# Pancreatitis — GCMD Library living collection

Also covered as: chronic pancreatitis · acute pancreatitis · acute recurrent pancreatitis · necrotizing pancreatitis · gallstone pancreatitis · portal vein thrombosis · choledocholithiasis · multi-organ failure

Experts: Dr. Todd Ponsky, Dr. Andrew Trout, Dr. Juan Gurria, Dr. Jamie Nathan

Updated: n/a · 27 episodes · 549 cited statements

## Episodes
### Foundations
- [Welcome and Introductions: Pancreatic Disease](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969) — video · 6:04 · [machine version](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969.md)
- [Gallstone Disease](https://library.globalcastmd.com/watch/gallstone-disease-1379) — podcast · 47:36 · [machine version](https://library.globalcastmd.com/watch/gallstone-disease-1379.md)
- [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)

### Acute Management
- [Misconceptions of Acute Pancreatitis: Pancreatic Disease](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974) — video · 2:28 · [machine version](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974.md)
- [Update Course Rewind: Management of Acute Pancreatitis 2023](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523) — video · 6:46 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523.md)

### Medical Management
- [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)

### Nutritional Management
- [Enteral Nutritional Support For Pancreatitis: Practice Gap discussion at...](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351) — video · 16:15 · [machine version](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351.md)
- [Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451) — video · 1:00 · [machine version](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451.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)
- [Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706) — video · 7:31 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706.md)

### Complications
- [ERCP: Pancreatic Disease](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967) — video · 9:11 · [machine version](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967.md)
- [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735) — video · 3:53 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735.md)
- [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)
- [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736) — podcast · 3:53 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736.md)

### Evidence & Research
- [Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558.md)
- [Exploración laparoscópica trancística del conducto biliar común en pacientes pediátricos con coledocolitiasis](https://library.globalcastmd.com/watch/exploraci-n-laparosc-pica-tranc-stica-del-conducto-biliar-com-n-en-pacientes-pedi-tricos-con-coledocolitiasis-8937) — video · 1:01 · [machine version](https://library.globalcastmd.com/watch/exploraci-n-laparosc-pica-tranc-stica-del-conducto-biliar-com-n-en-pacientes-pedi-tricos-con-coledocolitiasis-8937.md)
- [Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122.md)

### Case-Based Learning
- [Acute Pancreatitis](https://library.globalcastmd.com/watch/acute-pancreatitis-871) — podcast · 45:24 · [machine version](https://library.globalcastmd.com/watch/acute-pancreatitis-871.md)
- [Acute Pancreatitis](https://library.globalcastmd.com/watch/acute-pancreatitis-293) — podcast · 45:24 · [machine version](https://library.globalcastmd.com/watch/acute-pancreatitis-293.md)
- [Case-Based Journal Review: Cholelithiasis 2024](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797) — podcast · 18:12 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797.md)

### In-Depth Reviews
- [Acute and Acute Recurrent Pancreatitis: Pancreatic Disease](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970) — video · 56:45 · [machine version](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970.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)

### Long-Term Care
- [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)
- [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)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=0) Post-resection pancreatitis risk in pediatric solid pseudopapillary neoplasms (Ep 25)
- [2:15](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=135) Introduction and speaker credentials (Ep 26)
- [4:47](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=287) Pediatric pancreatitis etiology and diagnosis (Ep 26)
- [9:10](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=550) Genetic mutations and hereditary pancreatitis (Ep 26)
- [15:00](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=900) Acute pancreatitis complications and management (Ep 26)
- [24:31](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1471) Chronic pancreatitis: transition and surgical indications (Ep 26)
- [32:48](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1968) Conventional surgical options and their limitations (Ep 26)
- [38:58](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2338) Total pancreatectomy with islet autotransplantation: rationale (Ep 26)
- [44:10](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2650) TPIAT technique and perioperative management (Ep 26)
- [50:54](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3054) TPIAT outcomes: pain, insulin independence, quality of life (Ep 26)
- [57:24](https://library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3444) Q&A: pseudocyst management, feeding, and referral pathways (Ep 26)
- [0:00](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=0) Introduction and Case Presentation (Ep 2)
- [4:03](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=243) Diagnostic Markers and Pain Management (Ep 2)
- [7:02](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=422) Nutrition Management: Challenging NPO Dogma (Ep 2)
- [14:29](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=869) IV Fluid Resuscitation Strategy (Ep 2)
- [20:05](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1205) Standardized Order Sets and Outcomes (Ep 2)
- [24:50](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1490) Case Progression: Severe Pancreatitis with Necrosis (Ep 2)
- [31:52](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1912) Management of Complicated Pancreatitis (Ep 2)
- [36:28](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=2188) Workup of Acute Recurrent Pancreatitis (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=0) Introduction and Acute Pancreatitis Case (Ep 13)
- [7:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=420) Acute Pancreatitis Management Principles (Ep 13)
- [13:30](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=810) Chronic Pancreatitis and Genetics (Ep 13)
- [19:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1180) Surgical Options for Chronic Pancreatitis (Ep 13)
- [27:30](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1650) TPIAT Technical Details and Q&A (Ep 13)
- [0:01](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=1) Case Presentation and Initial Management Options (Ep 17)
- [1:28](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=88) Role of Genetics in Treatment Planning (Ep 17)
- [3:37](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=217) Timing of Referral and Imaging Strategies (Ep 17)
- [5:11](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=311) Fluid Collections and Summary (Ep 17)
- [0:00](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=0) Introduction and Case Presentation: Timing of Cholecystectomy (Ep 18)
- [4:50](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=290) Predicting Choledocholithiasis: Machine Learning Algorithm (Ep 18)
- [7:50](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=470) Management of Choledocholithiasis: ERCP vs. Laparoscopic Exploration (Ep 18)
- [13:00](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=780) Role of ICG Fluorescent Cholangiography and Summary (Ep 18)
- [0:04](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=4) Practice Gap #9: Enteral Nutrition in Pancreatitis (Ep 10)
- [0:00](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=0) Introduction and Definition of Chronic Pancreatitis (Ep 20)
- [1:41](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=101) Diagnosis and Imaging Modalities (Ep 20)
- [3:41](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=221) Genetic Testing (Ep 20)
- [4:29](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=269) Consequences and Complications (Ep 20)
- [5:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=315) Treatment Approaches (Ep 20)
- [0:00](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=0) Introduction and Patient Selection (Ep 21)
- [2:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=121) Surgical Procedure (Ep 21)

