# Pediatric Pancreatitis — GCMD Library living collection Updated: n/a · 6 episodes · 71 cited statements ## Episodes ### Diagnosis and Etiology - [Pediatric pancreatitis: diagnosis, causes, and genetic insights with Dr. Juan Gurria](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834) — podcast · 3:12 · [machine version](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834.md) ### Acute Pancreatitis - [Acute pancreatitis in children: early feeding and step-up surgical approach](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833) — podcast · 3:03 · [machine version](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833.md) ### Chronic Pancreatitis - [Surgical management of chronic pancreatitis in children: when and how to intervene](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831) — podcast · 4:05 · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831.md) - [Managing pancreatic fluid collections and chronic pancreatitis complications in children](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832) — podcast · 2:28 · [machine version](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832.md) ### Biliary Stone Disease - [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736) — podcast · 3:53 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736.md) - [Surgery-first approach for pediatric biliary stones and common bile duct management](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873) — podcast · 7:32 · [machine version](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=0) Introduction and Update Course Classification System (Ep 5) - [0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=53) Case Presentation: Neutropenic Patient with Cholecystitis (Ep 5) - [1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=99) Gallstone Pancreatitis Management Discussion (Ep 5) - [3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=191) Summary and Closing (Ep 5) - [0:00](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=0) Introduction and indications for surgical intervention (Ep 3) - [0:48](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=48) Surgical options and limitations in hereditary pancreatitis (Ep 3) - [1:46](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=106) Total pancreatectomy with islet autotransplantation technique and outcomes (Ep 3) - [3:17](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=197) Key takeaways and patient selection (Ep 3) - [0:00](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=0) Introduction and conservative management of pancreatic fluid collections (Ep 4) - [0:37](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=37) Atlanta classification and time course of acute pancreatitis complications (Ep 4) - [1:17](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=77) Transition to chronic pancreatitis and its complications (Ep 4) - [2:00](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=120) Key takeaways and closing (Ep 4) - [0:00](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=0) Early feeding in acute pancreatitis (Ep 2) - [1:09](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=69) Timing and indications for surgical intervention (Ep 2) - [2:01](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=121) Step-up approach to necrotizing pancreatitis (Ep 2) - [0:00](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=0) Introduction and speaker credentials (Ep 1) - [0:27](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=27) Diagnostic criteria for acute pancreatitis in children (Ep 1) - [0:48](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=48) Etiologic differences between pediatric and adult pancreatitis (Ep 1) - [1:16](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=76) Causes of pediatric pancreatitis including tumors (Ep 1) - [1:37](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=97) Genetic mutations as the primary cause of idiopathic pancreatitis (Ep 1) - [2:18](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=138) PRSS1 mutation and pancreatic cancer risk (Ep 1) - [2:50](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=170) Summary and conclusion (Ep 1) - [0:00](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=0) Introduction and first clinical scenario (Ep 6) - [1:25](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=85) Surgery-first versus ERCP-first approaches (Ep 6) - [2:59](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=179) ERCP complications and stone clearance rates (Ep 6) - [4:56](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=296) Technical considerations and equipment preparation (Ep 6) - [5:43](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=343) Second case and flushing technique cautions (Ep 6) - [7:22](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=442) Closing (Ep 6) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - The choice between surgery-first and ERCP-first depends on the setting and the surgeon's own technical capabilities. (opinion) [Ep 6 · 1:50](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=110) - ERCP causes pancreatitis 10% of the time, regardless of operator skill. (clinical) [Ep 6 · 3:02](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=182) - Pediatric surgeons and general surgeons need to improve their skills in intraoperative stone removal through courses and training. (opinion) [Ep 6 · 3:34](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=214) - A 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis. — David Vitale (clinical) [Ep 5 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=53) - Over 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient. — David Vitale (opinion) [Ep 5 · 1:18](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=78) - Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy. — David Vitale (clinical) [Ep 5 · 1:27](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=87) - Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas. — Luke Neff (clinical) [Ep 5 · 1:39](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=99) - Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week. — Luke Neff (opinion) [Ep 5 · 2:07](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=127) - From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis. — Luke