# Pediatric Liver Transplantation — GCMD Library living collection

Updated: n/a · 29 episodes · 92 cited statements

## Episodes
### Donor Selection and Preparation
- [Living Partial Liver Donation: A Life Saving Gift](https://library.globalcastmd.com/watch/living-partial-liver-donation-a-life-saving-gift-16008) — article · [machine version](https://library.globalcastmd.com/watch/living-partial-liver-donation-a-life-saving-gift-16008.md)
- [Machine Perfusion and Mitigating Risk Factors for Delayed Graft Function in Pediatric Kidney Transplant Recipients.](https://library.globalcastmd.com/watch/machine-perfusion-and-mitigating-risk-factors-for-delayed-graft-function-in-pedi-16038) — article · [machine version](https://library.globalcastmd.com/watch/machine-perfusion-and-mitigating-risk-factors-for-delayed-graft-function-in-pedi-16038.md)

### Surgical Techniques and Imaging
- [Pediatric Liver Transplant: Anatomic, Imaging, and Surgical Considerations-A Report of the Pediatric LI-RADS Working Group, From the AJR Special Series on Critical Anatomy](https://library.globalcastmd.com/watch/pediatric-liver-transplant-anatomic-imaging-and-surgical-considerations-a-report-16016) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-liver-transplant-anatomic-imaging-and-surgical-considerations-a-report-16016.md)
- [Pediatric Living Donor Liver Transplantation Outcomes-Is it Time for Outcome Optimization of Technical Aspects of Transplantation Using Learning Networks?](https://library.globalcastmd.com/watch/pediatric-living-donor-liver-transplantation-outcomes-is-it-time-for-outcome-opt-16068) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-living-donor-liver-transplantation-outcomes-is-it-time-for-outcome-opt-16068.md)
- [Hepatic Artery Pseudoaneurysm After Liver Transplantation](https://library.globalcastmd.com/watch/hepatic-artery-pseudoaneurysm-after-liver-transplantation-16079) — article · [machine version](https://library.globalcastmd.com/watch/hepatic-artery-pseudoaneurysm-after-liver-transplantation-16079.md)

### Perioperative Management
- [Ultra-Low Weight < 5 Versus 5-9.9-kg Pediatric Liver Transplant Recipients: Characteristics and Intraoperative Vasopressor Comparisons](https://library.globalcastmd.com/watch/ultra-low-weight-5-versus-5-9-9-kg-pediatric-liver-transplant-recipients-charact-16039) — article · [machine version](https://library.globalcastmd.com/watch/ultra-low-weight-5-versus-5-9-9-kg-pediatric-liver-transplant-recipients-charact-16039.md)
- [Anti-thymocyte globulin induction with delayed introduction of tacrolimus preserves renal function in pediatric liver transplant recipients](https://library.globalcastmd.com/watch/anti-thymocyte-globulin-induction-with-delayed-introduction-of-tacrolimus-preser-16061) — article · [machine version](https://library.globalcastmd.com/watch/anti-thymocyte-globulin-induction-with-delayed-introduction-of-tacrolimus-preser-16061.md)

### Complications and Outcomes
- [Impact of Hepatoblastoma on Infectious Complications Following Pediatric Liver Transplantation](https://library.globalcastmd.com/watch/impact-of-hepatoblastoma-on-infectious-complications-following-pediatric-liver-t-16011) — article · [machine version](https://library.globalcastmd.com/watch/impact-of-hepatoblastoma-on-infectious-complications-following-pediatric-liver-t-16011.md)
- [Children undergoing early liver re-transplantation for primary non-function have improved survival](https://library.globalcastmd.com/watch/children-undergoing-early-liver-re-transplantation-for-primary-non-function-have-16065) — article · [machine version](https://library.globalcastmd.com/watch/children-undergoing-early-liver-re-transplantation-for-primary-non-function-have-16065.md)
- [Pediatric liver transplant after traumatic liver injury: An analysis of the multicenter Scientific Registry of Transplant Recipients data set.](https://library.globalcastmd.com/watch/pediatric-liver-transplant-after-traumatic-liver-injury-an-analysis-of-the-multi-16049) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-liver-transplant-after-traumatic-liver-injury-an-analysis-of-the-multi-16049.md)

### Special Populations
- [Outcomes of Fontan patients undergoing combined heart-liver transplantation in pediatric hospitals across the United States](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-p-16012) — article · [machine version](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-p-16012.md)
