# Ulcerative Colitis — GCMD Library living collection

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

Updated: n/a · 4 episodes · 76 cited statements

## Episodes
### Acute Management
- [Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346) — video · 5:57 · [machine version](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346.md)

### Surgical Management
- [Ulcerative Colitis and Familial Adenomatous Polyposis: Update Course 2016](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422) — video · 46:16 · [machine version](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422.md)

### Evidence & Research
- [The Colorectal Quiz Episode 21: The History of Hirschsprung Disease](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861) — podcast · 15:56 · [machine version](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861.md)

### Case-Based Learning
- [Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655) — video · 28:36 · [machine version](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=0) Clinical vignette and historical context of IV fluid selection (Ep 1)
- [1:16](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=76) Evidence for isotonic maintenance fluids and the hyponatremia problem (Ep 1)
- [3:19](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=199) Dissemination of new practice and audience response (Ep 1)
- [4:44](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=284) Special populations and future directions (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=0) Case presentation and preoperative considerations in acute ulcerative colitis (Ep 2)
- [5:34](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=334) Anastomotic technique and height: stapled vs. hand-sewn approaches (Ep 2)
- [11:31](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=691) Surgical technique: laparoscopic approach and pouch construction (Ep 2)
- [17:02](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1022) Mesenteric management and operative efficiency (Ep 2)
- [23:01](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1381) Fertility, pregnancy, and sexual function outcomes (Ep 2)
- [30:31](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1831) Functional outcomes and conversion to Crohn disease (Ep 2)
- [36:58](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2218) Venous thromboembolism prophylaxis and risk factors (Ep 2)
- [40:35](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2435) Contrast studies before ileostomy closure and FAP timing (Ep 2)
- [45:02](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2702) Patient education tools and multimedia resources (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0) Case 1: Imaging modalities for fibrostenotic and fistulizing Crohn's disease (Ep 3)
- [7:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=420) Case 1: Surgical management of perianal abscess with ileal stricture (Ep 3)
- [15:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900) Seton techniques and perianal fistula outcomes (Ep 3)
- [20:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200) Isolated terminal ileal Crohn's as distinct entity (Ep 3)
- [23:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380) Case 2: Surgical approach to refractory ulcerative colitis (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=0) Introduction and Episode Setup (Ep 4)
- [0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26) Early Pioneers: Hirschsprung, Swenson, Yancey, Suave, Duhamel, Rabine, and Boley (Ep 4)
- [5:05](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=305) Personal Connections: Boley and Henry So (Ep 4)
- [9:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=576) Dr. Martin's Contributions: Long-Segment Technique and Ulcerative Colitis (Ep 4)
- [11:41](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701) Modern Era: Noblet, Jorgensen, Langer, de la Torre, and Teitelbaum (Ep 4)
- [14:47](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=887) Closing Remarks (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Harold Hirschsprung identified that a baby could be sick due to this problem but did not understand the pathology." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "The disease is named Hirschsprung disease, not apostrophe S." — Marc Levitt (guideline) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Orvar Swenson figured out the pathology by going to the pathology lab and defined the fact that there were no ganglion cells." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Prior to Swenson's work, removal of the dilated colon was the treatment, which was a mistake; it was the distal narrow colon that was the problem." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Swenson developed the first operation for Hirschsprung disease, a full-thickness rectal dissection." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Some surgeons still do Suave procedures, but they are becoming more Swenson-like with maybe a one-centimeter cuff; Dan von Allman calls those 'Suavesons with a one-centimeter cuff.'" — Marc Levitt (opinion) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Dr. Yancey was the first surgeon to describe a submucosal dissection for Hirschsprung disease, but published in a journal not widely read; Dr. Suave published later in a more widely read journal, so the technique is called Suave rather than Yancey." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "The Suave technique was developed because people said the Swenson caused fecal and urinary incontinence or voiding dysfunction; Swenson himself wrote that the operation was good but surgeons were doing it wrong by dissecting too wide." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Doing a proper Swenson right on the bowel wall, like a PSARP right on the bowel wall, avoids nerve injury; if you see fat you can get closer, as the nerves are in the fatty layer." