I haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.
I haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.
I haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.
I haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.
I haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.
I haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 0:18
quoteWe know that this is an underserved field in the pediatrics and even in adult pancreatology, so we're very excited.↗
▶Ep 5 · 0:18
quoteWe know that this is an underserved field in the pediatrics and even in adult pancreatology, so we're very excited.↗
▶Ep 5 · 0:55
guidelineAcute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis.↗
▶Ep 5 · 0:55
host_summaryAcute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis.↗
▶Ep 5 · 1:31
quoteWe always ask what is the normal range for the lab wherever we get the labs from, because not every lab runs the same ELISA test.↗
▶Ep 5 · 1:31
quoteWe always ask what is the normal range for the lab wherever we get the labs from, because not every lab runs the same ELISA test.↗
▶Ep 5 · 1:58
quoteWe're very lucky that in the majority of cases in pediatric pancreatitis this is self-limited and reversible, and you would just have a one-time event and resolves completely.↗
▶Ep 5 · 1:58
quoteWe're very lucky that in the majority of cases in pediatric pancreatitis this is self-limited and reversible, and you would just have a one-time event and resolves completely.↗
▶Ep 5 · 4:31
clinicalAmylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic.↗
▶Ep 5 · 4:31
clinicalLipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease.↗
▶Ep 5 · 4:31
clinicalAmylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic.↗
▶Ep 5 · 4:31
clinicalLipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease.↗
▶Ep 5 · 4:51
quoteLipase is more specific though. Um, so lipase half-life is about 7 days, but it's also more specific because it's mostly elevated if there's intestinal or pancreatic, um, things.↗
▶Ep 5 · 4:51
quoteLipase is more specific though. Um, so lipase half-life is about 7 days, but it's also more specific because it's mostly elevated if there's intestinal or pancreatic, um, things.↗
▶Ep 5 · 5:54
clinicalThe primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications.↗
▶Ep 5 · 5:54
quoteThe ultrasound is really, that's the most helpful use of it. It's not really to document that the patient has pancreatitis or looking for complications. It's really looking if there's a biliary component.↗
▶Ep 5 · 5:54
clinicalThe primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications.↗
▶Ep 5 · 5:54
quoteThe ultrasound is really, that's the most helpful use of it. It's not really to document that the patient has pancreatitis or looking for complications. It's really looking if there's a biliary component.↗
▶Ep 5 · 6:51
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound.↗
▶Ep 5 · 6:51
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound.↗
▶Ep 5 · 7:19
clinicalMRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves.↗
▶Ep 5 · 7:19
clinicalMRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves.↗
▶Ep 5 · 8:12
clinicalThere is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery.↗
▶Ep 5 · 8:12
quoteThere is no data on what is optimal management. Even the studies in adults have not identified a superior medication in acute pancreatitis, and don't be shy of using opioids actually.↗
▶Ep 5 · 8:12
quoteThere is no data on what is optimal management. Even the studies in adults have not identified a superior medication in acute pancreatitis, and don't be shy of using opioids actually.↗
▶Ep 5 · 8:12
clinicalThere is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery.↗
▶Ep 5 · 10:16
clinicalEarly enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response.↗
▶Ep 5 · 10:16
quoteThe data is very convincing that. You need to start it early, and early means really within 24 to 72 hours, and it's been proven. There is no debate.↗
▶Ep 5 · 10:16
quoteThe data is very convincing that. You need to start it early, and early means really within 24 to 72 hours, and it's been proven. There is no debate.↗
▶Ep 5 · 10:16
clinicalEarly enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response.↗
▶Ep 5 · 10:53
epidemiologicalA 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality.↗
▶Ep 5 · 10:53
host_summaryA 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality.↗
▶Ep 5 · 14:43
clinicalNasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater.↗
▶Ep 5 · 14:43
clinicalNasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater.↗
▶Ep 5 · 15:21
clinicalIn a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events.↗