## 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 25 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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)
- "Lipase half-life is about 7 days and is more specific than amylase for pancreatic pathology; amylase can be elevated in appendicitis, gynecologic conditions, and salivary disease" — Maissam Abu Al Haija (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=180)
- "Amylase rises and normalizes much quicker than lipase, so in a patient presenting 2 days after symptom onset, amylase may not be the best indicator" — Maissam Abu Al Haija (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=160)
- "Ultrasound is the initial imaging modality for acute pancreatitis because it is radiation-free and can identify gallstones and CBD dilation, but is limited for detecting complications" — Andrew Trout (clinical) [Ep 2 · 2:09](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=129)
- "There is no data identifying a superior pain medication in acute pancreatitis, even in adult studies" — Maissam Abu Al Haija (clinical) [Ep 2 · 6:21](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=381)
- "Opioids can be used appropriately in acute pancreatitis and may actually help advance feeds and improve outcomes when used in the right patient and setting" — Maissam Abu Al Haija (clinical) [Ep 2 · 6:35](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=395)
- "Early nutrition (within 24 to 72 hours) is associated with more favorable outcomes: maintains gut barrier function, inhibits bacterial translocation, and lowers incidence of systemic inflammatory response" — Maissam Abu Al Haija (clinical) [Ep 2 · 9:03](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=543)
- "A 2012 meta-analysis comparing TPN vs enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, surgical intervention rate, mortality, and infections" — Maissam Abu Al Haija (clinical) [Ep 2 · 9:38](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=578)
- "NG feeds and NJ feeds show no difference in outcomes; duration of hospital stay and mortality were very similar even in severe acute pancreatitis" — Maissam Abu Al Haija (clinical) [Ep 2 · 12:54](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=774)
- "The 2007 Ekerwal study randomized 60 adult patients to eat on admission vs NPO; the early feeding group had the same pain scores but decreased length of stay by 2 days" — Maissam Abu Al Haija (clinical) [Ep 2 · 13:19](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=799)
- "In a pediatric study of 38 admissions with mild pancreatitis, early nutrition was safe and feasible, with similar pain scores between fed and NPO patients" — Maissam Abu Al Haija (clinical) [Ep 2 · 14:35](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=875)
- "Pilot data showed patients who ate the most fat had the lowest pain scores, suggesting patients self-regulate and low-fat restriction may not be necessary" — Maissam Abu Al Haija (clinical) [Ep 2 · 15:40](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=940)
- "Adult studies show aggressive fluid resuscitation (more than one-third of 72-hour fluid volume in the first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours" — Maissam Abu Al Haija (clinical) [Ep 2 · 19:02](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1142)
- "In the late resuscitation group, patients received more total fluid than the early aggressive group, but outcomes were worse, indicating a critical 24-hour window for intervention" — Maissam Abu Al Haija (clinical) [Ep 2 · 19:45](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1185)
- "A 2011 study of 40 patients showed early resuscitation with lactated Ringer's led to reduced inflammation (measured by CRP) compared to normal saline, using goal-directed management targeting urine output of 3 mL/kg/hour" — Maissam Abu Al Haija (clinical) [Ep 2 · 20:18](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1218)
- "In a study of 201 patients, 35% of the NPO and low IV fluids group developed severe pancreatitis versus 4.2% in the early feeding and aggressive resuscitation group" — Maissam Abu Al Haija (clinical) [Ep 2 · 24:10](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1450)
- "CT is the imaging modality of choice for suspected complicated pancreatitis; a portal venous phase is sufficient without multi-phase imaging in pediatric patients" — Andrew Trout (clinical) [Ep 2 · 28:19](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1699)
- "Oral contrast is helpful in CT to separate fluid-filled bowel loops from pancreatic fluid collections, but is not a deal breaker if the patient cannot tolerate it" — Andrew Trout (clinical) [Ep 2 · 28:41](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1721)
- "Absent enhancement on contrast CT is highly concerning for pancreatic necrosis" — Andrew Trout (clinical) [Ep 2 · 29:51](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1791)
- "Ranson's criteria have not proven sensitive and specific when validated in pediatric studies, despite initial promise in a 2002 Midwest study" — Maissam Abu Al Haija (clinical) [Ep 2 · 30:31](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1831)
- "A Cincinnati study found that white blood cell count, albumin value, and lipase on admission together in a formula could predict severity in almost 70% of pediatric patients" — Maissam Abu Al Haija (clinical) [Ep 2 · 31:30](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1890)
- "Antibiotics should not be used routinely in mild pancreatitis or in severe pancreatitis unless there is infected necrosis; imipenem or 3rd generation cephalosporins are good initial choices when indicated" — Maissam Abu Al Haija (clinical) [Ep 2 · 32:59](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=1979)
- "MRCP is not the most helpful imaging in the acute attack because edema obscures ductal anatomy; it is better reserved for workup of biliary and pancreatic ductal issues after inflammation resolves" — Maissam Abu Al Haija (clinical) [Ep 2 · 5:28](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=328)
- "Acute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and a one-month pain-free interval, or normalization of enzymes with complete pain resolution in less than one month" — Maissam Abu Al Haija (guideline) [Ep 2 · 34:57](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=2097)
- "Workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic/mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP/ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC" — Maissam Abu Al Haija (guideline) [Ep 2 · 35:37](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=2137)
- "In adult literature, there is growing evidence for aggressive endoscopic necrosectomy via EUS-guided transmural approach with good outcomes, though pediatric evidence is extremely limited" — Tom Lynn (clinical) [Ep 2 · 41:12](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=2472)
- "Increased weight percentile for age (not BMI) during first attack predicts recurrence in a prospective Cincinnati registry of 85 patients over 3 years" — Maissam Abu Al Haija (epidemiological) [Ep 2 · 43:39](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=2619)
- "Higher BMI predicts severe pancreatitis course in adults and some pediatric studies outside the US, though this was not confirmed in the Cincinnati cohort possibly due to sample size and wide BMI variation" — Maissam Abu Al Haija (epidemiological) [Ep 2 · 44:06](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=2646)
- "The majority of pediatric pancreatitis cases are mild, defined as no evidence of pancreatic complications and no systemic inflammatory response syndrome or multi-organ failure" — Maissam Abu Al Haija (epidemiological) [Ep 2 · 7:27](https://library.globalcastmd.com/watch/acute-pancreatitis-871?t=447)
- "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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 6:01](https://library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=361)
- "Chile has the highest rate of cholelithiasis globally" — Jose Campos (epidemiological) [Ep 18 · 1:07](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=67)
- "Historical threshold for 'cool-off period' before cholecystectomy was 7-10 days in general surgery, later reduced to 2-3 days in pediatric surgery" — Jose Campos (clinical) [Ep 18 · 1:53](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=113)
- "In multi-center study of 246 patients (167 early, 79 delayed cholecystectomy), early cholecystectomy during index admission had 2% pancreatitis recurrence vs. 22% in delayed approach" — Cecilia Gigena (clinical) [Ep 18 · 3:11](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=191)
- "When cholecystectomy was delayed more than 6 weeks, pancreatitis recurrence rate increased to 60%" — Cecilia Gigena (clinical) [Ep 18 · 3:36](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=216)
- "Even with no stones remaining, 2% baseline recurrence rate of pancreatitis exists from initial insult" — Todd Ponsky (clinical) [Ep 18 · 3:44](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=224)
- "Early cholecystectomy did not result in increased biliary complications compared to delayed approach" — Cecilia Gigena (clinical) [Ep 18 · 4:27](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=267)
- "In gallstone pancreatitis, pain and elevated enzymes typically occur as the stone is passing, often resolving overnight" — Todd Ponsky (clinical) [Ep 18 · 5:01](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=301)
- "If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated; intraoperative cholangiogram is sufficient to check for retained stones" — Todd Ponsky (clinical) [Ep 18 · 5:36](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=336)
- "Western Pediatric Surgery Research Consortium machine learning algorithm for predicting CBD stones was developed from 1600 patients across 10 centers (2016-2019), with 20% having CBD stones" (clinical) [Ep 18 · 6:26](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=386)
- "The predictive algorithm has a 98% negative predictive value for common bile duct stones" — Jose Campos (clinical) [Ep 18 · 7:11](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=431)
- "Using the algorithm, risk of encountering unexpected CBD stone intraoperatively is only 2%" — Jose Campos (clinical) [Ep 18 · 7:22](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=442)
- "For patients with impacted CBD stone, worsening lipase, and increasing jaundice, ERCP is preferred because surgeon skill at retrieving impacted stones may be limited" — Todd Ponsky (opinion) [Ep 18 · 8:58](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=538)
- "Stones identified on ultrasound (non-impacted) are more amenable to intraoperative laparoscopic removal" — Todd Ponsky (clinical) [Ep 18 · 9:17](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=557)
- "In multi-center study of 252 patients (156 OR-first, 96 ERCP-first), OR-first approach with intraoperative cholangiogram had fewer complications and shorter length of stay" — Cecilia Gigena (clinical) [Ep 18 · 11:27](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=687)
- "86% of patients in OR-first group required only the initial surgery without subsequent ERCP" — Cecilia Gigena (clinical) [Ep 18 · 11:41](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=701)
- "The multi-center laparoscopic CBD exploration study included 4 centers with a broad range of surgeon expertise, demonstrating feasibility beyond single expert centers" — Jose Campos (clinical) [Ep 18 · 11:56](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=716)
- "14% of patients who underwent laparoscopic CBD exploration required subsequent ERCP without increased complications such as bile duct leak" — Jose Campos (clinical) [Ep 18 · 12:15](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=735)
- "In stepwise laparoscopic CBD exploration approach, 84% of CBD stones cleared with simple saline flush through ureteral catheter" — Jose Campos (clinical) [Ep 18 · 12:30](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=750)