- [Metabolic syndrome in liver transplantation: A preoperative and postoperative concern](https://library.globalcastmd.com/watch/metabolic-syndrome-in-liver-transplantation-a-preoperative-and-postoperative-con-16078) — article · [machine version](https://library.globalcastmd.com/watch/metabolic-syndrome-in-liver-transplantation-a-preoperative-and-postoperative-con-16078.md)

### Organ Donation Education
- [Pediatric Organ Donation and Transplantation: Across the Care Continuum](https://library.globalcastmd.com/watch/pediatric-organ-donation-and-transplantation-across-the-care-continuum-16059) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-organ-donation-and-transplantation-across-the-care-continuum-16059.md)

### More resources
- [HDAC1-Dependent Repression of Markers of Hepatocytes and P21 Is Involved in Development of Pediatric Liver Cancer](https://library.globalcastmd.com/watch/hdac1-dependent-repression-of-markers-of-hepatocytes-and-p21-is-involved-in-deve-16072) — article · [machine version](https://library.globalcastmd.com/watch/hdac1-dependent-repression-of-markers-of-hepatocytes-and-p21-is-involved-in-deve-16072.md)
- [Myoepithelioma of the gland of the third eyelid in a dog](https://library.globalcastmd.com/watch/myoepithelioma-of-the-gland-of-the-third-eyelid-in-a-dog-16085) — article · [machine version](https://library.globalcastmd.com/watch/myoepithelioma-of-the-gland-of-the-third-eyelid-in-a-dog-16085.md)
- [Patient and Family Resources](https://library.globalcastmd.com/watch/patient-and-family-resources-15230) — article · [machine version](https://library.globalcastmd.com/watch/patient-and-family-resources-15230.md)
- [Resources for Healthcare Professionals](https://library.globalcastmd.com/watch/resources-for-healthcare-professionals-15231) — article · [machine version](https://library.globalcastmd.com/watch/resources-for-healthcare-professionals-15231.md)
- [Researchers, Cincinnati Children's Hospital Medical Center](https://library.globalcastmd.com/watch/researchers-cincinnati-children-s-hospital-medical-center-15232) — article · [machine version](https://library.globalcastmd.com/watch/researchers-cincinnati-children-s-hospital-medical-center-15232.md)
- [Support Services | Cincinnati Children's Research Foundation](https://library.globalcastmd.com/watch/support-services-cincinnati-children-s-research-foundation-15233) — article · [machine version](https://library.globalcastmd.com/watch/support-services-cincinnati-children-s-research-foundation-15233.md)
- [Digestive Health Center (DHC)](https://library.globalcastmd.com/watch/digestive-health-center-16086) — article · [machine version](https://library.globalcastmd.com/watch/digestive-health-center-16086.md)
- [Research](https://library.globalcastmd.com/watch/research-16087) — article · [machine version](https://library.globalcastmd.com/watch/research-16087.md)
- [Newsroom](https://library.globalcastmd.com/watch/newsroom-15235) — article · [machine version](https://library.globalcastmd.com/watch/newsroom-15235.md)
- [Pdf Non Discrimination Statement.Pdf](https://library.globalcastmd.com/watch/pdf-non-discrimination-statement-pdf-15236) — article · [machine version](https://library.globalcastmd.com/watch/pdf-non-discrimination-statement-pdf-15236.md)
- [Choledochal Cyst Surgery: Roux-en-Y Hepaticojejunostomy Technique Explained w/ Dr. Alexander Bondoc](https://library.globalcastmd.com/watch/choledochal-cyst-surgery-roux-en-y-hepaticojejunostomy-technique-explained-w-dr-15968) — video · 0:31 · [machine version](https://library.globalcastmd.com/watch/choledochal-cyst-surgery-roux-en-y-hepaticojejunostomy-technique-explained-w-dr-15968.md)
- [Biliary Atresia: Diagnosis and Lifelong Follow-up for Jaundiced Children w/ Dr. Alexander Bondoc](https://library.globalcastmd.com/watch/biliary-atresia-diagnosis-and-lifelong-follow-up-for-jaundiced-children-w-dr-ale-15967) — video · 0:37 · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-diagnosis-and-lifelong-follow-up-for-jaundiced-children-w-dr-ale-15967.md)
- [Hepatoblastoma & Liver Transplant: Criteria for Transplantability in Pediatric Patients](https://library.globalcastmd.com/watch/hepatoblastoma-liver-transplant-criteria-for-transplantability-in-pediatric-pati-15963) — video · 0:34 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-liver-transplant-criteria-for-transplantability-in-pediatric-pati-15963.md)
- [Biliary Atresia - Clinical Practice Updates](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000) — video · [machine version](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000.md)