▶Ep 5 · 15:21
host_summaryIn a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events.↗
▶Ep 5 · 15:46
quoteThey found that you could feed without increased abdominal pain, so you're going to wait on feeding your patients until their pain is gone, but their pain is going to be the same whether you feed them or not, and that's what the study showed.↗
▶Ep 5 · 15:46
quoteThey found that you could feed without increased abdominal pain, so you're going to wait on feeding your patients until their pain is gone, but their pain is going to be the same whether you feed them or not, and that's what the study showed.↗
▶Ep 5 · 16:31
clinicalIn a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients.↗
▶Ep 5 · 16:31
clinicalIn a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients.↗
▶Ep 5 · 17:17
opinionThere is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion.↗
▶Ep 5 · 17:17
opinionThere is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion.↗
▶Ep 5 · 17:27
quoteI haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:27
quoteI haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:30
clinicalPilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately.↗
▶Ep 5 · 17:30
clinicalPilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately.↗
▶Ep 5 · 17:42
quoteThe lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:42
quoteThe lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:56
quoteIt's, it's, it's probably that they're ready to eat more. They self-regulate again, so they eat more and they order a burger by their 2nd or 3rd day, and then you feel, OK, you're ready to go home.↗
▶Ep 5 · 17:56
quoteIt's, it's, it's probably that they're ready to eat more. They self-regulate again, so they eat more and they order a burger by their 2nd or 3rd day, and then you feel, OK, you're ready to go home.↗
▶Ep 5 · 20:10
clinicalAdult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.↗
▶Ep 5 · 20:10
host_summaryAdult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.↗
▶Ep 5 · 21:22
host_summaryA 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline.↗
▶Ep 5 · 21:22
clinicalA 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline.↗
▶Ep 5 · 25:44
quoteWe really defaulted our management to D5NS since we're using higher rates. We didn't want people to use half an S, so hypotonic solutions with the higher rates.↗
▶Ep 5 · 25:44
quoteWe really defaulted our management to D5NS since we're using higher rates. We didn't want people to use half an S, so hypotonic solutions with the higher rates.↗
▶Ep 5 · 26:09
clinicalIn a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group.↗
▶Ep 5 · 26:09
clinicalIn a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group.↗
▶Ep 5 · 28:23
quoteI think I really have to say we're very blessed here that sometimes we don't see it. The radiology colleagues help us get the patient back to an ultrasound. If that's still kind of a needed study, we give the patient a few hours and then repeat it.↗
▶Ep 5 · 28:23
quoteI think I really have to say we're very blessed here that sometimes we don't see it. The radiology colleagues help us get the patient back to an ultrasound. If that's still kind of a needed study, we give the patient a few hours and then repeat it.↗
▶Ep 5 · 31:03
clinicalRanson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002.↗
▶Ep 5 · 31:03
clinicalRanson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002.↗
▶Ep 5 · 31:54
clinicalA prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization.↗
▶Ep 5 · 31:54
clinicalA prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization.↗
▶Ep 5 · 34:55
quoteThe patient is afebrile. I don't think this is an infected necrosis, so we did not start antibiotics.↗
▶Ep 5 · 34:55
quoteThe patient is afebrile. I don't think this is an infected necrosis, so we did not start antibiotics.↗
▶Ep 5 · 35:22
clinicalProphylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis.↗
▶Ep 5 · 35:22
clinicalProphylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis.↗
▶Ep 5 · 35:31
clinicalWhen antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence.↗
▶Ep 5 · 35:31
clinicalWhen antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence.↗
▶Ep 5 · 37:19
guidelineAcute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month.↗
▶Ep 5 · 37:19
host_summaryAcute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month.↗
▶Ep 5 · 38:00
clinicalComprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.↗
▶Ep 5 · 38:00
clinicalComprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.↗
▶Ep 5 · 46:01
clinicalIn pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients.↗