- "ICG cholangiography study (2013-2023, 173 patients: 83 standard, 90 ICG) showed perioperative complication rate of 12% in standard technique vs. 0% with ICG" (clinical) [Ep 18 · 13:34](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=814)
- "ICG technique showed significantly shorter operative time, cystic duct isolation time, clipping time, and gallbladder removal time compared to standard technique" (clinical) [Ep 18 · 14:03](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=843)
- "Complete biliary tree visualization rate was significantly higher with ICG compared to standard technique" (clinical) [Ep 18 · 14:03](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=843)
- "ICG study compared different time periods (2013-2023) rather than concurrent randomized groups, introducing confounding from improved surgical technique and instrumentation over time" — Jose Campos (opinion) [Ep 18 · 14:25](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=865)
- "ICG study grouped all complications together without separately reporting common bile duct injuries, and bleeding complications are unlikely attributable to presence/absence of ICG" — Jose Campos (opinion) [Ep 18 · 14:43](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=883)
- "Zero complications in ICG group raises methodological concerns about reporting accuracy" — Jose Campos (opinion) [Ep 18 · 14:57](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=897)
- "ICG study compared ICG to simple visualization without intraoperative cholangiogram, not ICG vs. intraoperative cholangiogram" — Jose Campos (opinion) [Ep 18 · 15:38](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=938)
- "Intravenous ICG administration eliminates need for instrumentation of the biliary tree, which is a significant advantage" — Todd Ponsky (clinical) [Ep 18 · 15:26](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=926)
- "Early enteral feedings when not associated with vomiting decrease morbidity, infectious risk, and mortality in pancreatitis" — Ray (clinical) [Ep 10 · 0:17](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=17)
- "Nasogastric feeds are equally as tolerated as nasojejunal feeds in pancreatitis" — Ray (clinical) [Ep 10 · 0:26](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=26)
- "Earlier surgical intervention is recommended for gallstone pancreatitis" — Ray (guideline) [Ep 10 · 0:26](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=26)
- "Traditional teaching was to wait many days for amylase and lipase to normalize and for abdominal pain to resolve before starting feeds in pancreatitis" (opinion) [Ep 10 · 0:35](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=35)
- "Enteral feeding can be provided even in the presence of infected pancreatic phlegmon" (clinical) [Ep 10 · 0:49](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=49)
- "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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 20 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 8:39](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=519)
- "Dantes et al. performed a multi-center retrospective review of pediatric and adult patients treated for choledocholithiasis between 2018 and 2024" — Alex Halpern (epidemiological) [Ep 22 · 0:11](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=11)
- "724 patients were included in the study" — Alex Halpern (epidemiological) [Ep 22 · 0:22](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=22)
- "Surgery first approach with upfront laparoscopic cholecystectomy with intraoperative cholangiogram was performed in 201 pediatric patients and 169 adult patients" — Alex Halpern (clinical) [Ep 22 · 0:25](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=25)
- "Laparoscopic common bile duct exploration was attempted in 84 children and 140 adults in the surgery first group" — Alex Halpern (clinical) [Ep 22 · 0:35](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=35)
- "Common bile duct exploration success was higher in pediatric than adult patients" — Alex Halpern (clinical) [Ep 22 · 0:43](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=43)
- "Complication rates were similar between pediatric and adult patients in the surgery first approach" — Alex Halpern (clinical) [Ep 22 · 0:43](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=43)
- "A surgery first approach can be a safe and effective tool for managing choledocholithiasis in pediatric patients" — Alex Halpern (opinion) [Ep 22 · 0:49](https://library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=49)
- "Lipase half-life is about 7 days and is more specific than amylase because it is mostly elevated with intestinal or pancreatic pathology, whereas amylase can be elevated in appendicitis, gynecologic conditions, or salivary issues." — Maissam Abu Al Haija (clinical) [Ep 12 · 3:00](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=180)
- "Amylase rises and normalizes much quicker than lipase, so in a patient presenting 2 days after symptom onset, amylase may not be the best indicator." — Maissam Abu Al Haija (clinical) [Ep 12 · 2:40](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=160)
- "Ultrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas, though limited for detecting complications." — Andrew Trout (guideline) [Ep 12 · 2:09](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=129)
- "The most helpful use of ultrasound in acute pancreatitis is looking for a biliary component—CBD dilation (suggesting early ERCP) or gallstones—rather than documenting pancreatitis or looking for complications." — Maissam Abu Al Haija (clinical) [Ep 12 · 4:03](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=243)
- "CT is the imaging modality of choice for complicated acute pancreatitis cases to better visualize necrosis, fluid collections, hemorrhage, or masses." — Maissam Abu Al Haija (guideline) [Ep 12 · 5:00](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=300)
- "MRCP is not the first imaging modality to consider during an acute pancreatitis attack because edema tends to obscure ductal anatomy; it is reserved for workup of biliary and pancreatic ductal issues after the acute phase." — Maissam Abu Al Haija (clinical) [Ep 12 · 5:28](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=328)
- "There is no data identifying optimal pain management in acute pancreatitis; even adult studies have not identified a superior medication." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 6:21](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=381)
- "Opioids, when used in the right patient and setting in acute pancreatitis, can actually allow advancement of feeds, improve outcomes, and enable earlier discharge." — Maissam Abu Al Haija (clinical) [Ep 12 · 6:35](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=395)
- "Early enteral nutrition (within 24 to 72 hours) in acute pancreatitis is associated with more favorable outcomes: it maintains gut barrier function, inhibits bacterial translocation, and lowers the incidence of systemic inflammatory response." — Maissam Abu Al Haija (clinical) [Ep 12 · 9:03](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=543)
- "A 2012 meta-analysis comparing TPN versus enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, surgical intervention rate, mortality, and infections." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 9:32](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=572)
- "NG feeds versus NJ feeds in acute pancreatitis show no difference in outcomes; duration of hospital stay and mortality are very similar, even in severe acute pancreatitis." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 12:54](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=774)
- "The Ekerwal 2007 study randomized 60 adult patients to eat on admission versus NPO and found that early feeding did not increase abdominal pain and decreased length of stay by 2 days." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 13:19](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=799)
- "A Cincinnati Children's study of 38 admissions with mild pancreatitis showed early nutrition is safe and feasible in children and is not associated with worse pain outcomes." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 14:35](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=875)
- "Pilot analysis showed patients who ate the most fat had the lowest pain scores, likely because they self-regulate and are ready to eat more when clinically improving." — Maissam Abu Al Haija (clinical) [Ep 12 · 15:28](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=928)
- "Fat intake did not increase length of hospital stay in the Cincinnati pediatric pancreatitis cohort." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 16:09](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=969)
- "Adult studies show aggressive IV fluid resuscitation (more than one-third of 72-hour fluid volume in the first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 19:02](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1142)
- "In the late resuscitation group, patients received more total fluid than the early aggressive group, but outcomes were worse, indicating a critical 24-hour window for intervention." — Maissam Abu Al Haija (clinical) [Ep 12 · 19:53](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1193)
- "Small studies (40 patients each) suggest lactated Ringer's solution may reduce inflammation (measured by CRP) compared to normal saline in acute pancreatitis, but pediatric data are lacking." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 20:13](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1213)
- "Aggressive IV fluid resuscitation can cause pulmonary edema, and SIRS itself can contribute to this complication, so close monitoring of respiratory status is essential." — Maissam Abu Al Haija (clinical) [Ep 12 · 22:13](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1333)
- "A Cincinnati study of 201 patients showed that NPO with low IV fluids was associated with 35% developing severe pancreatitis, versus 4.2% in the group that ate early and received aggressive resuscitation." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 24:10](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1450)
- "The pancreas can be difficult to visualize on ultrasound in larger patients, when the patient is not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration." — Andrew Trout (clinical) [Ep 12 · 25:39](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1539)
- "CT is the test of choice when complications are suspected in acute pancreatitis; it provides the best view of the pancreas, adjacent structures, and potential complications like necrosis, fluid collections, and vascular thrombosis." — Andrew Trout (guideline) [Ep 12 · 29:05](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1745)
- "For pediatric pancreatitis CT, a single portal venous phase is sufficient; multi-phase imaging is not needed unless looking for masses. Oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not mandatory." — Andrew Trout (clinical) [Ep 12 · 28:19](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1699)
- "Absent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis." — Andrew Trout (clinical) [Ep 12 · 30:00](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1800)
- "Ranson criteria have not been validated in pediatric pancreatitis; early studies (2002 Midwest study) showed initial promise but subsequent validation studies showed insufficient sensitivity and specificity." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 30:31](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1831)
- "A Cincinnati admission-based prediction tool using white blood cell count, albumin, and lipase can predict severity in almost 70% of pediatric pancreatitis patients, though it still needs optimization." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 31:20](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1880)