Neff (clinical) [Ep 5 · 2:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=135) - When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed. — David Vitale (clinical) [Ep 5 · 2:24](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=144) - Studies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy. — Luke Neff (clinical) [Ep 5 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=158) - If amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted. — Luke Neff (clinical) [Ep 5 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=158) - Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment. — David Vitale (clinical) [Ep 5 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=179) - Local resources and what is available must be factored into management decisions for biliary stones. — David Vitale (opinion) [Ep 5 · 3:07](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=187) - Most pancreatic fluid collections are self-limited and should not be drained unless absolutely necessary. — Juan Gurria (clinical) [Ep 4 · 0:32](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=32) - According to the Atlanta classification, acute problems occur in fluid collections less than 4 weeks old. — Juan Gurria (guideline) [Ep 4 · 0:50](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=50) - Pseudocysts that develop over 4 weeks are either self-limited or amenable to drainage. — Juan Gurria (clinical) [Ep 4 · 0:53](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=53) - Walled-off necrosis with an encapsulated wall and necrotic tissue is problematic and requires specialist consultation. — Juan Gurria (clinical) [Ep 4 · 0:53](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=53) - Chronic pancreatitis is marked by calcifications, atrophy, and ductal irregularities in the pancreatic parenchyma and duct that were not present with acute events. — Juan Gurria (clinical) [Ep 4 · 1:21](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=81) - When imaging findings of chronic pancreatitis appear, pancreatic function will start failing very soon. — Juan Gurria (clinical) [Ep 4 · 1:31](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=91) - Chronic pancreatitis diagnosis requires evidence of abdominal pain consistent with pancreatic origin. — Juan Gurria (clinical) [Ep 4 · 1:41](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=101) - Chronic pancreatitis diagnosis requires evidence of exocrine pancreatic insufficiency. — Juan Gurria (clinical) [Ep 4 · 1:44](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=104) - All patients with chronic pancreatitis have some sort of gastroparesis. — Juan Gurria (clinical) [Ep 4 · 1:53](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=113) - Pseudoaneurysms can occur on the splenic arteries, celiac artery, and SMA in chronic pancreatitis. — Juan Gurria (clinical) [Ep 4 · 1:55](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=115) - Traditional practice keeps pancreatitis patients NPO to avoid affecting the pancreas — Juan Gurria (clinical) [Ep 2 · 0:27](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=27) - Patients with acute pancreatitis should be fed as soon as possible — Juan Gurria (clinical) [Ep 2 · 0:35](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=35) - Bacterial translocation from NPO status will complicate acute pancreatitis — Juan Gurria (clinical) [Ep 2 · 0:46](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=46) - Lactated Ringer solution is better for resuscitation in acute pancreatitis — Juan Gurria (clinical) [Ep 2 · 0:52](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=52) - There is no role for early pancreatectomies of any kind in acute necrotizing pancreatitis — Juan Gurria (clinical) [Ep 2 · 1:15](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=75) - There is no role for early drainage procedures in acute necrotizing pancreatitis — Juan Gurria (clinical) [Ep 2 · 1:18](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=78) - Early drainage comes with a lot of morbidity unless the patient is progressing to multi-organ failure — Juan Gurria (clinical) [Ep 2 · 1:21](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=81) - Early necrosectomies are usually unnecessary and increase mortality — Juan Gurria (clinical) [Ep 2 · 1:27](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=87) - Gas on CT scan can indicate sepsis in necrotizing pancreatitis — Juan Gurria (clinical) [Ep 2 · 1:39](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=99) - Clinical symptoms and imaging should guide suspicion of sepsis — Juan Gurria (clinical) [Ep 2 · 1:39](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=99) - FNA can be performed to assess for infection in necrotizing pancreatitis — Juan Gurria (clinical) [Ep 2 · 1:43](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=103) - Patterns and trends in vital signs in the ICU indicate whether the patient is becoming septic — Juan Gurria (clinical) [Ep 2 · 1:46](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=106) - The step-up approach starts with the least invasive intervention possible — Juan Gurria (clinical) [Ep 2 · 2:04](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=124) - Endoscopic necrosectomy has a reduced risk of major complications — Juan Gurria (clinical) [Ep 2 · 2:09](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=129) - Cincinnati Children's Pancreas Care Center evaluates over 100 patients per year for chronic pancreatitis and operates on only 30 of them because medical management options remain for the others. — Juan Gurria (clinical) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=29) - Some pediatric chronic pancreatitis patients are as young as 3 years old, have known only pain in their lives, fail to achieve developmental milestones, and are on opioids by age 5 or 6. — Juan Gurria (clinical) [Ep 3 · 0:38](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=38) - In patients with genetic mutations causing pancreatitis, partial pancreatic resection may temporarily relieve pain but the genetic mutations continue to affect the remaining pancreas, making partial resection a disservice to the patient. — Juan Gurria (clinical) [Ep 3 · 1:05](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=65) - Some referrals for pancreatic tumors