▶Ep 5 · 46:01
clinicalIn pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients.↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 0:18
quoteWe know that this is an underserved field in the pediatrics and even in adult pancreatology, so we're very excited.↗
▶Ep 5 · 0:18
quoteWe know that this is an underserved field in the pediatrics and even in adult pancreatology, so we're very excited.↗
▶Ep 5 · 0:55
guidelineAcute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis.↗
▶Ep 5 · 0:55
host_summaryAcute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis.↗
▶Ep 5 · 1:31
quoteWe always ask what is the normal range for the lab wherever we get the labs from, because not every lab runs the same ELISA test.↗
▶Ep 5 · 1:31
quoteWe always ask what is the normal range for the lab wherever we get the labs from, because not every lab runs the same ELISA test.↗
▶Ep 5 · 1:58
quoteWe're very lucky that in the majority of cases in pediatric pancreatitis this is self-limited and reversible, and you would just have a one-time event and resolves completely.↗
▶Ep 5 · 1:58
quoteWe're very lucky that in the majority of cases in pediatric pancreatitis this is self-limited and reversible, and you would just have a one-time event and resolves completely.↗
▶Ep 5 · 4:31
clinicalLipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease.↗
▶Ep 5 · 4:31
clinicalAmylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic.↗
▶Ep 5 · 4:31
clinicalLipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease.↗
▶Ep 5 · 4:31
clinicalAmylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic.↗
▶Ep 5 · 4:51
quoteLipase is more specific though. Um, so lipase half-life is about 7 days, but it's also more specific because it's mostly elevated if there's intestinal or pancreatic, um, things.↗
▶Ep 5 · 4:51
quoteLipase is more specific though. Um, so lipase half-life is about 7 days, but it's also more specific because it's mostly elevated if there's intestinal or pancreatic, um, things.↗
▶Ep 5 · 5:54
quoteThe ultrasound is really, that's the most helpful use of it. It's not really to document that the patient has pancreatitis or looking for complications. It's really looking if there's a biliary component.↗
▶Ep 5 · 5:54
quoteThe ultrasound is really, that's the most helpful use of it. It's not really to document that the patient has pancreatitis or looking for complications. It's really looking if there's a biliary component.↗
▶Ep 5 · 5:54
clinicalThe primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications.↗
▶Ep 5 · 5:54
clinicalThe primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications.↗
▶Ep 5 · 6:51
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound.↗
▶Ep 5 · 6:51
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound.↗
▶Ep 5 · 7:19
clinicalMRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves.↗
▶Ep 5 · 7:19
clinicalMRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves.↗
▶Ep 5 · 8:12
clinicalThere is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery.↗
▶Ep 5 · 8:12
quoteThere is no data on what is optimal management. Even the studies in adults have not identified a superior medication in acute pancreatitis, and don't be shy of using opioids actually.↗
▶Ep 5 · 8:12
clinicalThere is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery.↗
▶Ep 5 · 8:12
quoteThere is no data on what is optimal management. Even the studies in adults have not identified a superior medication in acute pancreatitis, and don't be shy of using opioids actually.↗
▶Ep 5 · 10:16
quoteThe data is very convincing that. You need to start it early, and early means really within 24 to 72 hours, and it's been proven. There is no debate.↗
▶Ep 5 · 10:16
clinicalEarly enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response.↗
▶Ep 5 · 10:16
quoteThe data is very convincing that. You need to start it early, and early means really within 24 to 72 hours, and it's been proven. There is no debate.↗
▶Ep 5 · 10:16
clinicalEarly enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response.↗
▶Ep 5 · 10:53
epidemiologicalA 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality.↗
▶Ep 5 · 10:53
host_summaryA 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality.↗
▶Ep 5 · 14:43
clinicalNasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater.↗
▶Ep 5 · 14:43
clinicalNasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater.↗
▶Ep 5 · 15:21
clinicalIn a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events.↗
▶Ep 5 · 15:21
host_summaryIn a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events.↗
▶Ep 5 · 15:46