- "Antibiotics should not be used routinely in mild acute pancreatitis or in sterile necrosis; they are reserved for infected necrosis, with imipenem or third-generation cephalosporins as preferred initial choices." — Maissam Abu Al Haija (guideline) [Ep 12 · 32:59](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=1979)
- "Acute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and a one-month pain-free interval, or normalization of enzymes with complete pain resolution in less than one month." — Maissam Abu Al Haija (clinical) [Ep 12 · 34:57](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2097)
- "Workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic/mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing (PRSS1, SPINK1, CFTR, CTRC)." — Maissam Abu Al Haija (guideline) [Ep 12 · 35:37](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2137)
- "Aspiration of pancreatic necrosis to distinguish sterile from infected necrosis is rarely indicated; there is risk of introducing infection into a sterile collection, and clinical judgment (fever, deterioration) guides empiric antibiotic use." — Maissam Abu Al Haija (opinion) [Ep 12 · 38:58](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2338)
- "Endoscopic necrosectomy via EUS-guided transmural access is emerging in adult literature with positive outcomes, but has not been performed at Cincinnati Children's due to lack of appropriate cases." — Tom Lynn (clinical) [Ep 12 · 41:12](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2472)
- "Secretin-enhanced MRCP may improve visualization of ductal anomalies, but adult literature shows iffy data on added value, and in pediatric acute recurrent pancreatitis the ducts are often dilated enough to see without secretin." — Andrew Trout (opinion) [Ep 12 · 42:36](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2556)
- "Cincinnati prospective registry data (85 patients, 3 years) shows increased weight percentile-for-age during the first pancreatitis attack predicts recurrence, though BMI did not show this association in the pediatric cohort." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 43:39](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2619)
- "Higher BMI may predict severe pancreatitis course in adults and possibly children, but the Cincinnati pediatric sample showed wide BMI variation in both recurrence and non-recurrence groups." — Maissam Abu Al Haija (epidemiological) [Ep 12 · 44:06](https://library.globalcastmd.com/watch/acute-pancreatitis-293?t=2646)
- "Restrictive transfusion policy with hemoglobin threshold of 7 g/dL rather than 9 g/dL will have no difference in mortality" (clinical) [Ep 1 · 1:03](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=63)
- "RBC transfusions may confer increased risk of DVT according to JAMA Surgery paper in adults and pediatrics (not NICU)" — Chuck (clinical) [Ep 1 · 1:20](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=80)
- "There is very strong evidence in adults that you should feed people with acute pancreatitis" — Chuck (clinical) [Ep 1 · 6:01](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=361)
- "Evidence in adults strongly recommends early feeding at 24 to 48 hours with enteral feedings" — Chuck (guideline) [Ep 1 · 6:22](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=382)
- "The route at which enteral feeds are given (nasogastric vs nasojejunal) doesn't seem to really make any difference" — Chuck (clinical) [Ep 1 · 6:28](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=388)
- "Very good evidence in adults from meta-analyses and multiple studies that enteral feedings reduces morbidity, infectious complications, and mortality, particularly with severe pancreatitis" — Chuck (clinical) [Ep 1 · 6:44](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=404)
- "There isn't any benefit to supplemental administration of specific amino acids like glutamine or arginine in pancreatitis cases" — Chuck (clinical) [Ep 1 · 7:05](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=425)
- "Most studies in children regarding enteral feeding in pancreatitis are fairly small and retrospective" — Chuck (epidemiological) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=437)
- "The myth from surgery training was that feeding would stimulate hormones and pancreas, but that's not the case" — Craig (opinion) [Ep 1 · 7:28](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=448)
- "Studies specifically tracked pain and lipase levels and found they didn't particularly correlate with enteral feeding - they didn't bump up with feeding" — Chuck (clinical) [Ep 1 · 8:09](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=489)
- "SAGES is now recommending and pushing forth new paradigm of trying lap with IOC first even for stuck stone, rather than pre-ERCP" (guideline) [Ep 1 · 12:54](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=774)
- "By the time ERCP is set up, stone has often passed, which is why there are so many negative ERCPs" (clinical) [Ep 1 · 13:23](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=803)
- "Experience shows you probably don't gain with delay in cholecystectomy timing; if you delay intermediate period you may be in worse spot" — Craig (clinical) [Ep 1 · 12:35](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=755)
- "Literature shows amylase and lipase are not good predictors of severity of pancreatitis" — Ron (clinical) [Ep 1 · 15:18](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=918)
- "There is no advantage of NJ versus NG feeds unless patient is vomiting and cannot tolerate NG feeds" — Chuck (clinical) [Ep 1 · 15:31](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=931)
- "Early enteral feeding with acute pancreatitis is safe and actually better than keeping patients NPO" (clinical) [Ep 1 · 15:45](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=945)
- "For gallstone pancreatitis, operate early during same hospitalization rather than delayed interval surgery" (clinical) [Ep 1 · 16:09](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=969)
- "ERCP was introduced in the 1970s as a purely diagnostic modality" (clinical) [Ep 9 · 0:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "ERCP has evolved from diagnostic to therapeutic modality over time" (clinical) [Ep 9 · 0:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "Advances in radiology have enabled non-invasive identification of abnormalities that previously required ERCP" (clinical) [Ep 9 · 0:10](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "CT provides value in complex cases and complex patients for pancreatic imaging" (clinical) [Ep 9 · 1:39](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=99)
- "Severe scoliotic curvature and spinal hardware make it difficult to get a good ultrasound" (clinical) [Ep 9 · 1:56](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=116)
- "Once you have established findings with CT, ultrasound can be used to target and follow areas of interest serially over time" (clinical) [Ep 9 · 3:05](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=185)
- "Ultrasound is easier on patients and lacks ionizing radiation compared to CT" (clinical) [Ep 9 · 3:36](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=216)
- "If ultrasound findings change dramatically or are unclear, return to cross-sectional imaging (CT or MRI) may be needed" (clinical) [Ep 9 · 3:05](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=185)
- "Therapeutic endoscopic therapy for pancreatic duct leak includes pancreatic sphincterotomy and pancreatic duct stent placement to allow flow of pancreatic juices to path of least resistance" (clinical) [Ep 9 · 5:33](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=333)
- "The goal of pancreatic duct stenting is to resolve the defect in the duct" (clinical) [Ep 9 · 5:33](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=333)
- "There is a growing number of pediatric gastroenterologists becoming skilled in performing ERCP" (epidemiological) [Ep 9 · 6:42](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "ERCP has the potential to exacerbate pancreatitis" (clinical) [Ep 9 · 6:42](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "The decision to proceed with ERCP should be based on clinical suspicion and institutional expertise availability" (opinion) [Ep 9 · 6:22](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=382)
- "A patient with an enlarging collection is potentially failing watchful waiting" (clinical) [Ep 9 · 8:40](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=520)
- "Conservative approach continuation was not acceptable to the patient's family" (clinical) [Ep 9 · 8:19](https://library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499)
- "Cincinnati Children's has been leading the world in pediatric surgical education" — Todd (opinion) [Ep 4 · 0:28](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=28)
- "The event will be recorded and available after 48 hours" — Todd (clinical) [Ep 4 · 1:22](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=82)
- "A new video portal will allow keyword searching to watch specific minutes of topics rather than entire events" — Todd (clinical) [Ep 4 · 1:27](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=87)
- "The Center of Telehealth at Cincinnati Children's is used every day by experts to help other physicians and patients around the world" — Todd (clinical) [Ep 4 · 2:00](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=120)
- "Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric surgeon and transplant surgeon, and surgical director of the Pancreatic Care Center" — Todd (clinical) [Ep 4 · 3:06](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=186)
- "The session will cover surgical approaches, interventional endoscopic approaches, acute pancreatitis, acute recurrent pancreatitis, chronic pancreatitis, and medical management over four hours" — Jamie Nathan (clinical) [Ep 4 · 3:38](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=218)
- "Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program" — Jamie Nathan (clinical) [Ep 4 · 4:05](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=245)
- "Ken Goldschneider is director of pain management at Cincinnati Children's and professor of clinical pediatrics and anesthesia, playing a central role in pain management for patients with pancreatic diseases" — Jamie Nathan (clinical) [Ep 4 · 4:23](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=263)
- "Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center" — Jamie Nathan (clinical) [Ep 4 · 4:40](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=280)
- "Tom Lynn is a gastroenterologist who takes care of the vast majority or all endoscopic needs in children with pancreatic disorders, director of endoscopy for the Pancreas Care Center, and co-director of endoscopy for the division of gastroenterology" — Jamie Nathan (clinical) [Ep 4 · 4:54](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=294)
- "Andrew Trout is the lead radiologist for the multidisciplinary Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine" — Jamie Nathan (clinical) [Ep 4 · 5:17](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=317)
- "Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the session" — Jamie Nathan (clinical) [Ep 4 · 5:33](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=333)
- "Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the session" — Jamie Nathan (clinical) [Ep 4 · 5:47](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=347)
- "There is no good data supporting the concern that opioids worsen pancreatitis by causing sphincter of Oddi spasm" (clinical) [Ep 7 · 0:18](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=18)
- "Data on opioids and pancreatitis is conflicting" (clinical) [Ep 7 · 0:29](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=29)