- [Biliary dyskinesia: diagnosis and management in pediatric patients](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088) — video · 2:15 · [machine version](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088.md)
- [Choledochal Cyst Podcast](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310) — podcast · 22:07 · [machine version](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=0) Case Presentation and Differential Diagnosis (Ep 27)
- [4:44](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=284) Diagnostic Algorithm and Laboratory Workup (Ep 27)
- [11:41](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=701) Imaging and Laparoscopic Diagnosis Debate (Ep 27)
- [20:28](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1228) Liver Biopsy Controversy and Centralization (Ep 27)
- [24:33](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1473) Cystic Biliary Atresia Variant (Ep 27)
- [0:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=0) Definition, Epidemiology, and Etiology of Choledochal Cysts (Ep 29)
- [2:01](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=121) Tadani Classification of Choledochal Cysts (Ep 29)
- [3:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=200) Clinical Presentation and Differential Diagnosis (Ep 29)
- [5:41](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=341) Diagnostic Workup (Ep 29)
- [7:53](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=473) Indications for Surgery and Malignancy Risk (Ep 29)
- [11:08](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=668) Surgical Goals and Type-Specific Approaches (Ep 29)
- [13:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=796) Surgical Technique for Type 1 and 4 Cysts (Ep 29)
- [18:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1120) Postoperative Management and Long-Term Outcomes (Ep 29)
- [0:04](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=4) Clinical presentation and diagnostic criteria for biliary dyskinesia (Ep 28)
- [0:59](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=59) Diagnostic workup and definitive treatment (Ep 28)
- [1:14](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=74) Treatment limitations and patient counseling (Ep 28)
- [1:37](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=97) Postoperative management and recovery timeline (Ep 28)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In the US and Europe, alpha-1 antitrypsin deficiency is the most common cause of neonatal cholestasis in the differential diagnosis — Jorge Bezerra (epidemiological) [Ep 27 · 3:22](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=202)
- By two weeks of age, if the baby still has jaundice, the pediatrician needs to fractionate the bilirubin; if the direct or conjugated fraction is elevated, think about pathologic jaundice — Jorge Bezerra (guideline) [Ep 27 · 4:16](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=256)
- The Taiwanese published in the Journal of Pediatrics in 2006 that they send all their kids home with stool color cards — Alex Bondoc (clinical) [Ep 27 · 6:13](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=373)
- MMP7 was identified as a serum marker of epithelial injury in biliary atresia through large-scale proteomic analysis of 30 children with biliary atresia in 2017 — Alex Bondoc (clinical) [Ep 27 · 9:59](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=599)
- MMP7 using a cutoff value of 52-53 nanograms per ml demonstrated a sensitivity of diagnosing biliary atresia of about 98% with a specificity of about 95% in 135 consecutive infants in China — Alex Bondoc (clinical) [Ep 27 · 10:40](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=640)
- The MMP7 assay is run every other day and is a six-hour assay — Jorge Bezerra (clinical) [Ep 27 · 12:51](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=771)
- MMP7 has the potential to eliminate a lot of other testing and eliminate things like a liver biopsy if confidence grows in its impact — Alex Bondoc (opinion) [Ep 27 · 13:10](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=790)
- Cutoff values for MMP7 changed depending on reports from Asia, with much lower cutoff levels reported from Taiwan and China — Jorge Bezerra (clinical) [Ep 27 · 12:20](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=740)
- A combination of blood tests and laparoscopy can diagnose biliary atresia promptly and accurately — Alex Bondoc (clinical) [Ep 27 · 14:44](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=884)
- Nearly all patients with biliary atresia have a hard liver, whereas hepatitis and Alagille syndrome patients have livers that are not as hard — Yamataka (clinical) [Ep 27 · 17:57](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1077)