quoteThey found that you could feed without increased abdominal pain, so you're going to wait on feeding your patients until their pain is gone, but their pain is going to be the same whether you feed them or not, and that's what the study showed.↗
▶Ep 5 · 15:46
quoteThey found that you could feed without increased abdominal pain, so you're going to wait on feeding your patients until their pain is gone, but their pain is going to be the same whether you feed them or not, and that's what the study showed.↗
▶Ep 5 · 16:31
clinicalIn a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients.↗
▶Ep 5 · 16:31
clinicalIn a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients.↗
▶Ep 5 · 17:17
opinionThere is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion.↗
▶Ep 5 · 17:17
opinionThere is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion.↗
▶Ep 5 · 17:27
quoteI haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:27
quoteI haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:30
clinicalPilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately.↗
▶Ep 5 · 17:30
clinicalPilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately.↗
▶Ep 5 · 17:42
quoteThe lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:42
quoteThe lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 5 · 17:56
quoteIt's, it's, it's probably that they're ready to eat more. They self-regulate again, so they eat more and they order a burger by their 2nd or 3rd day, and then you feel, OK, you're ready to go home.↗
▶Ep 5 · 17:56
quoteIt's, it's, it's probably that they're ready to eat more. They self-regulate again, so they eat more and they order a burger by their 2nd or 3rd day, and then you feel, OK, you're ready to go home.↗
▶Ep 5 · 20:10
clinicalAdult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.↗
▶Ep 5 · 20:10
host_summaryAdult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.↗
▶Ep 5 · 21:22
host_summaryA 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline.↗
▶Ep 5 · 21:22
clinicalA 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline.↗
▶Ep 5 · 25:44
quoteWe really defaulted our management to D5NS since we're using higher rates. We didn't want people to use half an S, so hypotonic solutions with the higher rates.↗
▶Ep 5 · 25:44
quoteWe really defaulted our management to D5NS since we're using higher rates. We didn't want people to use half an S, so hypotonic solutions with the higher rates.↗
▶Ep 5 · 26:09
clinicalIn a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group.↗
▶Ep 5 · 26:09
clinicalIn a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group.↗
▶Ep 5 · 28:23
quoteI think I really have to say we're very blessed here that sometimes we don't see it. The radiology colleagues help us get the patient back to an ultrasound. If that's still kind of a needed study, we give the patient a few hours and then repeat it.↗
▶Ep 5 · 28:23
quoteI think I really have to say we're very blessed here that sometimes we don't see it. The radiology colleagues help us get the patient back to an ultrasound. If that's still kind of a needed study, we give the patient a few hours and then repeat it.↗
▶Ep 5 · 31:03
clinicalRanson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002.↗
▶Ep 5 · 31:03
clinicalRanson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002.↗
▶Ep 5 · 31:54
clinicalA prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization.↗
▶Ep 5 · 31:54
clinicalA prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization.↗
▶Ep 5 · 34:55
quoteThe patient is afebrile. I don't think this is an infected necrosis, so we did not start antibiotics.↗
▶Ep 5 · 34:55
quoteThe patient is afebrile. I don't think this is an infected necrosis, so we did not start antibiotics.↗
▶Ep 5 · 35:22
clinicalProphylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis.↗
▶Ep 5 · 35:22
clinicalProphylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis.↗
▶Ep 5 · 35:31
clinicalWhen antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence.↗
▶Ep 5 · 35:31
clinicalWhen antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence.↗
▶Ep 5 · 37:19
guidelineAcute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month.↗
▶Ep 5 · 37:19
host_summaryAcute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month.↗
▶Ep 5 · 38:00
clinicalComprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.↗
▶Ep 5 · 38:00
clinicalComprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.↗
▶Ep 5 · 46:01
clinicalIn pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients.↗
▶Ep 5 · 46:01
clinicalIn pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients.↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 6 · 0:18
quoteWe know that this is an underserved field in the pediatrics and even in adult pancreatology, so we're very excited.↗