- "The majority of clinicians keep pancreatitis patients NPO until pain improves or lipase and amylase normalize" (epidemiological) [Ep 7 · 0:40](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=40)
- "Clinicians are commonly afraid of aggravating the pancreas with feeding" (opinion) [Ep 7 · 0:51](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=51)
- "Every mild pancreatitis case receives standardized management at the speaker's institution" (clinical) [Ep 7 · 1:07](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=67)
- "The hospital is 659 beds or almost 700 beds with expansion" (epidemiological) [Ep 7 · 1:10](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=70)
- "Standardizing pancreatitis management across a large hospital was very important" (opinion) [Ep 7 · 1:15](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=75)
- "Pancreatitis patients are managed on multiple floors including HMO, trauma, cardiac, GI, and general pediatrics" (clinical) [Ep 7 · 1:23](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=83)
- "If the pancreatic duct is not in continuity, patients probably cannot be fed" (clinical) [Ep 7 · 1:23](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=83)
- "Allowing children with mild pancreatitis to eat and self-regulate was the easiest management change to implement" (opinion) [Ep 7 · 1:36](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=96)
- "Data supports allowing pediatric pancreatitis patients to self-regulate their oral intake" (clinical) [Ep 7 · 1:44](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=104)
- "The institution has not moved to aggressive feeding in mild pancreatitis" (clinical) [Ep 7 · 1:49](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=109)
- "Patients with severe pancreatitis are probably not going to be able to eat" (clinical) [Ep 7 · 1:49](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=109)
- "In severe pancreatitis, enteral nutrition can expedite healing without tipping things over" (clinical) [Ep 7 · 1:54](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=114)
- "The electronic medical record makes it easy for providers to order standardized management" (clinical) [Ep 7 · 2:03](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=123)
- "The standardized approach could be implemented with paper orders or other electronic medical record systems" (opinion) [Ep 7 · 2:11](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=131)
- "The speaker has shared the standardized protocol with other institutions who found it helpful" (epidemiological) [Ep 7 · 2:22](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=142)
- "Direct pancreatic function testing means directly obtaining function from the pancreas, not relying on stool testing for fecal elastase" (clinical) [Ep 3 · 0:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=5)
- "The drilling method for pancreatic function testing uses a double lumen tube with one lumen suctioning gastric fluid and the other suctioning duodenal fluid directly in front of the ampulla" (clinical) [Ep 3 · 1:35](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=95)
- "Bicarbonate concentration is lower in chronic pancreatitis compared to normal controls in drilling method testing" (clinical) [Ep 3 · 1:48](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=108)
- "Endoscopic function testing replaced the drilling method by the end of the 1990s and beginning of the 2000s" (clinical) [Ep 3 · 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 drilling method" (clinical) [Ep 3 · 2:13](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=133)
- "Endoscopic testing became the standard because drilling requires the patient to be awake, placement of two tubes, and interventional radiology" (clinical) [Ep 3 · 2:39](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=159)
- "The protocol uses secretin at 0.2 micrograms per kilogram or CCK at 0.04 micrograms per kilogram given at time zero" (clinical) [Ep 3 · 3:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=185)
- "Duodenal aspirates are collected using separate syringes every five minutes for three collections using an ERCP tapered catheter" (clinical) [Ep 3 · 3:23](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=203)
- "The lab measures activities for four enzymes: trypsin, amylase, lipase, and chemotrypsin" (clinical) [Ep 3 · 3:48](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=228)
- "Pancreatic function can be abnormal if checked around an acute attack" (clinical) [Ep 3 · 4:25](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=265)
- "There is a maturation process of pancreatic function over the first 2 to 3 years of life in children" (clinical) [Ep 3 · 4:33](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=273)
- "MR pancreatic function testing acquires identical imaging both prior to and following administration of secretin" — Andrew Trout (clinical) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=318)
- "The delay between pre and post secretin imaging in their protocol is about 15 minutes to allow fluid to accumulate" — Andrew Trout (clinical) [Ep 3 · 6:27](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=387)
- "MR sequences can be thresholded to quantify the volume of fluid secreted by subtracting pre-secretin from post-secretin fluid volume" — Andrew Trout (clinical) [Ep 3 · 7:38](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=458)
- "Accurate fluid quantitation has been proven using phantoms in the MR scanner" — Andrew Trout (clinical) [Ep 3 · 8:13](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=493)
- "Preliminary data in about 35 patients is examining correlation between endoscopic pancreatic function testing and MR-based assessment" — Andrew Trout (clinical) [Ep 3 · 8:28](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=508)
- "Qualitative assessment of exocrine function appears different between pediatric and adult patients" — Andrew Trout (opinion) [Ep 3 · 8:49](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=529)
- "In chronic pancreatitis patients with ductal changes, the duct at baseline is dilated and abnormal, making it visible even without secretin" — Andrew Trout (clinical) [Ep 3 · 9:41](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=581)
- "Low fat diet, PERT, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes" (clinical) [Ep 3 · 12:05](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=725)
- "PERT may improve bloating and other GI symptoms in patients with pancreatic exocrine insufficiency" (clinical) [Ep 3 · 12:22](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=742)
- "A low fat diet is a healthier diet that may be helpful with symptoms" (opinion) [Ep 3 · 12:27](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=747)
- "The pain consult comprises three disciplines: pain physician for medical assessment and medication/interventional management, psychologist for psychosocial assessment and cognitive behavioral therapy, and nurses" — Goldschneider (clinical) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=900)
- "Psychology involvement is 100% of the time, not an optional modality" — Goldschneider (clinical) [Ep 3 · 15:24](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=924)
- "Cognitive behavioral therapy is the standard, state of the art therapy for pain management" — Goldschneider (guideline) [Ep 3 · 18:16](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1096)
- "In Ohio, informed consent is required for the use of opioids for chronic purposes in minors, a law implemented about a year ago" — Goldschneider (guideline) [Ep 3 · 21:28](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1288)
- "A controlled substance agreement laying out rules and expectations is important for understanding between physician and patient, though not medically-legally worth very much" — Goldschneider (opinion) [Ep 3 · 21:39](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1299)
- "Opioids should be viewed like any other medication or procedure - as a tool to do a job, using the right tool for the right patient" — Goldschneider (opinion) [Ep 3 · 20:40](https://library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1240)
- "Acute pancreatitis diagnosis requires 2 of 3 Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase at least 3 times upper limit of normal, and findings on imaging" — Abu Haija (guideline) [Ep 5 · 0:55](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=55)
- "Lipase half-life is about 7 days and is more specific for pancreatic pathology than amylase" — Abu Haija (clinical) [Ep 5 · 4:51](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=291)
- "Amylase rises and normalizes much quicker than lipase, making lipase more reliable in patients presenting 2 days after symptom onset" — Abu Haija (clinical) [Ep 5 · 4:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=271)
- "Ultrasound should be the initial imaging modality for acute pancreatitis to confirm diagnosis, screen for complications, and identify gallstones" — Abu Haija (guideline) [Ep 5 · 6:37](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=397)
- "CT is the imaging modality of choice for complicated pancreatitis cases to better visualize necrosis, fluid collections, hemorrhage, or masses" — Abu Haija (guideline) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=411)
- "MRCP is not the optimal imaging modality during acute pancreatitis attack because edema obscures ductal anatomy" — Abu Haija (clinical) [Ep 5 · 7:19](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=439)
- "There is no data identifying a superior pain medication for acute pancreatitis, even in adult studies" — Abu Haija (clinical) [Ep 5 · 8:12](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=492)
- "Appropriate use of opioids in acute pancreatitis can advance feeds, improve outcomes, and enable earlier discharge" — Abu Haija (clinical) [Ep 5 · 8:27](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=507)
- "Early enteral nutrition within 24 to 72 hours is associated with more favorable outcomes in acute pancreatitis" — Abu Haija (clinical) [Ep 5 · 10:19](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=619)
- "Early nutrition maintains gut barrier function, inhibits bacterial translocation, and lowers incidence of systemic inflammatory response" — Abu Haija (clinical) [Ep 5 · 10:32](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=632)
- "Meta-analysis in 2012 showed enteral nutrition versus TPN in predicted severe acute pancreatitis was associated with decreased organ failure and surgical intervention rate" — Abu Haija (clinical) [Ep 5 · 10:47](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=647)
- "NG feeds versus NJ feeds show no difference in outcomes including duration of hospital stay and mortality, even in severe acute pancreatitis" — Abu Haija (clinical) [Ep 5 · 14:43](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=883)
- "2007 study by Ekerwal randomized 60 adult patients to eat on admission versus NPO, showing same pain scores in both groups but 2 days shorter length of stay in early feeding group" — Abu Haija (clinical) [Ep 5 · 15:21](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=921)
- "Pediatric study of 38 admissions with mild pancreatitis showed early nutrition is safe, feasible, and not associated with worse pain outcomes" — Abu Haija (clinical) [Ep 5 · 16:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=991)
- "Pilot analysis showed patients who ate the most fat had the lowest pain scores, suggesting patients self-regulate fat intake appropriately" — Abu Haija (clinical) [Ep 5 · 17:30](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1050)
- "Adult studies show aggressive IV fluid resuscitation is associated with improved outcomes, defined as more than one-third of 72-hour fluid volume given in first day" — Abu Haija (clinical) [Ep 5 · 20:10](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1210)
- "Early aggressive fluid resuscitation was associated with reduced incidence of SIRS and organ failure at 72 hours" — Abu Haija (clinical) [Ep 5 · 20:36](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1236)