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Swenson was 105 when he died and used to write letters to Levitt and Alberto Pena asking them to promote the Swenson operation." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Duhamel had the idea to leave the original rectum behind and do a pull-through next to it, then mate the two lumens." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "The Duhamel is now really only appropriate for an ilio-Duhamel, although Levitt would still do an ilioanal." — Marc Levitt (opinion) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Rabine did a low anterior resection for Hirschsprung disease, leaving about six centimeters behind; some patients did fine as ganglionated bowel pooped through the six centimeters of aganglionated bowel, but that operation has gone to the wayside." — Marc Levitt (clinical) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- "Dr. Boley was the first to do the primary coloanal anastomosis of a Suave, eliminating the need to leave the bowel hanging out and come back at day seven; the proper description is the Suave technique with the Boley modification, i.e., a Suave-Boley." — Marc Levitt (clinical) [Ep 4 · 5:57](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=357)
- "Henry So was a pediatric surgeon in the Philippines and the first to do a primary pull-through (transabdominal) with no preceding stoma, because patients with stomas at home in the Philippines faced such social stigma that babies were basically left to die by their families." — Marc Levitt (clinical) [Ep 4 · 5:57](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=357)
- "Dr. Martin was the first surgeon-in-chief and pediatric surgeon at Cincinnati Children's Hospital." — Jason Frischer (clinical) [Ep 4 · 9:40](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=580)
- "Dr. Martin developed the Martin procedure, an expansion of the Duhamel for long-segment Hirschsprung disease, leaving a longer aganglionated segment of rectum and pulling through ganglionated bowel." — Jason Frischer (clinical) [Ep 4 · 9:40](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=580)
- "Dr. Martin's biggest contribution was in ulcerative colitis; in 1977, before the J-pouch, he took the endorectal pull-through technique used in Hirschsprung disease and applied it to ulcerative colitis, doing a total proctocolectomy with ilioanal anastomosis." — Marc Levitt (clinical) [Ep 4 · 10:34](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=634)
- "The transanal dissection and Suave plane dissection is the same concept as the mucosectomy in ulcerative colitis." — Marc Levitt (clinical) [Ep 4 · 10:34](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=634)
- "Helen Noblet figured out the suction rectal biopsy; she is from Melbourne, Australia." — Marc Levitt (clinical) [Ep 4 · 11:41](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- "Keith Jorgensen did the laparoscopic version of the Suave; in his original description (with Tom Inge on the paper), they talked about leaving a five-centimeter cuff, which nowadays would be way too much." — Marc Levitt (clinical) [Ep 4 · 11:41](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- "Jack Langer approached Hirschsprung disease transanally, doing a transanal resection of the rectosigmoid with or without laparoscopy or laparotomy." — Marc Levitt (clinical) [Ep 4 · 11:41](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- "Luis de la Torre also did transanal resection around the same time as Jack Langer; some places around the world are doing transanal only, and Levitt does that in certain circumstances." — Marc Levitt (clinical) [Ep 4 · 11:41](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- "Dan Teitelbaum did an incredible amount of work in Hirschsprung disease, particularly significant research in enterocolitis; he passed away from a brain tumor." — Marc Levitt (clinical) [Ep 4 · 11:41](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- "Iatrogenic hyponatremia is one of the biggest problems in hospitals, related to ADH physiology and the use of hypotonic fluids rather than normal saline." (clinical) [Ep 1 · 1:23](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=83)
- "Children become hyponatremic because they are given half normal saline, and the data on this are clear." (clinical) [Ep 1 · 1:23](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=83)
- "The correct maintenance fluid for a 15-year-old post-colectomy patient is D5 normal saline with 20 milliequivalents of potassium." (guideline) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=125)
- "The American Academy of Pediatrics is coming out with a consensus statement on isotonic maintenance fluids (anticipated as of March)." (guideline) [Ep 1 · 2:31](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=151)
- "Hospitalized children develop hyponatremia because they receive less than isotonic (hypotonic) solutions, leading to cerebral edema and other complications." (clinical) [Ep 1 · 2:31](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=151)
- "The traditional teaching was to resuscitate with isotonic fluid and then convert to hypotonic maintenance fluids; the new practice is to keep patients on isotonic fluid to prevent hyponatremia." (guideline) [Ep 1 · 2:58](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=178)
- "At ABSA, 48% of respondents correctly identified isotonic fluid as the answer, which the speakers considered a high number given the radical change from traditional teaching." (epidemiological) [Ep 1 · 3:30](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=210)
- "Hypotonic fluids were originally developed based on theoretical calculations of sodium and chloride losses by a scientist approximately 100 years ago, not on evidence from real patients." (clinical) [Ep 1 · 4:24](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=264)