▶Ep 6 · 0:18
quoteWe know that this is an underserved field in the pediatrics and even in adult pancreatology, so we're very excited.↗
▶Ep 6 · 0:55
host_summaryAcute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis.↗
▶Ep 6 · 0:55
guidelineAcute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis.↗
▶Ep 6 · 1:31
quoteWe always ask what is the normal range for the lab wherever we get the labs from, because not every lab runs the same ELISA test.↗
▶Ep 6 · 1:31
quoteWe always ask what is the normal range for the lab wherever we get the labs from, because not every lab runs the same ELISA test.↗
▶Ep 6 · 1:58
quoteWe're very lucky that in the majority of cases in pediatric pancreatitis this is self-limited and reversible, and you would just have a one-time event and resolves completely.↗
▶Ep 6 · 1:58
quoteWe're very lucky that in the majority of cases in pediatric pancreatitis this is self-limited and reversible, and you would just have a one-time event and resolves completely.↗
▶Ep 6 · 4:31
clinicalAmylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic.↗
▶Ep 6 · 4:31
clinicalLipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease.↗
▶Ep 6 · 4:31
clinicalAmylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic.↗
▶Ep 6 · 4:31
clinicalLipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease.↗
▶Ep 6 · 4:51
quoteLipase is more specific though. Um, so lipase half-life is about 7 days, but it's also more specific because it's mostly elevated if there's intestinal or pancreatic, um, things.↗
▶Ep 6 · 4:51
quoteLipase is more specific though. Um, so lipase half-life is about 7 days, but it's also more specific because it's mostly elevated if there's intestinal or pancreatic, um, things.↗
▶Ep 6 · 5:54
clinicalThe primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications.↗
▶Ep 6 · 5:54
quoteThe ultrasound is really, that's the most helpful use of it. It's not really to document that the patient has pancreatitis or looking for complications. It's really looking if there's a biliary component.↗
▶Ep 6 · 5:54
quoteThe ultrasound is really, that's the most helpful use of it. It's not really to document that the patient has pancreatitis or looking for complications. It's really looking if there's a biliary component.↗
▶Ep 6 · 5:54
clinicalThe primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications.↗
▶Ep 6 · 6:51
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound.↗
▶Ep 6 · 6:51
clinicalCT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound.↗
▶Ep 6 · 7:19
clinicalMRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves.↗
▶Ep 6 · 7:19
clinicalMRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves.↗
▶Ep 6 · 8:12
quoteThere is no data on what is optimal management. Even the studies in adults have not identified a superior medication in acute pancreatitis, and don't be shy of using opioids actually.↗
▶Ep 6 · 8:12
clinicalThere is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery.↗
▶Ep 6 · 8:12
quoteThere is no data on what is optimal management. Even the studies in adults have not identified a superior medication in acute pancreatitis, and don't be shy of using opioids actually.↗
▶Ep 6 · 8:12
clinicalThere is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery.↗
▶Ep 6 · 10:16
quoteThe data is very convincing that. You need to start it early, and early means really within 24 to 72 hours, and it's been proven. There is no debate.↗
▶Ep 6 · 10:16
clinicalEarly enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response.↗
▶Ep 6 · 10:16
quoteThe data is very convincing that. You need to start it early, and early means really within 24 to 72 hours, and it's been proven. There is no debate.↗
▶Ep 6 · 10:16
clinicalEarly enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response.↗
▶Ep 6 · 10:53
host_summaryA 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality.↗
▶Ep 6 · 10:53
epidemiologicalA 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality.↗
▶Ep 6 · 14:43
clinicalNasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater.↗
▶Ep 6 · 14:43
clinicalNasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater.↗
▶Ep 6 · 15:21
host_summaryIn a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events.↗
▶Ep 6 · 15:21
clinicalIn a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events.↗
▶Ep 6 · 15:46
quoteThey found that you could feed without increased abdominal pain, so you're going to wait on feeding your patients until their pain is gone, but their pain is going to be the same whether you feed them or not, and that's what the study showed.↗
▶Ep 6 · 15:46