- "Study of 40 patients showed early resuscitation with lactated Ringer's led to reduced inflammation markers (CRP) compared to normal saline" — Abu Haija (clinical) [Ep 5 · 21:26](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1286)
- "Study comparing NPO/low IV fluids versus early PO/high IV fluids showed 35% versus 4.2% rate of developing severe pancreatitis" — Abu Haija (clinical) [Ep 5 · 26:09](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1569)
- "Acute recurrent pancreatitis is defined as at least 2 distinct episodes with complete resolution of pain and 1-month pain-free interval, or normalization of enzymes with pain resolution in less than 1 month" — Abu Haija (guideline) [Ep 5 · 37:19](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2239)
- "Comprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium), anatomic evaluation, and genetic testing" — Abu Haija (guideline) [Ep 5 · 38:00](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2280)
- "Prospective registry data shows increased weight percentile for age during first attack predicts recurrence in pediatric pancreatitis" — Abu Haija (epidemiological) [Ep 5 · 46:01](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2761)
- "Higher BMI predicts severe pancreatitis course in adults and children based on international studies" — Abu Haija (epidemiological) [Ep 5 · 46:21](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2781)
- "For infected necrosis, imipenem or 3rd generation cephalosporins are good initial antibiotic choices" — Abu Haija (guideline) [Ep 5 · 35:22](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2122)
- "In absence of fever, antibiotics are not indicated for sterile pancreatic necrosis" — Abu Haija (clinical) [Ep 5 · 34:56](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2096)
- "CT for pancreatitis should use portal venous phase only, not multi-phase, to assess for complications like venous thrombosis, necrosis, and fluid collections" — Andrew Trout (guideline) [Ep 5 · 33:31](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2011)
- "Oral contrast is helpful for CT to separate fluid-filled bowel loops from pancreatic fluid collections, but exam can provide useful information without it in sick patients" — Andrew Trout (clinical) [Ep 5 · 33:50](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2030)
- "Adult literature shows growing evidence for endoscopic necrosectomy via EUS with transmural approach showing good positive outcomes" — Tom Lin (clinical) [Ep 5 · 43:34](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2614)
- "Evidence for secretin use in pediatric MRCP is limited; adult literature shows iffy data on added value" — Andrew Trout (opinion) [Ep 5 · 45:01](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2701)
- "In chronic pancreatitis or acute recurrent cases, pancreatic ducts are often dilated enough to visualize without secretin" — Andrew Trout (clinical) [Ep 5 · 45:18](https://library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2718)
- "TPIAT is indicated for chronic pain unresponsive to medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes" — Joe Palermo (guideline) [Ep 8 · 4:44](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=284)
- "The main indication for TPIAT is chronic pain unresponsive to optimal medical and endoscopic approaches and significantly impaired quality of life" — Joe Palermo (guideline) [Ep 8 · 5:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=328)
- "Evaluation for TPIAT requires multidisciplinary assessment including gastroenterology, surgery, endocrine, pain team, human genetics, infectious disease, social workers and other ancillary services" — Joe Palermo (guideline) [Ep 8 · 6:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=362)
- "Social workers assess support structures, resources, and assist with school and work issues, with families away from home for at least 6 to 8 weeks for TPIAT" — Joe Palermo (clinical) [Ep 8 · 7:27](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=447)
- "Infectious disease team ensures immunizations are up to date, discusses post-splenectomy prophylaxis and management, and evaluates for MRSA colonization prior to surgery" — Joe Palermo (guideline) [Ep 8 · 7:52](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=472)
- "TPIAT benefits include improved quality of life, reduction of pain, less missed school days, participation in activities, and titration of pain medications" — Deb Elder (clinical) [Ep 8 · 8:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=511)
- "After TPIAT, patients will have an insulin dependent form of diabetes with hope for recovery and insulin independence over the course of a year, but immediately postoperatively they will need insulin" — Deb Elder (clinical) [Ep 8 · 9:00](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=540)
- "Type 3C diabetes describes a pancreatic form of diabetes that is insulin deficient, unlike type 1 diabetes which is autoimmune or type 2 diabetes which is insulin resistant" — Deb Elder (clinical) [Ep 8 · 11:05](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=665)
- "The choice of therapy in type 3C diabetes is insulin and not oral hypoglycemic agents" — Deb Elder (guideline) [Ep 8 · 11:27](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=687)
- "A normal peak insulin in response to oral glucose tolerance load is typically at 30 minutes" — Deb Elder (clinical) [Ep 8 · 12:21](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=741)
- "Tramadol is useful for moderate pain because it doesn't generally slow gut motility very much, avoiding GI slowing that occurs with conventional opioids" — Ken Goldschneider (clinical) [Ep 8 · 16:42](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1002)
- "Neuropathic medications like tricyclic antidepressants and gabapentin are used because sensitization occurs in both the enteric and central nervous system from repeated inflammatory insults" — Ken Goldschneider (clinical) [Ep 8 · 17:26](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1046)
- "Neuropathic pain from sensitization is not treated with opioids" — Ken Goldschneider (guideline) [Ep 8 · 17:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1069)
- "The primary goal of TPIAT is to relieve incapacitating pain or debilitation of acute recurrent pancreatitis, not the transplant itself" — Jamie (clinical) [Ep 8 · 20:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1231)
- "The goal of islet autotransplantation is to preserve alpha and beta cell mass as well as pancreatic polypeptide secreting cells to prevent or minimize potentially challenging diabetes" — Jamie (clinical) [Ep 8 · 21:03](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1263)
- "Brittle diabetes describes a form of diabetes with unpredictable extreme highs and extreme lows for no reason, thought to be due to lack of contraregulatory hormones when alpha cells are removed" — Deb Elder (clinical) [Ep 8 · 21:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1293)
- "Brittle diabetes is only reported in a small subset of type 1 diabetes patients, less than 1%, and recent studies comparing total pancreatectomy population with type 1 complications show no difference" — Deb Elder (epidemiological) [Ep 8 · 21:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1306)
- "Criteria for TPIAT include diagnosis of acute recurrent pancreatitis or chronic pancreatitis, chronic pain greater than 6 months duration with daily opioid use or severely impaired quality of life, absence of reversible cause, and failure of medical or endoscopic intervention" — Jamie (guideline) [Ep 8 · 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 8 · 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 8 · 24:35](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1475)
- "Perioperative pain protocol includes preoperative gabapentin, intraoperative methadone, ketamine infusion during and post-op, lidocaine infusion for first 8 hours, and dexmedetomidine infusion prior to ICU transport" — Ken Goldschneider (guideline) [Ep 8 · 25:51](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1551)
- "TPIAT involves total pancreatectomy and near total duodenectomy, preserving D1 to reduce bile reflux by creating a Roux limb and preserving the pylorus" — Jamie (clinical) [Ep 8 · 26:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1606)
- "Splenectomy is performed routinely for TPIAT; attempting to preserve the spleen risks warm ischemia to islets during dissection and potential spleen loss if relying only on short gastric vessels" — Jamie (clinical) [Ep 8 · 27:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1642)
- "Cholecystectomy and appendectomy are performed during TPIAT to prevent future complications" — Jamie (clinical) [Ep 8 · 28:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1681)
- "There is a relationship between islet yield and severity of chronic pancreatitic changes by imaging or histopathology" — Jamie (clinical) [Ep 8 · 29:19](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1759)
- "Insulin independence is dependent on the number of islet equivalents transplanted" — Jamie (clinical) [Ep 8 · 29:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1781)
- "Prior ductal drainage procedures and distal pancreatectomy compromise islet yield" — Jamie (clinical) [Ep 8 · 29:50](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1790)
- "Patients have delayed gastric emptying after TPIAT due to Roux limb reconstruction and pylorus preservation, which improves by about 3 to 5 weeks" — Jamie (clinical) [Ep 8 · 30:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1841)
- "Portal vein pressures exceeding 25 centimeters of water pressure are associated with higher risk of portal vein thrombosis post TPIAT" — Jamie (clinical) [Ep 8 · 31:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1905)
- "Insulin infusion is started early in the operation and is critical to maintain glycemic control post TPIAT to protect from toxic hyperglycemia" — Jamie (guideline) [Ep 8 · 32:19](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1939)
- "Islets do not resume function immediately after transplantation and rely on diffusion of nutrients and oxygen until neovascularization occurs, which takes weeks to months" — Jamie (clinical) [Ep 8 · 32:43](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1963)
- "Post-operative management includes heparin infusion for one week and dexamethasone infusion for first 2 days to decrease instant blood mediated inflammatory response" — Jamie (guideline) [Ep 8 · 33:10](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1990)
- "Tight glucose control is maintained between 80 and 120 mg/dL using continuous glucose monitoring" — Jamie (guideline) [Ep 8 · 33:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2008)
- "Acetaminophen is not used because some continuous glucose monitoring will read falsely with it" — Ken Goldschneider (clinical) [Ep 8 · 34:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2071)
- "Significant thrombocytosis occurs after TPIAT, likely not just related to splenectomy but may have mechanism based on increased thrombopoietin levels produced by hepatocytes" — Jamie (clinical) [Ep 8 · 35:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2149)
- "Complication rate for TPIAT is about 15 to 20%, with bleeding in 5 to 7%, and portal vein thrombosis in a handful of percent" — Jamie (epidemiological) [Ep 8 · 36:16](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2176)
- "Every patient gets a systemic inflammatory response with fevers for several days, typically resolving by post-op day 6 or 7" — Jamie (clinical) [Ep 8 · 36:29](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2189)
- "Up to 85-90% of TPIAT patients can achieve opioid independence" — Jamie (epidemiological) [Ep 8 · 37:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2222)