- Bile duct proliferation and portal edema may not appear on very early liver biopsies and may delay diagnosis by up to 30 days — Alex Bondoc (clinical) [Ep 27 · 17:09](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1029)
- In Yamataka's series, 16 cases were not typical biliary atresia on laparoscopy, and all 16 were confirmed not to be biliary atresia, including 8 cases of Alagille syndrome — Yamataka (clinical) [Ep 27 · 19:13](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1153)
- If you do a Kasai operation on Alagille patients, you just shorten that patient's natural liver life and convert those patients to needing transplant at a much earlier age (clinical) [Ep 27 · 18:24](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1104)
- Infants coming to surgery for other matters who later turned out to have biliary atresia in the first week of life all had normal livers, so you can't diagnose early biliary atresia on liver biopsy — Mark Davenport (clinical) [Ep 27 · 22:18](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1338)
- Liver histology looking at inflammation and fibrosis has not shown great discrimination for prognosis in babies coming to surgery before 100 days — Mark Davenport (clinical) [Ep 27 · 23:08](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1388)
- Liver biopsy has additional value to quantify inflammation and use that information to personalize treatment — Jorge Bezerra (opinion) [Ep 27 · 24:04](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1444)
- The key differential for a prenatally detected cyst is between cystic biliary atresia and a choledochal cyst — Mark Davenport (clinical) [Ep 27 · 24:57](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1497)
- If the baby is not jaundiced and not raising conjugated bilirubin, then it's not cystic biliary atresia and you can wait to do the laparotomy — Mark Davenport (clinical) [Ep 27 · 25:51](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1551)
- Cystic biliary atresia patients get to surgery earlier, potentially because of prenatal diagnosis and heightened level of suspicion — Alex Bondoc (clinical) [Ep 27 · 26:20](https://library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1580)
- Choledochal cyst is a congenital cystic dilation of the biliary tree. — Alex Bondoc (clinical) [Ep 29 · 0:29](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=29)
- Incidence of choledochal cysts in the Western world is about 1 in 100,000. — Alex Bondoc (epidemiological) [Ep 29 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- In Eastern Asia, choledochal cyst incidence is 1 in 13,000. — Alex Bondoc (epidemiological) [Ep 29 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- Choledochal cysts are three to four times more likely in females than in males. — Alex Bondoc (epidemiological) [Ep 29 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- There is no genetic predisposition to choledochal cysts, but some genes including PKD1 have been identified in limited studies for type 5 choledochal cysts. — Alex Bondoc (clinical) [Ep 29 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- The most common classification system for choledochal cysts was developed by a surgeon named Tadani in Japan and includes five types. — Alex Bondoc (clinical) [Ep 29 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- For types 1 and 4 choledochal cysts, the etiology is likely embryologic, relating to pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel of the pancreaticobiliary duct. — Alex Bondoc (clinical) [Ep 29 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes in types 1 and 4 choledochal cysts. — Alex Bondoc (clinical) [Ep 29 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- In type 5 choledochal cysts, genetic mutation might predispose to more diffuse dilation of both the intra- and extrahepatic biliary trees. — Alex Bondoc (clinical) [Ep 29 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular. — Alex Bondoc (clinical) [Ep 29 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 2 choledochal cyst is a small diverticulum off of the common bile duct. — Alex Bondoc (clinical) [Ep 29 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 3 choledochal cyst is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum. — Alex Bondoc (clinical) [Ep 29 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree. — Alex Bondoc (clinical) [Ep 29 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only. — Alex Bondoc (clinical) [Ep 29 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- Type 5 choledochal cyst is intrahepatic only and diffusely throughout, called Caroli's disease, which can be diffuse or limited to one lobe or one hemi-liver. — Alex Bondoc (clinical) [Ep 29 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Patients with choledochal cysts can have a palpable right upper quadrant mass. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- The triad of jaundice, fever, and palpable right upper quadrant mass (Charcot's triad) is incredibly uncommon as a presentation of choledochal cysts. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Giant choledochal cysts in small children can perforate and present with biliary ascites. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Prenatally diagnosed choledochal cysts require fetal consultation at a fetal surgery center for establishment of care and counseling, because cystic biliary atresia must be ruled out postnatally. — Alex Bondoc (guideline) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- A recent citation demonstrated that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention. — Alex Bondoc (clinical) [Ep 29 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- Differential diagnosis for a one-year-old presenting with jaundice includes problems with the pancreatic or biliary tree, stone disease (choledocholithiasis, cholelithiasis), gallstone pancreatitis, and choledochal cyst. — Alex Bondoc (clinical) [Ep 29 · 5:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- A one-year-old with jaundice is a little old for biliary atresia, which is usually considered in an infant. — Alex Bondoc (clinical) [Ep 29 · 5:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- Physical exam findings to look for in suspected choledochal cyst include jaundice or scleral icterus and, in younger children, a palpable abdominal mass. — Alex Bondoc (clinical) [Ep 29 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- Labs to check for suspected choledochal cyst include liver function tests (total, direct, and indirect bilirubin levels) and possibly a CBC to look for evidence of cholangitis or infection. — Alex Bondoc (clinical) [Ep 29 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- The major initial screening imaging test for choledochal cyst is an abdominal ultrasound. — Alex Bondoc (clinical) [Ep 29 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- Liver biopsy is not typically needed for older patients with reliable ultrasound imaging, but becomes critical in neonates or newborns to rule out cystic biliary atresia variant. — Alex Bondoc (clinical) [Ep 29 · 6:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=385)
- CT scan is commonly used for choledochal cyst workup because of the ease with which young children can be scanned. — Alex Bondoc (clinical) [Ep 29 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- MRCP is useful for choledochal cysts with hilar or intrahepatic disease to understand the extent of cystic change and to identify variant biliary anatomy, which occurs in 15 to 20% of patients. — Alex Bondoc (clinical) [Ep 29 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- ERCP can be used for both diagnostic and therapeutic purposes in choledochal cysts, depending on prior scan findings and the type of cyst. — Alex Bondoc (clinical) [Ep 29 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- There are no non-surgical treatment options for choledochal cysts. — Alex Bondoc (clinical) [Ep 29 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Choledochal cysts require surgery due to the risk of recurrent cholangitis from biliary stasis and superinfection. — Alex Bondoc (clinical) [Ep 29 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Type 1 and type 4 choledochal cysts with pancreaticobiliary malunion carry approximately an 8% lifetime risk of hepatobiliary malignancy, most specifically cholangiocarcinoma and gallbladder cancer. — Alex Bondoc (clinical) [Ep 29 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Studies estimate the lifetime risk of malignancy in choledochal cysts to be anywhere from 6% to 30%. — Alex Bondoc (clinical) [Ep 29 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- Even after surgical resection of choledochal cysts, some studies suggest there is still about a 4% lifetime risk of malignancy, requiring lifelong surveillance. — Alex Bondoc (clinical) [Ep 29 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- If a patient with choledochal cyst presents with active