- "Newborn babies are different because their kidney function is immature when first born, so the amount of electrolytes given changes over the first couple of days of life." (clinical) [Ep 1 · 4:47](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=287)
- "Term newborns on the first day of life should receive D10W (dextrose 10% in water) with no saline." (guideline) [Ep 1 · 4:47](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=287)
- "In adult critical care literature, practice is shifting from normal saline to lactated Ringer's as the normal isotonic solution, and the same shift is expected to occur in pediatrics." (opinion) [Ep 1 · 5:14](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=314)
- "Lactated Ringer's is a more physiologic isotonic solution than normal saline." (clinical) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=340)
- "There is not yet literature in children supporting the use of D5 lactated Ringer's, but it is anticipated." (opinion) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=340)
- "In the last 50 J-pouch patients at Cincinnati Children's, none had an albumin level greater than 3.5 g/dL at the time of surgery." — Jason Frischer (clinical) [Ep 2 · 3:18](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=198)
- "Cleveland Clinic data showed anastomotic leak rates were significantly different in hypoalbuminemic patients (albumin <3.5) compared to those with normal albumin levels after pouch surgery." — Jason Frischer (host_summary) [Ep 2 · 2:31](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=151)
- "Pediatric UC patients differ from adult populations because adults often undergo reconstructive surgery for dysplasia, which is extremely rare in pediatric patients." — Jason Frischer (clinical) [Ep 2 · 3:38](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=218)
- "A consensus statement recommends that delay in surgical intervention to enhance nutrition is not recommended in acute UC flares." — Jason Frischer (host_summary) [Ep 2 · 4:22](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=262)
- "Pre-operative steroid administration is associated with increased risk of anastomotic leak and infectious complications." — Jason Frischer (host_summary) [Ep 2 · 4:35](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=275)
- "Low serum albumin is a marker associated with increased risk of post-operative infections." — Jason Frischer (host_summary) [Ep 2 · 4:45](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=285)
- "The cumulative risk of cancer approximately 25 years after restorative proctocolectomy is about 3.5%." — Jason Frischer (host_summary) [Ep 2 · 10:40](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=640)
- "Average-risk J-pouch patients should undergo pouchoscopy and biopsy every 3 years, starting 10 years following their diagnosis of ulcerative colitis." — Jason Frischer (host_summary) [Ep 2 · 10:55](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=655)
- "The speaker's rule of thumb for pouch sizing is age of patient plus 1 cm (e.g., 6 cm pouch for a 5-year-old, 11 cm for a 10-year-old), with a maximum of 15 cm for post-pubertal patients." — Jason Frischer (clinical) [Ep 2 · 15:12](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=912)
- "The speaker limits maximum pouch size to 12 cm after having several 15 cm pouches become so dilated they required revision." — Todd Ponsky (clinical) [Ep 2 · 15:45](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=945)
- "Taking the mesentery extracorporeally (after laparoscopic mobilization) took a solid hour off the procedure time, reducing cases from all-day to 2-2.5 hours." — Todd Ponsky (clinical) [Ep 2 · 17:02](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1022)
- "The speaker converted from open stapling device to endoscopic stapling device for pouch creation because the limbs are smaller, making the common enterotomy smaller and the operation cleaner." — Jason Frischer (clinical) [Ep 2 · 19:40](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1180)
- "Leak rate after J-pouch is quoted as somewhere between 5 and 15%, which correlates with pelvic infections." — Jason Frischer (clinical) [Ep 2 · 23:01](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1381)
- "Infertility rates after J-pouch are between 43% and 63% at two years, compared to North American baseline infertility rate of approximately 8%." — Jason Frischer (host_summary) [Ep 2 · 24:10](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1450)
- "Infertility rates following open J-pouch operations went as high as 90+%, but more recent papers following laparoscopic approach show rates in the 20-30% range." — Jason Frischer (host_summary) [Ep 2 · 24:40](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1480)
- "C-section rate in J-pouch patients is between 38 and 78% versus 22% in the general population." — Jason Frischer (host_summary) [Ep 2 · 26:10](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1570)
- "There is no literature to support whether C-section versus vaginal delivery is safer in J-pouch patients, but when asked, colorectal surgeons unanimously suggest C-section." — Jason Frischer (host_summary) [Ep 2 · 26:25](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1585)
- "Helsinki Group data showed daytime stooling frequency of about 5-6 bowel movements per day in J-pouch patients, with daytime incontinence in 22% and nighttime soiling in 56%." — Jason Frischer (host_summary) [Ep 2 · 28:20](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1700)
- "Cincinnati Children's data showed daytime soiling rate of about 5% in younger patients and nighttime soiling in about one-third of patients (18% in older patients), with no statistically significant difference between younger (mean age 7) and older (mean age 14) groups." — Jason Frischer (epidemiological) [Ep 2 · 29:00](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1740)