- "There is a reduction in pancreatitis type pain and severity of pain after TPIAT, with most improvement occurring over the first several months" — Jamie (clinical) [Ep 8 · 37:13](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2233)
- "40% of children achieve insulin independence after TPIAT, typically occurring over the first 12 months" — Jamie (epidemiological) [Ep 8 · 37:37](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2257)
- "30% of TPIAT patients have partial graft function requiring basal insulin, and 30% require basal-bolus insulin requirements" — Jamie (epidemiological) [Ep 8 · 37:48](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2268)
- "Best TPIAT outcomes are seen in patients under 12 years old, with up to 55% insulin independence rate" — Jamie (epidemiological) [Ep 8 · 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 potential islet neogenesis of ductal origin may explain better outcomes in younger patients" — Jamie (clinical) [Ep 8 · 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 short history of pancreatic disease" — Jamie (epidemiological) [Ep 8 · 38:26](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2306)
- "In Cincinnati's experience through 8 cases, there were no significant surgical complications, 4 patients are off opioids, 2 are actively weaning, 1 patient is off exogenous insulin, and 4 are aggressively weaning insulin" — Jamie (epidemiological) [Ep 8 · 38:40](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2320)
- "Acute pancreatitis could be fatal" — Juan Gurria (clinical) [Ep 14 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=116)
- "Pancreatitis is a state of hypoxia requiring re-establishment of intravascular flow to the pancreas to prevent hypoxia, necrosis, and atrophic pancreas insufficiency" — Juan Gurria (clinical) [Ep 14 · 2:06](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=126)
- "Early fluid resuscitation is the key to preventing pancreatic complications" — Juan Gurria (clinical) [Ep 14 · 2:22](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=142)
- "There is no reason to give antibiotics for pancreatitis, even in the face of necrosis or necrotizing pancreatitis, unless there are signs of sepsis or infected pancreatitis" — Juan Gurria (guideline) [Ep 14 · 2:29](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=149)
- "Fluid bolus of 10 to 20 mL per kg, up to 3L in the first 24 hours, with reassessment at 12-hour mark using urine output and vital signs" — Juan Gurria (guideline) [Ep 14 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=191)
- "Excessive fluid administration leads to worse outcomes because it can overload the lungs" — Juan Gurria (clinical) [Ep 14 · 3:25](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=205)
- "Maintenance fluids should be 1.5 to 2 times maintenance after initial resuscitation" (guideline) [Ep 14 · 3:31](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=211)
- "Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline" — Juan Gurria (clinical) [Ep 14 · 3:45](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=225)
- "If albumin is low, albumin should be given" — Juan Gurria (clinical) [Ep 14 · 3:54](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=234)
- "The Waterfall trial had to stop early because patients getting too much fluid were developing organ failure" — Juan Gurria (clinical) [Ep 14 · 4:10](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=250)
- "The Waterland trial is an upcoming multi-center, multi-country RCT that will compare lactated Ringer's to normal saline, expected in one to two years" — Juan Gurria (clinical) [Ep 14 · 4:27](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=267)
- "Enteral nutrition is significantly better compared to TPN or NPO for pancreatitis patients" — Juan Gurria (clinical) [Ep 14 · 4:47](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=287)
- "Gastric feeding is preferred over other routes if the patient can tolerate it" — Juan Gurria (clinical) [Ep 14 · 4:57](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=297)
- "Some vomiting is tolerable when attempting enteral feeding, similar to gastroschisis management" — Juan Gurria (opinion) [Ep 14 · 5:19](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=319)
- "If nutrition is lost and the patient is losing ground, outcomes will be worse with dropping albumin and worse inflammatory reaction" — Juan Gurria (clinical) [Ep 14 · 5:26](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=326)
- "Outcomes are dramatically better when feeding the gut compared to NPO or TPN" — Juan Gurria (clinical) [Ep 14 · 5:34](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=334)
- "ICU admission is indicated for patients who are not hemodynamically normal" — Juan Gurria (guideline) [Ep 14 · 1:52](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=112)
- "Bolus times 2 is adequate for initial fluid resuscitation, followed by 1.5x maintenance once past the early acute resuscitation phase" — Juan Gurria (guideline) [Ep 14 · 1:58](https://library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=118)
- "The study was a multi-center retrospective study conducted in the US from 2018 to 2022" — Cecilia Gigena (epidemiological) [Ep 16 · 0:09](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=9)
- "The study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first" — Cecilia Gigena (epidemiological) [Ep 16 · 0:09](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=9)
- "The study included 252 patients total" — Cecilia Gigena (epidemiological) [Ep 16 · 0:28](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=28)
- "156 patients were in group one (transcystic laparoscopic common bile duct exploration)" — Cecilia Gigena (epidemiological) [Ep 16 · 0:28](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=28)
- "96 patients were in group two (ERCP first)" — Cecilia Gigena (epidemiological) [Ep 16 · 0:38](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=38)
- "Patients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two" — Cecilia Gigena (clinical) [Ep 16 · 0:38](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=38)
- "Patients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two" — Cecilia Gigena (clinical) [Ep 16 · 0:38](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=38)
- "Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis" — Cecilia Gigena (opinion) [Ep 16 · 0:52](https://library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=52)
- "Up to 50% of patients with chronic pancreatitis will eventually require surgery" — Juan Gurria (epidemiological) [Ep 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 7:10](https://library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=430)
- "Patient is 16 years old undergoing treatment for acute lymphoblastic leukemia" — Luke Neff (clinical) [Ep 24 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=53)
- "Patient is neutropenic with markedly elevated liver function tests and ultrasound findings consistent with acute cholecystitis and choledocholithiasis" — Em Gootee (clinical) [Ep 24 · 0:56](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=56)
- "Patient is thrombocytopenic" — Luke Neff (clinical) [Ep 24 · 1:13](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=73)
- "Over 50% of audience opted to start antibiotics and address elevated liver function tests" — Em Gootee (opinion) [Ep 24 · 1:20](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=80)
- "Patient spontaneously passed the stone and LFTs came back down" — Luke Neff (clinical) [Ep 24 · 1:31](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=91)
- "Patient's counts recovered and proceeded to elective cholecystectomy" — Luke Neff (clinical) [Ep 24 · 1:34](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=94)
- "Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage" — Em Gootee (clinical) [Ep 24 · 1:49](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=109)
- "Blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas" — Em Gootee (clinical) [Ep 24 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=117)
- "Some surgeons do cholecystectomy within a few days for gallstone pancreatitis, some wait for a week" — Jeff Ponsky (opinion) [Ep 24 · 2:06](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=126)
- "From ERCP standpoint, unless there's persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis" — Jeff Ponsky (clinical) [Ep 24 · 2:13](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=133)
- "When symptoms are improving, proceed to cholecystectomy with intraoperative cholangiogram without waiting for biochemical normalization" (clinical) [Ep 24 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=145)
- "Studies show if amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because stone is impacted" — David Vitale (clinical) [Ep 24 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=158)
- "Most of the time amylase and lipase will go down, indicating the stone has passed, and can proceed to cholecystectomy" — David Vitale (clinical) [Ep 24 · 2:49](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=169)
- "Most stones can be cleared" — Luke Neff (clinical) [Ep 24 · 3:01](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=181)
- "Some stones pass spontaneously" — Luke Neff (clinical) [Ep 24 · 3:03](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=183)
- "Good judgment and local resources must be factored into management decisions" — Luke Neff (opinion) [Ep 24 · 3:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=185)
- "Stone disease is increasing along with obesity in pediatric patients around the world, not just in the United States" — Em Gootee (epidemiological) [Ep 23 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=52)
- "There are two main approaches for CBD stones requiring cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or surgery-first with IOC to identify and potentially remove stones during the same surgery" — Em Gootee (clinical) [Ep 23 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=85)
- "The choice between surgery-first and ERCP-first depends on the setting and the surgeon's technical capabilities" (opinion) [Ep 23 · 1:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=110)
- "A surgery-first pathway reduces resource utilization, including MRCP" — Em Gootee (clinical) [Ep 23 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=131)
- "ERCP adds potential morbidity, with a pancreatitis rate of 10% even when performed well" — Em Gootee (clinical) [Ep 23 · 3:02](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=182)
- "If a surgeon cannot perform a cholangiogram, then ERCP is necessary if available" — Em Gootee (clinical) [Ep 23 · 3:16](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=196)
- "Many pediatric surgeons lack confidence in intraoperative stone removal because they have been spoiled by ERCP availability and have done very few cases" (opinion) [Ep 23 · 3:23](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=203)
- "Pediatric surgeons need courses to learn the tricks of intraoperative stone removal" (opinion) [Ep 23 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=217)
- "If you know how to put in a central line and understand Seldinger technique, you can perform intraoperative stone removal" — Em Gootee (opinion) [Ep 23 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=224)
- "With a surgery-first mindset, stone clearance rate reflected by negative IOC was 86%" — Em Gootee (clinical) [Ep 23 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=230)
- "With simple adjuncts like advancing the catheter into the CBD or reaming the sphincter, success rate rises to the 90s" — Em Gootee (clinical) [Ep 23 · 4:01](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=241)
- "For the 15% of unsuccessful cases, the plan is to clip the cystic duct, close, and have ERCP performed within the next day or two, or same-day in the OR if an endoscopist is available" — Em Gootee (clinical) [Ep 23 · 4:17](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=257)
