# Jaundice — GCMD Library living collection

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

Updated: n/a · 3 episodes · 62 cited statements

## Episodes
### Evidence & Research
- [Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911.md)

### Case-Based Learning
- [Biliary Atresia-Case Presentation and Panel Discussion: Update Course 2014](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909) — video · 23:47 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909.md)

### In-Depth Reviews
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=0) PRETEXT Staging System and Case Presentation (Ep 1)
- [3:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=232) Management Strategies and Chemotherapy Response (Ep 1)
- [12:08](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=728) Transplant Versus Extended Resection (Ep 1)
- [18:56](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1136) Surgical Decision-Making and Biopsy Practices (Ep 1)
- [24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489) Pulmonary Metastases and Future Research (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=0) Case Presentation and Optimal Timing for Kasai (Ep 2)
- [7:01](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=421) Contraindications and Redo Procedures (Ep 2)
- [13:21](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=801) Diagnostic Workup: HIDA, Phenobarbital, and Liver Biopsy (Ep 2)
- [18:21](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1101) Postoperative Steroids and Japanese Technical Refinements (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=0) MMP-7 as a Prognostic Marker in Biliary Atresia (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "French registry data show significantly better 5- and 10-year native liver survival when Kasai performed before 30 days versus after 90 days, with nearly twice the survival rate" (clinical) [Ep 2 · 2:44](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=164)
- "In a Michigan series, children who had Kasai after 3 months had the best drainage and long-term outcomes" (clinical) [Ep 2 · 1:03](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=63)
- "Under 60 days there was a clear difference in outcomes; procedures done on weekends if approaching day 60" (clinical) [Ep 2 · 1:50](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=110)
- "The critical factor determining outcome is the degree of cirrhosis developed in the liver, which varies among children and does not always correlate directly with age" (clinical) [Ep 2 · 3:24](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=204)
- "Biliary atresia does not start at day zero in all patients; some may begin at day 20 and progress from there" (clinical) [Ep 2 · 3:53](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=233)
- "A series from Rich Ricketts showed not statistically significant better results with Kasai performed at 76 days or older versus 0-75 days" (clinical) [Ep 2 · 4:03](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=243)
- "Peter Altman from Columbia, who had the largest US series, argued Kasai should be done between 60 and 75 days" (opinion) [Ep 2 · 5:57](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=357)
- "Reversal of portal flow is very concerning because patients can achieve good biliary drainage and normal bilirubin but portal hypertension continues to progress, leading to transplant need" (clinical) [Ep 2 · 9:19](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=559)
- "Performing Kasai can buy time and increase the donor pool potential, even if the liver looks horrible" (clinical) [Ep 2 · 10:05](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=605)
- "Transplant becomes technically easier in older children with lower risk of hepatic artery thrombosis" (clinical) [Ep 2 · 10:27](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=627)
- "Hepatologists can manage biliary atresia patients medically for about a year in the absence of Kasai or transplant, though nutritional status is not optimal" (clinical) [Ep 2 · 10:41](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=641)
- "If patients have signs of end-stage liver disease with profound fibrosis and reversal of portal flow, Kasai may not improve outcomes and the operation may stress them unnecessarily" (opinion) [Ep 2 · 10:56](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=656)
- "The Kasai operation itself is not technically demanding with low technical risk, so if uncertain, redo procedures are reasonable" (opinion) [Ep 2 · 11:44](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=704)
- "Some biliary atresia cases show a race between hepatocyte regeneration and fibrosis progression; one patient's bilirubin dropped to normal 5 months post-op" (clinical) [Ep 2 · 12:20](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=740)
- "If liver biopsy is suggestive of biliary atresia, additional testing is not needed" (opinion) [Ep 2 · 14:02](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=842)
- "HIDA scan with phenobarbital has high sensitivity and specificity for biliary atresia" (clinical) [Ep 2 · 15:21](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=921)
- "An effective HIDA requires at least 5 days of phenobarbital at therapeutic levels" (clinical) [Ep 2 · 15:47](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=947)
- "In cases where initial HIDA without adequate phenobarbital was negative, about one-third showed biliary atresia when repeated with proper phenobarbital levels" (clinical) [Ep 2 · 16:40](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1000)
- "A recent paper in Gastroenterology showed a scoring system combining liver biopsy with clinical parameters had almost 100% ability to predict biliary atresia" (clinical) [Ep 2 · 17:35](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1055)
- "Pathologists' understanding of what to look for in biliary atresia biopsies has improved compared to 20 years ago" (clinical) [Ep 2 · 18:01](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1081)
- "Interventional radiologists can perform percutaneous liver biopsies safely and routinely" (clinical) [Ep 2 · 18:10](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1090)
- "Patent gallbladder in true biliary atresia is super rare" (clinical) [Ep 2 · 18:41](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1121)
- "In Milwaukee, percutaneous cholangiography combined with biopsy can quickly provide answers when successful" (clinical) [Ep 2 · 18:59](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1139)
- "If percutaneous cholangiography shows contrast in the gallbladder and bowel, biliary atresia is ruled out without need for surgery" (clinical) [Ep 2 · 19:49](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1189)
- "Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent" (clinical) [Ep 2 · 20:44](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1244)
- "Japanese centers still recommend steroids either routinely or when drainage decreases after Kasai" (clinical) [Ep 2 · 21:46](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1306)
- "Japanese surgeons now perform Kasai with wider porta dissection than Dr. Kasai originally did" (clinical) [Ep 2 · 22:15](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1335)
