Cholestasis
Everything in the library about cholestasis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Medical Management
1 item
Intestinal Rehabilitation, Episode 6: Cholestasis
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We’re back with a new episode from the intestinal rehabilitation center at Cincinnati Children’s Hospital.
This time we’re talking about Cholestasis with Drs. Helmrath and Wales.
Hosts: Cecilia Gigena & Ellen Encisco.
podcast15:25 · Jun 2023
Surgical Management
1 item
Biliary Atresia: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. Greg M. Tiao, Chief of Pediatric Surgery at Cincinnati Children's Hospital, discusses biliary atresia. Dr. Tiao covers topics on cholestasis in infants, diag
video20:34 · Jan 2019
Case-Based Learning
1 item
Biliary Atresia - Robert Parry: Update Course 2014
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Dr. Robert Parry, Director of Pediatric Surgery, Akron Children's Hospital, presents a clinical case of biliary atresia diagnosis. Topics discussed include kasai procedure, HIDA scan for biliary atresia, postoperative corticosteroids, and r
video24:55 · Nov 2018
In-Depth Reviews
2 items
Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric...
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At the Advanced Practice Providers Pediatric Surgery Update Course in 2014, many distinguished advanced practice providers from around the world address the current evidence based management of the common pediatric surgical conditions. The
video48:21 · Jan 2019
Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways
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In November 2023 we held the first Intestinal Rehabilitation webinar with Dr. Paul Wales & Dr. Michael Helmrath, 2 experts from the Intestinal Rehab center at Cincinnati Children's.
These are the top 5 key takeaways from this webinar!!
video12:14 · Jun 2024
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric...
Pathologic jaundice occurs in 1 in 2500 live births
epidemiological2:24 ↗
Biliary atresia is a progressive, obliterative, idiopathic cholangiopathy with two forms: perinatal/postnatal (80-90%) and fetal/embryonic (10-20%)
clinical5:01 ↗
Biliary atresia incidence ranges from 1 in 5000 in Taiwan, 1 in 8-10,000 in Japan, and 1 in 18,000 in the United States and Europe
epidemiological5:42 ↗
More females than males are affected by biliary atresia
epidemiological6:05 ↗
Seasonal clustering of biliary atresia cases suggests viruses or infectious processes may be triggers
clinical6:09 ↗
Biliary atresia is lethal if untreated
clinical6:10 ↗
If conjugated or direct bilirubin is greater than or equal to 2, the child needs closer evaluation
guideline7:59 ↗
Some babies with biliary atresia have normal ultrasounds
clinical8:16 ↗
The gold standard for biliary atresia diagnosis is the intraoperative cholangiogram
guideline8:26 ↗
At Children's Hospital Los Angeles, babies are pre-treated with 5 days of phenobarbital before HIDA scan
clinical9:31 ↗
Timing of diagnosis and Kasai procedure is extremely important, with the sweet spot being 6 to 8 weeks of age
clinical15:14 ↗
A French study showed 23% of Kasai patients had their native liver 20 years post-Kasai
epidemiological15:50 ↗
Factors affecting survival with native liver include age at Kasai, type of biliary atresia, liver histology (bridging fibrosis), and center caseload
clinical16:24 ↗
In England, consolidating Kasai procedures to 3 centers increased success rates
epidemiological16:48 ↗
At Children's Hospital Los Angeles, 6 to 12 biliary atresia cases are seen per year, considered a high rate
epidemiological17:20 ↗
If cirrhosis is seen on liver biopsy or frozen section during intraoperative cholangiogram, the procedure is stopped and the patient is listed for transplant
clinical19:57 ↗
Kasai procedures in older babies (3.5-4 months) can bridge patients to transplant at one year of age, though with complications including ascending cholangitis and frequent hospitalizations
clinical20:20 ↗
Bigger babies at time of transplant have easier transplant procedures
opinion21:24 ↗
Children's Hospital Los Angeles has a very large, possibly the largest, living donor liver transplant center in the country, offering an alternative to cadaveric transplant
clinical22:27 ↗
Most centers put babies on antibiotic prophylaxis postoperatively until they are eating
clinical23:23 ↗
Post-operative steroids for biliary atresia are unproven
clinical23:48 ↗
At Children's Hospital Los Angeles, peripheral IV lines are used postoperatively rather than Broviacs, and babies are not sent home on IV antibiotics
clinical24:06 ↗
Babies are switched from IV antibiotics to Bactrim once taking orals; babies under 6 weeks receive amoxicillin until 6 weeks of age, then switch to Bactrim at 4-5 mg/kg/day
clinical25:08 ↗
Babies are placed on ursodeoxycholic acid twice daily post-Kasai
clinical25:35 ↗
Biliary atresia babies are often deficient in fat-soluble vitamins D, E, and K, which are supplemented using aqueous solutions (Aquadek or ADeck) for better absorption
clinical25:41 ↗
Probiotics, herbal remedies, and omega-3 supplements have not been proven beneficial for biliary atresia
clinical26:29 ↗
The BARC (Biliary Atresia Research Consortium) protocol enrolled 140 babies in a randomized double-blind placebo-controlled study with steroids
clinical27:01 ↗
When a post-Kasai baby has unexplained fever, ascending cholangitis is suspected
clinical28:15 ↗
Multiple episodes of ascending cholangitis cause further liver damage and may lead to earlier need for transplant
clinical29:36 ↗
Biliary atresia is the most common indication for pediatric liver transplant
epidemiological31:09 ↗
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