in children turn out to be autoimmune pancreatitis upon evaluation. — Juan Gurria (clinical) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=85) - Segmental resection should never be offered to a patient with a PRSS1 mutation. — Juan Gurria (opinion) [Ep 3 · 1:42](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=102) - After total pancreatectomy, patients become automatic diabetics; to address this, islets are extracted from pancreatic tissue and infused back into the patient's system. — Juan Gurria (clinical) [Ep 3 · 1:58](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=118) - Dr. Gurria performs post-pyloric duodenal resection during TPIAT reconstruction because all these patients have gastroparesis. — Juan Gurria (clinical) [Ep 3 · 2:18](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=138) - Dr. Gurria injects Botox into the pyloric muscle to keep the pyloric gate open during TPIAT reconstruction. — Juan Gurria (clinical) [Ep 3 · 2:23](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=143) - Cincinnati Children's has an in-house lab that performs islet isolation, which takes about 3.5 hours. — Juan Gurria (clinical) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=163) - When islet cells are ready, they are injected through the splenic vein into the portal vein. — Juan Gurria (clinical) [Ep 3 · 2:47](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=167) - Portal vein thrombosis is a significant risk during TPIAT because islet infusion is like putting milkshake into a low-flow vein, which can easily clog. — Juan Gurria (clinical) [Ep 3 · 3:07](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=187) - Dr. Gurria performs TPIAT under anticoagulation to reduce the risk of portal vein thrombosis. — Juan Gurria (clinical) [Ep 3 · 3:13](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=193) - To diagnose acute pancreatitis, symptoms must match lab work and imaging findings — Juan Gurria (clinical) [Ep 1 · 0:27](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=27) - Serum lipase must be at least 3 times the upper limit of normal for diagnosis — Juan Gurria (clinical) [Ep 1 · 0:34](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=34) - CT is used to follow the progression of pancreatitis disease — Juan Gurria (clinical) [Ep 1 · 0:37](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=37) - MRI is the key imaging component for diagnosing pancreatitis — Juan Gurria (clinical) [Ep 1 · 0:37](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=37) - Pediatric pancreatitis patients are not alcoholics, not full of stones, or smokers — Juan Gurria (epidemiological) [Ep 1 · 0:55](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=55) - Pediatric pancreatitis presents as a similar pathologic problem to adult disease but comes from a different reason — Juan Gurria (clinical) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=60) - Anatomic abnormalities from development in the biliary tree can cause strictures leading to pancreatitis — Juan Gurria (clinical) [Ep 1 · 1:16](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=76) - Traumatic injuries cause pancreatitis in children — Juan Gurria (clinical) [Ep 1 · 1:16](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=76) - Solid pseudopapillary neoplasms are seen frequently in pediatric pancreatitis — Juan Gurria (epidemiological) [Ep 1 · 1:29](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=89) - Neuroendocrine tumors can cause pancreatitis in children — Juan Gurria (clinical) [Ep 1 · 1:29](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=89) - Historically, idiopathic pancreatitis was a black box category after trauma, alcohol, drugs, and smoking were ruled out — Juan Gurria (epidemiological) [Ep 1 · 1:37](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=97) - Idiopathic pancreatitis is now known to be caused by genetic mutations — Juan Gurria (clinical) [Ep 1 · 1:50](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=110) - Cincinnati Children's has a running list of 1000 pediatric patients with pancreatitis — Juan Gurria (epidemiological) [Ep 1 · 1:52](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=112) - Over 1000 patients at Cincinnati Children's, 85% have genetic mutations — Juan Gurria (epidemiological) [Ep 1 · 2:04](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=124) - Cincinnati Children's tests for a panel of 10 genetic mutations — Juan Gurria (clinical) [Ep 1 · 2:09](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=129) - The PRSS1 mutation causes very aggressive pancreatitis attacks early in life — Juan Gurria (clinical) [Ep 1 · 2:18](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=138) - Children as young as 12-13 years old present with acute pancreatitis and acute recurrent pancreatitis from PRSS1 mutation — Juan Gurria (epidemiological) [Ep 1 · 2:23](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=143) - The PRSS1 gene affects trypsinogen — Juan Gurria (clinical) [Ep 1 · 2:23](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=143) - Genetic mutations causing pancreatitis can increase the risk of pancreatic cancer — Juan Gurria (clinical) [Ep 1 · 2:36](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=156) - Children diagnosed with genetic pancreatitis at 5 or 6 years old have hopefully 95 years of life remaining — Juan Gurria (epidemiological) [Ep 1 · 2:42](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=162) - The risk of pancreatic cancer in children with genetic pancreatitis is tremendous due to their long life expectancy — Juan Gurria (clinical) [Ep 1 · 2:47](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=167) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Stone disease is increasing along with obesity in pediatric patients around the world, not just in the United States. — Em Gootee summarizing the discussion [Ep 6 · 0:52](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=52) - There are two main approaches for patients with common bile duct stones who need cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery. — Em Gootee summarizing the discussion [Ep 6 · 1:25](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=85) - A surgery-first pathway reduces resource utilization, including MRCP. — Em Gootee summarizing the discussion [Ep 6 · 2:11](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=131) - A predictive score for cholelithiasis published in the Journal of American College of Surgeons can help guide pathway decisions. — Em Gootee summarizing the discussion [Ep 6 · 2:25](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=145) - If a surgeon cannot perform a cholangiogram, then ERCP is necessary if someone can do it. — Em Gootee summarizing the discussion [Ep 6 · 3:16](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=196) - If you understand central line placement and Seldinger technique principles, you can perform intraoperative stone removal. — Em Gootee summarizing the discussion [Ep 6 · 3:44](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=224) - In a JPS paper, surgery-first approach achieved 86% stone clearance rate with negative intraoperative cholangiogram. — Em Gootee summarizing the discussion [Ep 6 · 3:50](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=230) - With simple additional maneuvers like advancing the catheter into the common bile duct or reaming the sphincter, stone clearance success rate reaches the 90s. — Em Gootee summarizing the discussion [Ep 6 · 4:02](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=242) - For the 15% of unsuccessful cases, the surgeon clips or places an endo loop, closes, and arranges ERCP within the next day or two. — Em Gootee summarizing the discussion [Ep 6 · 4:17](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=257) - At Cincinnati Children's, when surgeons cannot clear the duct, they call the endoscopist to the OR and ERCP is performed quickly in most cases. — Em Gootee summarizing the discussion [Ep 6 · 4:38](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=278) - According to Doctor Huntington, 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 summarizing the discussion [Ep 6 · 5:15](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=315) - If the common bile duct has 3-4 impacted stones on IOC, surgery-first is typically not very successful. — Em Gootee summarizing the discussion [Ep 6 · 5:26](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=326) - Doctor Vitale cautions that when flushing with an impacted stone, there is risk of inadvertently injecting contrast into the pancreatic duct, which can increase pancreatitis risk. — Em Gootee summarizing the discussion [Ep 6 · 6:03](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=363) - When the pancreatic duct lights up during flushing, this is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present. — Em Gootee summarizing the discussion [Ep 6 · 6:15](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=375) - A study demonstrated 86% success rate for surgery-first, while the ERCP group had 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia. — Em Gootee summarizing the discussion [Ep 6 · 6:33](https://library.globalcastmd.com/watch/surgery-first-approach-for-pediatric-biliary-stones-and-common-bile-duct-managem-16873?t=393) - The 12th annual update course in pediatric surgery introduced a new classification system with three categories: Green Circle for established practice, Blue Square for promising newer practice, and Black Diamond for early adopter practice only. — Em Gootee summarizing the discussion [Ep 5 · 0:08](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=8) - In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs. — Em Gootee summarizing the discussion [Ep 5 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-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 Gootee summarizing the discussion [Ep 5 · 3:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=205) - The timing of cholecystectomy in gallstone pancreatitis should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed. — Em Gootee summarizing the discussion [Ep 5 · 3:35](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-13736?t=215) - Local complications of acute pancreatitis include pseudocysts, walled-off necrosis, and abscesses. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 4 · 0:37](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=37) - Pancreatic fluid collections either resolve on their own within 4 weeks, or if still present after 4 weeks, are more mature and amenable to safer drainage. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 4 · 1:09](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=69) - Diabetes is a complication of chronic pancreatitis and screening should be done every year. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 4 · 1:47](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=107) - Chronic pancreatitis leads to progressive pancreatic injury including calcifications, atrophy, chronic pain, and exocrine and endocrine pancreatic insufficiency. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 4 · 2:11](https://library.globalcastmd.com/watch/managing-pancreatic-fluid-collections-and-chronic-pancreatitis-complications-in-16832?t=131) - If patients can tolerate oral intake, feed them orally — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 0:38](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=38) - If patients are vomiting, consider nasoduodenal feeding — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 0:41](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=41) - The goal of early feeding is to maintain gut integrity — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 0:44](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=44) - Early nutrition is key to preventing exocrine and endocrine insufficiency, diabetes, and surgery in the future — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 0:56](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=56) - Wait at least 4 weeks after the episode of acute pancreatitis begins until it becomes walled-off necrosis — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 1:30](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=90) - If sepsis is strongly suspected, start antibiotics such as carbapenem — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 1:53](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=113) - If sepsis is strongly suspected, drain the necrosis and order cross-sectional imaging — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 