- "The rate of conversion from UC to Crohn disease was approximately 10-12% in both younger and older patient populations, with no difference between age groups." — Jason Frischer (epidemiological) [Ep 2 · 29:20](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1760)
- "A 12-year-old UC patient developed a golf ball-sized thrombus in the right atrium 3 hours after subtotal colectomy, despite compression boots for thromboprophylaxis." — Jason Frischer (clinical) [Ep 2 · 30:31](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1831)
- "Adult literature strongly supports using heparin or low molecular weight heparin in combination with compression boots for VTE prophylaxis, showing no increased bleeding risk or adverse outcomes." — Jason Frischer (host_summary) [Ep 2 · 37:53](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2273)
- "All IBD patients are at higher risk for thromboembolism, which puts the surgical patient population at elevated baseline risk." — Jason Frischer (host_summary) [Ep 2 · 36:58](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2218)
- "PICC lines in IBD patients are a huge risk factor for thromboembolism, with much greater odds ratio for developing thromboembolic events." — Jason Frischer (host_summary) [Ep 2 · 38:32](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2312)
- "Thromboprophylaxis efficacy is much better if administered before induction of anesthesia rather than during or after." — Todd Ponsky (host_summary) [Ep 2 · 37:39](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2259)
- "The compartment syndrome rate in patients with elevated legs for extended periods is surprisingly high, leading one surgeon to keep legs down in stirrups until anal work is required." — Todd Ponsky (clinical) [Ep 2 · 26:50](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1610)
- "In a study of contrast enemas before ileostomy closure, none demonstrated problems that weren't already known clinically; symptomatic patients had pouch problems, asymptomatic patients did not." — Jason Frischer (clinical) [Ep 2 · 40:35](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2435)
- "Indications for FAP surgery include: symptomatic presentation (bleeding, pain), colonoscopy showing >100 polyps with increasing burden, or dysplasia (extremely rare in pediatric population)." — Todd Ponsky (clinical) [Ep 2 · 43:50](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2630)
- "For FAP patients with family history, colonoscopy screening typically begins at least 10 years prior to the age when the affected parent was diagnosed with heavy polyp burden." — Todd Ponsky (clinical) [Ep 2 · 44:25](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2665)
- "Pediatric gastroenterologists are so committed to medical management that they sometimes keep UC patients longer on therapy, resulting in sicker children (bleeding, on TPN, steroids, and Remicade) when surgery is finally consulted." — Todd Ponsky (opinion) [Ep 2 · 23:01](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1381)
- "Three-stage operations (simple colectomy first) can dramatically change the course for very sick UC patients, allowing them to become immunocompetent before subsequent reconstructive procedures." — Todd Ponsky (opinion) [Ep 2 · 23:40](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1420)
- "Cincinnati Children's averages 10-18 J-pouches per year in recent years." — Jason Frischer (epidemiological) [Ep 2 · 25:50](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1550)
- "One surgeon made an agreement with a partner to specialize: taking thyroids and IBD patients while giving up lung lesions, allowing the team to develop expertise through repetition (10,000 hours concept) and reduce case times significantly." — Todd Ponsky (clinical) [Ep 2 · 25:00](https://library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1500)
- "In a review study published recently, CT enterography is more accurate than MR enterography for Crohn's disease, though institutional radiologist expertise determines which modality performs better in practice." — Samir Pandya (host_summary) [Ep 3 · 0:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0)
- "Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease." — Samir Pandya (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=180)
- "Contrast-enhanced ultrasound has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in patients with known diagnosis, according to the Peloda study published in Pediatrics 2013." — Samir Pandya (host_summary) [Ep 3 · 4:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- "Contrast-enhanced ultrasound is only available for clinical use in Europe at present and has not been approved by the FDA." — Samir Pandya (host_summary) [Ep 3 · 4:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- "In Europe, ultrasound is the first-line imaging choice for Crohn's disease, followed by MR or CT enterography, whereas in the US, MR/CT enterography is first-line." — Samir Pandya (host_summary) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=300)
- "MR enterography provides information about the chronicity of Crohn's disease strictures, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy." — Samir Pandya (host_summary) [Ep 3 · 6:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=360)
- "Perianal abscesses in Crohn's disease are unlikely to heal without fecal diversion because bowel continuity slows healing." — Samir Pandya (opinion) [Ep 3 · 10:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=600)
- "Modern TNF inhibitor drugs are effective at healing perianal disease in Crohn's, potentially allowing avoidance of fecal diversion in selected patients." — Samir Pandya (clinical) [Ep 3 · 11:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=660)