- "An endo-loop may be used instead of a clip when ERCP is planned, to facilitate subsequent endoscopic access" — Em Gootee (clinical) [Ep 23 · 4:56](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=296)
- "The learning curve for intraoperative stone removal is manageable: the first few times are difficult, but after a few cases it becomes easier and even enjoyable" — Em Gootee (opinion) [Ep 23 · 5:06](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=306)
- "The biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly" — Em Gootee (clinical) [Ep 23 · 5:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=315)
- "Success depends on IOC findings: a CBD chock full of 3-4 impacted stones is typically not amenable to surgery-first approach" — Em Gootee (clinical) [Ep 23 · 5:26](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=326)
- "When flushing an impacted stone, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis" — Em Gootee (clinical) [Ep 23 · 6:03](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=363)
- "If the pancreatic duct lights up during flushing, that is a signal to slow down and be careful to avoid causing pancreatitis" — Em Gootee (clinical) [Ep 23 · 6:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=375)
- "A study demonstrated 86% success rate for surgery-first, while the ERCP group had a 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia" — Em Gootee (clinical) [Ep 23 · 6:33](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=393)
- "Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes of pancreatitis" — Joe Palermo (epidemiological) [Ep 6 · 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 (guideline) [Ep 6 · 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 including ductal irregularities, calcifications, or pancreatic gland atrophy" — Joe Palermo (guideline) [Ep 6 · 3:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=217)
- "Patients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss" — Joe Palermo (clinical) [Ep 6 · 5:48](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=348)
- "In adults, alcohol causes up to 70% of chronic pancreatitis cases" — Joe Palermo (epidemiological) [Ep 6 · 11:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "In pediatric populations, the main risk factors for chronic pancreatitis are genetic, followed by obstructive or anatomic processes" — Joe Palermo (epidemiological) [Ep 6 · 11:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "PRSS1 is an autosomal dominant disorder causing acute pancreatitis in 80% of people who have the gene, chronic pancreatitis in about half, and pancreatic cancer in more than 40%" (clinical) [Ep 6 · 13:14](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=794)
- "SPINK1 is an autosomal recessive trypsin inhibitor gene that acts as a modifier, though heterozygous cases can result in disease" (clinical) [Ep 6 · 13:37](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=817)
- "Severe CFTR mutations like delta 508 cause exocrine pancreatic insufficiency, while patients who are pancreatic sufficient with CF mutations are at risk for pancreatitis and chronic pancreatitis" (clinical) [Ep 6 · 13:59](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=839)
- "In a study of 50 patients, 85% of acute recurrent pancreatitis patients and 100% of chronic pancreatitis patients received extensive genetic testing for CFTR, PRSS1, CTRC, and SPINK1" (clinical) [Ep 6 · 14:50](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=890)
- "55% of acute recurrent pancreatitis patients and 68% of chronic pancreatitis patients tested positive for genetic mutations" (epidemiological) [Ep 6 · 15:16](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=916)
- "Chronic pancreatitis patients were diagnosed earlier with first attack, had more additional attacks, and were more likely to be exocrine insufficient compared to acute recurrent pancreatitis patients" (clinical) [Ep 6 · 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 are more likely to have two genes affected compared to one" (clinical) [Ep 6 · 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) have become known to be associated with acute recurrent and chronic pancreatitis in the last 2 years" (clinical) [Ep 6 · 16:17](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=977)
- "PRSS1 penetrance shows that half of patients would get chronic pancreatitis, not everybody" (clinical) [Ep 6 · 19:31](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1171)
- "Heterozygous CFTR mutations by themselves increase the risk for chronic pancreatitis in kids" (clinical) [Ep 6 · 19:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1196)
- "The combination of SPINK1 and CFTR mutations carries an almost 800 relative risk of having chronic pancreatitis" (clinical) [Ep 6 · 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 to optimize CFTR function, particularly for atypical mutations" — Joe Palermo (clinical) [Ep 6 · 20:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1256)
- "There are patients with pancreas divisum who don't develop pancreatitis, suggesting a two-hit or multi-hit hypothesis where additional risk factors increase propensity to develop chronic disease" (clinical) [Ep 6 · 22:44](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1364)
- "Direct pancreatic function testing means directly getting function from the pancreas, not relying on stool testing for fecal elastase" (guideline) [Ep 6 · 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 at 0.2 micrograms per kilogram or CCK at 0.4 micrograms per kilogram, with duodenal aspirates collected every five minutes for three samples" (guideline) [Ep 6 · 27:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1660)
- "Pancreatic function can be abnormal if checked around an acute attack" (clinical) [Ep 6 · 29:00](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1740)
- "There is a maturation process of pancreatic function over the first 2 to 3 years of life" (clinical) [Ep 6 · 29:08](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1748)
- "MR pancreatic function testing acquires identical imaging both prior to and following secretin administration, with about 15 minutes between pre and post imaging" — Andrew Trout (guideline) [Ep 6 · 29:53](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1793)
- "MR sequences can be thresholded to quantify the volume of fluid secreted in response to secretin by subtracting pre from post measurements" — Andrew Trout (clinical) [Ep 6 · 32:00](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1920)
- "In chronic pancreatitis patients with dilated and abnormal ducts at baseline, it is unclear whether secretin is needed to increase conspicuity of the duct" — Andrew Trout (opinion) [Ep 6 · 34:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2055)
- "Low fat diet, pancreatic enzyme replacement therapy, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes" — Joe Palermo (clinical) [Ep 6 · 36:40](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2200)
- "A multidisciplinary pain team comprises a pain physician responsible for medical assessment and medication management, a psychologist providing cognitive behavioral therapy and functional assessment, and nurses" — Goldschneider (guideline) [Ep 6 · 39:31](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2371)
- "Cognitive behavioral therapy is the standard state of the art therapy for pain management" — Goldschneider (guideline) [Ep 6 · 42:51](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2571)
- "Opioids should be viewed as a tool for the right patient, with risk assessment, mitigation protocols, informed consent, controlled substance agreements, and prescription history tracking" — Goldschneider (guideline) [Ep 6 · 45:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2715)
- "The patient was a 16-year-old male currently undergoing treatment for acute lymphoblastic leukemia" — David Vitale (clinical) [Ep 27 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=53)
- "The patient was neutropenic with markedly elevated liver function tests" — David Vitale (clinical) [Ep 27 · 1:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=65)
- "Ultrasound findings were consistent with acute cholecystitis and choledocholithiasis" — David Vitale (clinical) [Ep 27 · 1:12](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=72)
- "Over 50% of the audience poll opted to start antibiotics and address the elevated liver function tests" — David Vitale (opinion) [Ep 27 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=85)
- "The patient spontaneously passed the stone and LFTs came back down" — David Vitale (clinical) [Ep 27 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=92)
- "After counts recovered, the patient proceeded to elective cholecystectomy" — David Vitale (clinical) [Ep 27 · 1:36](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=96)
- "Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage" (clinical) [Ep 27 · 1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=99)
- "In gallstone pancreatitis, blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas" (clinical) [Ep 27 · 1:55](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=115)
- "Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others wait for a week" (opinion) [Ep 27 · 2:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=125)
- "From an ERCP standpoint, unless there's persistent biliary obstruction or cholangitis, ERCP is not performed right away" (clinical) [Ep 27 · 2:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=135)
- "When symptoms are improving, biochemical normalization is not required before proceeding to cholecystectomy" — David Vitale (clinical) [Ep 27 · 2:24](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=144)
- "Cholecystectomy is performed with intraoperative cholangiogram and coordination with ERCP team in case there might be a need" — David Vitale (clinical) [Ep 27 · 2:31](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=151)
- "Studies show that if you wait one day when the patient comes in with acute biliary pancreatitis and amylase lipase go up, then ERCP is indicated for an impacted stone" (clinical) [Ep 27 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=158)
- "Most of the time in gallstone pancreatitis, amylase and lipase will go right down as the stone passes spontaneously" (clinical) [Ep 27 · 2:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=170)
- "When biochemical markers start going down, patients have passed the stone and can proceed to cholecystectomy" (clinical) [Ep 27 · 2:56](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=176)
- "Most stones can be cleared and some stones pass spontaneously" — David Vitale (clinical) [Ep 27 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=179)
- "Local resources and what is available must be factored into management decisions" — David Vitale (opinion) [Ep 27 · 3:05](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=185)
- "In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs" — Em Gaudi (clinical) [Ep 27 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=191)
- "For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention" — Em Gaudi (clinical) [Ep 27 · 3:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=205)
- "Timing of cholecystectomy should be based on clinical improvement rather than complete biochemical normalization" — Em Gaudi (clinical) [Ep 27 · 3:35](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=215)

## Changelog
- Aug 31: 24 doctors auto-found from episode dossiers
- Aug 30: 23 doctors auto-found from episode dossiers
- Aug 30: 23 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 27 doctors auto-found from episode dossiers
- Aug 29: 29 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 34 items, 29 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 30 items, 29 dossiers, summaries for 3 audience(s)
- Aug 29: Collection generated from campaign corpus: 30 items, 29 dossiers, summaries for 1 audience(s)

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