infection, pancreatitis, or cholangitis, the best approach is to cool the patient off and treat the underlying process before scheduling surgery after sufficient recovery. — Alex Bondoc (clinical) [Ep 29 · 9:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- For incidentally found choledochal cysts, surgery should be scheduled sooner rather than later, when it makes sense for the family schedule. — Alex Bondoc (opinion) [Ep 29 · 9:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- Preoperative workup for choledochal cyst surgery includes laboratory values to ensure no other disease process is impairing liver function, and imaging (ultrasound and CT scan are often sufficient). — Alex Bondoc (clinical) [Ep 29 · 10:14](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- MRCP is recommended preoperatively if there is any question about the patient's anatomy or if the patient has a very proximal choledochal cyst or dilation into the hepatic ducts. — Alex Bondoc (clinical) [Ep 29 · 10:14](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- The surgical goal for choledochal cyst repair is complete excision of the cyst. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- For type 1 and type 4 choledochal cysts, the goal is to remove as much of the duct as possible, taking the duct all the way down behind or into the head of the pancreas to where it tapers, to avoid leaving remnant cyst. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- For type 1 and type 4 choledochal cysts, biliary drainage reconstruction often includes a Roux-en-Y hepaticojejunostomy, but a hepaticoduodenostomy is also an option. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- Type 2 choledochal cyst can be treated by simple removal of the diverticulum at its neck with repair of the common bile duct. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- Type 3 choledochal cyst (limited choledochocele) can be treated with ERCP and sphincterotomy. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- If type 3 choledochal cyst involves the wall of the duodenum, transduodenal resection options exist, and biopsy of the choledochocele mucosa is important because biliary epithelium exposed to intestinal secretions could become malignant. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- Type 5 choledochal cyst (Caroli's disease) management depends on disease extent: if limited to an anatomic part of the liver, resection may be appropriate; if diffuse throughout the liver without adequate functional remnant, transplantation may be necessary. — Alex Bondoc (clinical) [Ep 29 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- For choledochal cyst surgery in children less than 2 years old, a transverse incision or right subcostal incision is preferred; for older children, an upper midline incision is a viable option. — Alex Bondoc (clinical) [Ep 29 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- During choledochal cyst dissection, hepatic arteries are medial and the portal vein is posterior to the cyst. — Alex Bondoc (clinical) [Ep 29 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- Dr. Bondock performs an intraoperative cholangiogram through the gallbladder to understand where the tapering of the distal cyst occurs to avoid leaving remnant cyst. — Alex Bondoc (clinical) [Ep 29 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- For Roux-en-Y hepaticojejunostomy reconstruction, Dr. Bondock goes about 15 to 20 centimeters distal from the ligament of Treitz, performs a two-layer jejunojejunostomy, and does a hepaticojejunostomy with interrupted 5-0 or 6-0 Maxon suture. — Alex Bondoc (clinical) [Ep 29 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- Dr. Bondock performs the Roux-en-Y limb retrocolic and closes the small bowel mesentery. — Alex Bondoc (clinical) [Ep 29 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- For type 2 choledochal cyst, once the cyst is tapered down to the common bile duct, the neck is resected and the common bile duct is repaired with interrupted absorbable suture without leaving a T-tube. — Alex Bondoc (clinical) [Ep 29 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- Type 3 choledochal cyst can be approached endoscopically with ERCP and sphincterotomy, but if the lesion is large and obstructing the common duct, a transduodenal approach is needed, sometimes with preoperative stents to separate it from the duodenum. — Alex Bondoc (clinical) [Ep 29 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- Type 5 choledochal cyst (Caroli's disease) can be addressed