- "Patients and parents would rather deal with a chronic perianal problem than manage a stoma." — Samir Pandya (opinion) [Ep 3 · 12:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=720)
- "Most Crohn's perianal abscesses are not single; when draining a perianal abscess in Crohn's disease, there are usually several fistulas present." — Samir Pandya (clinical) [Ep 3 · 13:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=780)
- "Setons are very effective for perianal fistulas and should be used more often in pediatric surgery than they currently are." — Samir Pandya (opinion) [Ep 3 · 14:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=840)
- "It is less morbid to perform laparoscopic diversion in 15% of patients whose perianal disease fails to heal than to give 100% of patients an ostomy upfront." — Samir Pandya (opinion) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900)
- "Crohn's patients can develop peristomal fistulas as a complication of stoma creation." — Samir Pandya (clinical) [Ep 3 · 16:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=960)
- "Crohn's disease affects the entire GI tract as a chronic disorder, even when only one segment shows active stricturing disease." — Samir Pandya (clinical) [Ep 3 · 17:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1020)
- "Rectal advancement flap for Crohn's perianal fistula is only appropriate in the setting of no active proctitis, and results diminish with time." — Samir Pandya (host_summary) [Ep 3 · 18:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1080)
- "A cutting seton requires 360-degree tension on tissue to actively divide it, whereas a non-cutting seton is placed loosely to allow drainage and gradual fibrosis without active cutting." — Samir Pandya (clinical) [Ep 3 · 19:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1140)
- "Even with permanent fecal diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood." — Samir Pandya (host_summary) [Ep 3 · 20:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200)
- "For duodenal Crohn's strictures, endoscopic and fluoroscopic dilation combined with Remicade can be effective, making the stricture more pliable and allowing weight gain." — Samir Pandya (clinical) [Ep 3 · 21:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1260)
- "Isolated ileocecal Crohn's disease in teenagers can have recurrence-free intervals as long as 10 to 15 years after resection, allowing symptom-free passage through puberty into adulthood." — Samir Pandya (host_summary) [Ep 3 · 22:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- "Isolated terminal ileal Crohn's disease may be a separate disease entity from perianal or diffuse Crohn's disease because it behaves very differently, with prolonged remission after resection." — Samir Pandya (opinion) [Ep 3 · 22:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- "Patients with isolated terminal ileal Crohn's disease should be considered for earlier resection before starting Remicade because of the favorable long-term outcomes after resection." — Samir Pandya (opinion) [Ep 3 · 22:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- "Pediatric IBD patients referred for surgery are often in horrible nutritional shape because GI physicians view surgery as failure and carry patients on medical therapy for too long." — Samir Pandya (opinion) [Ep 3 · 23:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380)
- "Patients with severe ulcerative colitis who are emaciated, hypoalbuminemic, on steroids, and in poor nutritional status often require three-stage surgery: subtotal colectomy with end ileostomy, then subsequent J-pouch creation." — Samir Pandya (clinical) [Ep 3 · 24:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1440)
- "Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after the subsequent J-pouch operation." — Samir Pandya (clinical) [Ep 3 · 25:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1500)
- "The best ulcerative colitis patients ever look is when they have their end ileostomy after subtotal colectomy, before J-pouch creation." — Samir Pandya (opinion) [Ep 3 · 26:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1560)
- "Ongoing rectal bleeding from the rectal stump after subtotal colectomy for ulcerative colitis is rare but can be managed with local therapy." — Samir Pandya (clinical) [Ep 3 · 27:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1620)
- "Endorectal dissection technique (similar to Hirschsprung surgery) can be performed safely for ulcerative colitis J-pouch even in relatively sick patients, as long as a diverting ileostomy is created." — Samir Pandya (clinical) [Ep 3 · 28:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1680)
- "Continued bleeding from the rectal stump after subtotal colectomy for ulcerative colitis can force earlier-than-anticipated completion of the J-pouch procedure." — Samir Pandya (clinical) [Ep 3 · 29:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1740)
- "Between stage 1 and stage 2 of ulcerative colitis surgery, patients often gain 20 to 30 pounds, which can make the subsequent operation technically harder." — Samir Pandya (clinical) [Ep 3 · 30:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1800)
- "If a patient has received infliximab within the last 6 weeks before surgery for ulcerative colitis, there is evidence (both adult and pediatric) that a three-stage approach should probably be used due to increased complication risk." — Samir Pandya (host_summary) [Ep 3 · 28:36](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- "At 2 years follow-up, there is hardly any difference in bowel frequency between straight ileoanal anastomosis and J-pouch (10 cm J-pouches) for ulcerative colitis, based on a series of 120-130 straight and 110-115 J-pouch patients." — Samir Pandya (host_summary) [Ep 3 · 28:36](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)

## Changelog
- Sep 15: 4 items added automatically

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