- "Japanese technique uses more superficial sutures to avoid damaging ductules and avoids placing sutures at 10 o'clock and 3 o'clock positions where normal bile ducts bifurcate" (clinical) [Ep 2 · 22:39](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1359)
- "Japanese centers claim better results with modified technique, though numbers are not statistically valid" (clinical) [Ep 2 · 23:06](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1386)
- "Yamataka is attempting to show laparoscopic Kasai results are as good as open, contrary to IPEG recommendations" (clinical) [Ep 2 · 23:08](https://library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1388)
- "The study was a retrospective cohort study conducted in China" — Cecilia Gigena (epidemiological) [Ep 3 · 0:11](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=11)
- "The study included 329 patients with biliary atresia" — Cecilia Gigena (epidemiological) [Ep 3 · 0:21](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=21)
- "40 of the 329 patients had low MMP-7 levels" — Cecilia Gigena (epidemiological) [Ep 3 · 0:21](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=21)
- "Patients with low MMP-7 had significantly lower 3-month jaundice clearance" — Cecilia Gigena (clinical) [Ep 3 · 0:27](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27)
- "Patients with low MMP-7 had significantly lower 6-month jaundice clearance" — Cecilia Gigena (clinical) [Ep 3 · 0:27](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27)
- "Patients with low MMP-7 had significantly lower 1-year native liver survival" — Cecilia Gigena (clinical) [Ep 3 · 0:27](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27)
- "Measuring MMP-7 can help with prognosis in biliary atresia patients" — Cecilia Gigena (opinion) [Ep 3 · 0:40](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=40)
- "MMP-7 measurement may in the future help with treatment of biliary atresia patients" — Cecilia Gigena (opinion) [Ep 3 · 0:40](https://library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=40)
- "PRETEXT staging stands for pretreatment extent of disease and is based on segmental liver anatomy prior to chemotherapy" (clinical) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "PRETEXT staging has a tendency to overstage because it is based purely on imaging and bulky tumors make it hard to assess true vascular invasion versus mass effect" (clinical) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "POSTTEXT refers to extensive disease after neoadjuvant chemotherapy has been given" (clinical) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "Key staging annotations include involvement of the retrohepatic cava or hepatic veins and the portal vein bifurcation" (clinical) [Ep 1 · 3:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=232)
- "COG recommendations state that PRETEXT stage 2 tumors with no vascular involvement and achievable 1 cm margin can be resected upfront without neoadjuvant chemotherapy" (guideline) [Ep 1 · 7:30](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=450)
- "COG feels that PRETEXT stage 1 and 2 tumors do not necessarily need referral to centers with liver resection expertise if the local surgeon feels competent" (guideline) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=475)
- "Most tumor shrinkage from chemotherapy occurs within the first two cycles" (clinical) [Ep 1 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "Current recommendations are that after two cycles of chemotherapy, if the tumor has not shrunk to a resectable point, the patient should be evaluated for transplant" (guideline) [Ep 1 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from the vascular supply, so chemotherapy does not improve vascular margins" (clinical) [Ep 1 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "The goal surgical margin for hepatoblastoma resection is 1 cm" (clinical) [Ep 1 · 12:08](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=728)
- "Survival in patients undergoing extended or heroic resections (tumor liver explants with back table resection and reimplant, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival" (clinical) [Ep 1 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- "There has been a move away from heroic resections for hepatoblastoma" (opinion) [Ep 1 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- "Patients who undergo failed resection followed by rescue transplant have worse survival than patients who undergo planned transplant upfront" (clinical) [Ep 1 · 14:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=892)
- "Patients should be referred to a transplant center early even if they may not ultimately need transplant, to have pre-transplant evaluation completed and be plugged into the system" (guideline) [Ep 1 · 15:48](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=948)
- "Primary transplant patients with hepatoblastoma do surprisingly well despite immunosuppression against rejection in the setting of cancer" (clinical) [Ep 1 · 16:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=998)
- "For non-transplant center surgeons, criteria for proceeding with resection include feeling 95% confident of success and ability to perform an anatomic resection with good margin" (opinion) [Ep 1 · 18:56](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1136)
- "Disease close to hepatic veins, disease extending across the liver, or involvement of the portal vein should prompt referral to a transplant center" (opinion) [Ep 1 · 19:54](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1194)
- "The truth about resectability is determined at the time of operation despite all available imaging" (opinion) [Ep 1 · 21:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1312)
- "In Europe, all liver tumors receive chemotherapy upfront before surgery because it results in smaller, easier-to-resect tumors" (clinical) [Ep 1 · 22:13](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1333)
- "Core needle biopsy for hepatoblastoma typically requires about 10 passes through an area that includes normal parenchyma and tumor" (clinical) [Ep 1 · 23:53](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1433)
- "There are two camps regarding pulmonary metastasis treatment: one advocates resecting metastases upfront before hepatectomy, the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites" (clinical) [Ep 1 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- "There is no good data on either side of the pulmonary metastasis timing debate, with both approaches limited to a handful of patients" (opinion) [Ep 1 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- "Papers on stage IV hepatoblastoma with lung metastases are limited to cohorts of less than 20 patients, making it hard to draw good conclusions" (epidemiological) [Ep 1 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- "There may be reporting bias in transplant outcomes because successes are reported but not all failures" (opinion) [Ep 1 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)

## Changelog
- Sep 7: 3 items added automatically

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