quoteThey found that you could feed without increased abdominal pain, so you're going to wait on feeding your patients until their pain is gone, but their pain is going to be the same whether you feed them or not, and that's what the study showed.↗
▶Ep 6 · 16:31
clinicalIn a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients.↗
▶Ep 6 · 16:31
clinicalIn a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients.↗
▶Ep 6 · 17:17
opinionThere is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion.↗
▶Ep 6 · 17:17
opinionThere is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion.↗
▶Ep 6 · 17:27
quoteI haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 6 · 17:27
quoteI haven't found a good evidence for the low fat. However, we know that fat stimulates lipase and we don't want to increase lipase, but at least from this pilot analysis that we did, we showed that the ones who had, um, so if I want to show here. The lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 6 · 17:30
clinicalPilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately.↗
▶Ep 6 · 17:30
clinicalPilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately.↗
▶Ep 6 · 17:42
quoteThe lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 6 · 17:42
quoteThe lowest pain scores, this is the pain score on the X axis, were actually the ones who ate the most fat.↗
▶Ep 6 · 17:56
quoteIt's, it's, it's probably that they're ready to eat more. They self-regulate again, so they eat more and they order a burger by their 2nd or 3rd day, and then you feel, OK, you're ready to go home.↗
▶Ep 6 · 17:56
quoteIt's, it's, it's probably that they're ready to eat more. They self-regulate again, so they eat more and they order a burger by their 2nd or 3rd day, and then you feel, OK, you're ready to go home.↗
▶Ep 6 · 20:10
host_summaryAdult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.↗
▶Ep 6 · 20:10
clinicalAdult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.↗
▶Ep 6 · 21:22
clinicalA 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline.↗
▶Ep 6 · 21:22
host_summaryA 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline.↗
▶Ep 6 · 25:44
quoteWe really defaulted our management to D5NS since we're using higher rates. We didn't want people to use half an S, so hypotonic solutions with the higher rates.↗
▶Ep 6 · 25:44
quoteWe really defaulted our management to D5NS since we're using higher rates. We didn't want people to use half an S, so hypotonic solutions with the higher rates.↗
▶Ep 6 · 26:09
clinicalIn a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group.↗
▶Ep 6 · 26:09
clinicalIn a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group.↗
▶Ep 6 · 28:23
quoteI think I really have to say we're very blessed here that sometimes we don't see it. The radiology colleagues help us get the patient back to an ultrasound. If that's still kind of a needed study, we give the patient a few hours and then repeat it.↗
▶Ep 6 · 28:23
quoteI think I really have to say we're very blessed here that sometimes we don't see it. The radiology colleagues help us get the patient back to an ultrasound. If that's still kind of a needed study, we give the patient a few hours and then repeat it.↗
▶Ep 6 · 31:03
clinicalRanson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002.↗
▶Ep 6 · 31:03
clinicalRanson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002.↗
▶Ep 6 · 31:54
clinicalA prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization.↗
▶Ep 6 · 31:54
clinicalA prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization.↗
▶Ep 6 · 34:55
quoteThe patient is afebrile. I don't think this is an infected necrosis, so we did not start antibiotics.↗
▶Ep 6 · 34:55
quoteThe patient is afebrile. I don't think this is an infected necrosis, so we did not start antibiotics.↗
▶Ep 6 · 35:22
clinicalProphylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis.↗
▶Ep 6 · 35:22
clinicalProphylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis.↗
▶Ep 6 · 35:31
clinicalWhen antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence.↗
▶Ep 6 · 35:31
clinicalWhen antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence.↗
▶Ep 6 · 37:19
guidelineAcute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month.↗
▶Ep 6 · 37:19
host_summaryAcute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month.↗
▶Ep 6 · 38:00
clinicalComprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.↗
▶Ep 6 · 38:00
clinicalComprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.↗
▶Ep 6 · 46:01
clinicalIn pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients.↗
▶Ep 6 · 46:01
clinicalIn pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients.↗
