be exocrine insufficient compared to ARP patients." (epidemiological) [Ep 2 · 15:45](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=945)
- "CFTR gene was more commonly found in chronic pancreatitis patients compared to acute recurrent patients, and patients were more likely to have two genes affected than one." (epidemiological) [Ep 2 · 15:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=956)
- "Six additional genes beyond the original four (PRSS1, SPINK1, CFTR, CTRC) are now known to be associated with ARP and CP." (host_summary) [Ep 2 · 16:17](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=977)
- "A next-generation sequencing pancreas panel covering 10 genes will launch in October at Cincinnati Children's, offering efficient, low-cost testing with faster turnaround than whole exome sequencing." (clinical) [Ep 2 · 16:42](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1002)
- "PRSS1 penetrance is incomplete: half of patients with the gene develop chronic pancreatitis, not all." (host_summary) [Ep 2 · 19:31](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1171)
- "Heterozygous CFTR (one gene copy) increases the risk for chronic pancreatitis in children." (clinical) [Ep 2 · 19:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1196)
- "Combination of SPINK1 and CFTR mutations confers an approximately 800-fold relative risk of chronic pancreatitis." (epidemiological) [Ep 2 · 20:18](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1218)
- "The CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations." — Joe Palermo (clinical) [Ep 2 · 20:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1256)
- "Some patients with pancreas divisum do not develop pancreatitis, suggesting a two-hit or multi-hit hypothesis where additional risk factors (e.g., genetic mutations) increase disease propensity." (opinion) [Ep 2 · 23:07](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1387)
- "Direct pancreatic function testing means directly obtaining pancreatic function from the pancreas, not relying on stool testing like fecal elastase." (guideline) [Ep 2 · 24:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1480)
- "The endoscopic pancreatic function test protocol uses secretin (0.2 mcg/kg) or CCK (0.4 mcg/kg) at time zero, then collects duodenal aspirates via ERCP catheter every 5 minutes for three samples." (clinical) [Ep 2 · 27:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1660)
- "Samples are sent to Women's Children's Hospital lab to measure activities of trypsin, amylase, lipase, and chymotrypsin." (clinical) [Ep 2 · 28:21](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1701)
- "Pancreatic function can be abnormal if checked around an acute attack." (clinical) [Ep 2 · 29:08](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1748)
- "Pancreatic enzyme maturation occurs over the first 2 to 3 years of life." (clinical) [Ep 2 · 29:14](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1754)
- "MR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract." — Andrew Trout (clinical) [Ep 2 · 29:42](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1782)
- "In the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation." — Andrew Trout (clinical) [Ep 2 · 31:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1862)
- "MRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid." — Andrew Trout (clinical) [Ep 2 · 32:13](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1933)
- "Correlation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients." — Andrew Trout (clinical) [Ep 2 · 32:43](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1963)
- "Qualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency." — Andrew Trout (opinion) [Ep 2 · 33:24](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2004)
- "In chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment." — Andrew Trout (opinion) [Ep 2 · 34:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2055)
- "Low-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes." — Joe Palermo (host_summary) [Ep 2 · 36:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2200)
- "Pancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks." — Joe Palermo (clinical) [Ep 2 · 37:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2222)
- "The multidisciplinary pain team comprises a pain physician (medical/psychosocial assessment, medication, interventional procedures), a psychologist (cognitive behavioral therapy, school reintegration, family intervention), and a nurse." — Goldschneider (clinical) [Ep 2 · 39:31](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2371)
- "Psychology involvement is 100% of the time in the pain clinic, not optional, to address pain coping, functional and emotional impact, and school reintegration." — Goldschneider (clinical) [Ep 2 · 40:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2402)
- "Cognitive behavioral therapy is the standard, state-of-the-art therapy for pain management." — Goldschneider (host_summary) [Ep 2 · 42:51](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2571)
- "Opioids are a tool requiring risk assessment, mitigation, informed consent (mandated by Ohio law for chronic use in minors), controlled substance agreements, prescription history tracking, and use of the lowest effective dose." — Goldschneider (clinical) [Ep 2 · 45:38](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2738)
- "In the case of a 13-year-old with annular pancreas and chronic pancreatitis, multidisciplinary pain management (topiramate for migraines, low-dose methadone for 2 years, psychology, family intervention) resulted in pain resolution, return to school and activities, and indefinite deferral of Whipple surgery." — Goldschneider (clinical) [Ep 2 · 46:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2816)

## Changelog
- Sep 7: 4 items added automatically
- Sep 7: 6 items added automatically

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