1:53](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=113) - The next step after endoscopic necrosectomy is percutaneous retroperitoneal drainage — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 2:13](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=133) - If drainage fails to resolve sepsis or organ failure, try a minimally invasive necrosectomy — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 2:17](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=137) - Open surgery is the very last resort in necrotizing pancreatitis — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 2:23](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=143) - In children with acute pancreatitis, start enteral feeding as soon as it is tolerated to reduce bacterial translocation — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 2:28](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=148) - Avoid early surgical intervention in acute necrotizing pancreatitis unless there is clinical deterioration, infected necrosis, or persistent organ failure — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 2:35](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=155) - Intervention should be delayed until walled-off necrosis develops, typically about 4 weeks after onset — Lizzy Lee summarizes what Dr. Juan Guerrilla said [Ep 2 · 2:39](https://library.globalcastmd.com/watch/acute-pancreatitis-in-children-early-feeding-and-step-up-surgical-approach-16833?t=159) - The most common reason for surgical intervention in pediatric chronic pancreatitis is severe pain refractory to non-surgical treatment. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 0:48](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=48) - Surgical options for pediatric chronic pancreatitis include drainage, partial resection, and combination drainage-resection, but these do not work for children with hereditary disease. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 0:57](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=57) - When an inflammatory head mass is seen in the pancreas of a child, autoimmune pancreatitis should be considered in the differential diagnosis. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 1:18](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=78) - Surgery may be an option for children with large duct disease, strictures, or trauma-related pancreatic anatomy issues, but genetic causes of pancreatitis need a different strategy. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 1:32](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=92) - Total pancreatectomy with islet autotransplantation (TPIAT) removes the pancreas in children with severe refractory disease to control chronic pain. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 1:46](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=106) - In TPIAT, islet cells that normally produce insulin are extracted from the pancreas and transplanted back into the patient through the portal vein, where they take up residence in the liver. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 2:06](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=126) - Dr. Gurria published a 2025 paper showing that Botox injection after pancreatectomy with islet autotransplantation improved gastroparesis in children. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 2:30](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=150) - After TPIAT for chronic pancreatitis, there is an 80% drop in opioid use one month postoperatively with a sustained effect for years. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 2:53](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=173) - Complications after TPIAT can include bleeding or portal vein thrombosis. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 3:03](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=183) - Surgical intervention for pediatric chronic pancreatitis is reserved for patients with severe pain that persists despite other treatment options. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 3:17](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=197) - Conventional pancreatic drainage or resection procedures may help children with ductal obstruction, strictures, or trauma-related disease, but are generally not appropriate for hereditary pancreatitis because the underlying genetic process continues to damage the remaining pancreas. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 3:26](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=206) - TPIAT is not a first-line therapy for pancreatitis and careful patient selection is essential. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 3:42](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=222) - In appropriately selected patients, TPIAT can provide substantial pain relief, improve quality of life, and achieve acceptable long-term glycemic control. — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 3 · 3:48](https://library.globalcastmd.com/watch/surgical-management-of-chronic-pancreatitis-in-children-when-and-how-to-interven-16831?t=228) - MRI with MRCP gives the best picture of the patient's ductal anatomy — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 1 · 0:43](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=43) - In adults, alcohol and gallstones are the usual causes of pancreatitis — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 1 · 0:48](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=48) - Causes of pancreatitis in children include anatomy, trauma, medications, and especially genetics — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 1 · 1:08](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=68) - Cincinnati Children's has become the world's largest pediatric pancreatitis center — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 1 · 1:57](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=117) - The PRSS1 gene mutation causes the pancreas to degrade itself — Lizzy Lee summarizes what Dr. Juan Gurria said [Ep 1 · 2:31](https://library.globalcastmd.com/watch/pediatric-pancreatitis-diagnosis-causes-and-genetic-insights-with-dr-juan-gurria-16834?t=151) --- Educational content from recorded physician discussions — not medical advice. 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