surgically with liver resection if cystic disease is limited to one hemi-liver with adequate liver remnant and preserved biliary outflow, but if diffuse throughout the liver, liver transplantation may be necessary. — Alex Bondoc (clinical) [Ep 29 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- Postoperative considerations for choledochal cyst surgery include enteric drainage and awaiting return of bowel function. — Alex Bondoc (clinical) [Ep 29 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Dr. Bondock typically places an NG tube postoperatively because of the new jejunojejunostomy, but tries to remove it the day after surgery. — Alex Bondoc (clinical) [Ep 29 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Drains are placed postoperatively to assess for biliary leaks from the new hepatoenteric anastomosis and are typically removed once the patient is tolerating a regular diet. — Alex Bondoc (clinical) [Ep 29 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Institutionally, patients are placed on a choleretic like Actigall and cholangitis prophylaxis (daily Bactrim) for three to six months after choledochal cyst surgery. — Alex Bondoc (clinical) [Ep 29 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Short-term to long-term surgical complications of choledochal cyst surgery include anastomotic stricture, small bowel obstruction from intra-abdominal surgery, reflux gastritis, and recurrent cholangitis. — Alex Bondoc (clinical) [Ep 29 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Lifelong follow-up is needed for choledochal cyst patients because of the possibility of developing future malignancy even after resection of the cyst. — Alex Bondoc (clinical) [Ep 29 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- Biliary dyskinesia is a functional disorder of the gallbladder that is sometimes a diagnosis of exclusion that overlaps with other GI and intestinal problems such as dyspepsia or dysmotility. — Alex Bondoc (clinical) [Ep 28 · 0:12](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=12)
- Diagnostic symptoms include intense right upper quadrant pain that often peaks between 30 and 60 minutes after onset and takes several hours to resolve afterwards. — Alex Bondoc (clinical) [Ep 28 · 0:23](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=23)
- The pain can be associated with nausea and vomiting and diaphoresis and oftentimes occurs at infrequent intervals, not necessarily related to any type of food intake or fasting. — Alex Bondoc (clinical) [Ep 28 · 0:33](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=33)
- The symptoms of biliary dyskinesia can often interrupt the activities of daily living of the patients or even lead to emergency department visits. — Alex Bondoc (clinical) [Ep 28 · 0:43](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=43)
- Biliary dyskinesia most often affects adolescents and teenagers, but sometimes can affect younger children. — Alex Bondoc (epidemiological) [Ep 28 · 0:52](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=52)
- The diagnostic workup of biliary dyskinesia includes a liver function panel including transaminases and bilirubin levels, as well as a right upper quadrant ultrasound and cholecystokinin HIDA scan. — Alex Bondoc (guideline) [Ep 28 · 0:59](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=59)
- The definitive therapy for biliary dyskinesia is laparoscopic cholecystectomy. — Alex Bondoc (guideline) [Ep 28 · 1:10](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=70)
- In up to 40% of patients, symptoms will not resolve after cholecystectomy. — Alex Bondoc (clinical) [Ep 28 · 1:20](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=80)
- Postoperatively, patients are typically admitted for a 23-hour observation period to control pain and make sure they can tolerate a diet. — Alex Bondoc (guideline) [Ep 28 · 1:37](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=97)
- In some very limited situations, when discussed preoperatively, some patients do request to go home the same day. — Alex Bondoc (clinical) [Ep 28 · 1:45](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=105)
- Patients typically return to their normal state of health in approximately two weeks after surgery, although patients oftentimes will return to school or their normal activities in only several days. — Alex Bondoc (clinical) [Ep 28 · 1:52](https://library.globalcastmd.com/watch/biliary-dyskinesia-diagnosis-and-management-in-pediatric-patients-16088?t=112)

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