ALL
Everything in the library about ALL — 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.
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Acute Management
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Update Course Rewind: Management of Acute Pancreatitis 2023
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We are back with another Update Course Rewind video from the Update course in Pediatric Surgery 2023.
This time we are presenting you “Management of Acute Pancreatitis" with Dr. Juan Gurría.
Host: Cecilia Gigena
Brought to you by C
video6:46 · Apr 2024
Case-Based Learning
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Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
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In this session from the 12th Annual Update Course in Pediatric Surgery, Drs. David Vitale, Luke Neff, and Jeffrey Ponsky explore strategies for preventing gallstone pancreatitis in pediatric patients with biliary stones. This session is cl
video3:53 · Jul 2025
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
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Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024 | Podcast Episode on RSS.com Sign up free Features Resources Pricing Podcasts Sign up free Sign In Stay Current in Pediatric Surgery... Update Course Re
podcast3:53 · Jul 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course Rewind: Management of Acute Pancreatitis 2023
Acute pancreatitis could be fatal
clinicalJuan Gurria1:56 ↗
Bolus times 2 is adequate fluid resuscitation, with 1.5 times maintenance once past the early phase of acute resuscitation
clinicalJuan Gurria1:58 ↗
Pancreatitis is a state of hypoxia requiring re-establishment of intravascular flow to the pancreas to prevent hypoxia, necrosis, and atrophic pancreas insufficiency
clinicalJuan Gurria2:06 ↗
Early fluid resuscitation is key in pancreatitis management
clinicalJuan Gurria2:22 ↗
Excessive fluid administration worsens outcomes in pancreatitis
clinicalJuan Gurria2:26 ↗
There is no reason to give antibiotics for pancreatitis, even in the face of necrosis or necrotizing pancreatitis, unless there are signs of sepsis or infected pancreatitis
guidelineJuan Gurria2:29 ↗
The North American Society of Pancreatitis, GI Pathology, and Nutrition published a position paper with guideline recommendations for pancreatitis management
guidelineJuan Gurria2:57 ↗
Early fluids lead to better outcomes in pancreatitis
clinicalJuan Gurria3:07 ↗
Recommended fluid bolus is 10 to 20 mL per kg, up to 3L in the first 24 hours, with reassessment at the 12-hour mark using urine output and vital signs
guidelineJuan Gurria3:11 ↗
Excessive fluid administration can flood the lungs and worsen outcomes
clinicalJuan Gurria3:25 ↗
Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline in pancreatitis
clinicalJuan Gurria3:45 ↗
If albumin is low in pancreatitis patients, albumin should be given
clinicalJuan Gurria3:54 ↗
Enrique de Madaria conducted a multi-center worldwide RCT called the Waterfall trial comparing moderate versus aggressive fluid resuscitation in pancreatitis
clinicalJuan Gurria3:58 ↗
The Waterfall trial was stopped early because patients receiving too much fluid were developing organ failure
clinicalJuan Gurria4:18 ↗
A follow-up Waterland trial is underway to determine whether lactated Ringer's is better than normal saline, expected to be published in one to two years
clinicalJuan Gurria4:27 ↗
Patients with pancreatitis should be fed as soon as they are able to tolerate oral intake
clinicalJuan Gurria4:47 ↗
Enteral nutrition is significantly better compared to TPN or NPO in pancreatitis
clinicalJuan Gurria4:51 ↗
Gastric feeding is preferred over post-pyloric feeding in pancreatitis if the patient can tolerate it
clinicalJuan Gurria4:57 ↗
Some vomiting is tolerable during refeeding in pancreatitis, similar to gastroschisis management
opinionJuan Gurria5:19 ↗
If nutrition is lost and the patient loses ground, outcomes will be worse, with dropping albumin and worse inflammatory reaction
clinicalJuan Gurria5:26 ↗
Outcomes are dramatically better when the gut is fed in pancreatitis patients
clinicalJuan Gurria5:34 ↗
Vitals are the main consideration for deciding whether a pancreatitis patient should go to the floor or ICU
host_summary5:48 ↗
Fluid resuscitation is key in pancreatitis management
host_summaryCecilia Gigena5:55 ↗
Patients should be reassessed at the 12 and 24 hour mark to avoid fluid overload
host_summaryCecilia Gigena5:57 ↗
Current publications suggest lactated Ringer's is better in reducing inflammatory response in pancreatitis
host_summary6:07 ↗
It is important to feed pancreatitis patients as soon as possible, specifically aiming to feed in the stomach
host_summary6:17 ↗
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
The patient is a 16-year-old currently undergoing treatment for acute lymphoblastic leukemia (ALL) who presents with right upper quadrant pain, neutropenia, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.
host_summaryEm Gootee0:56 ↗
In this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests.
host_summaryEm Gootee1:20 ↗
The patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy.
clinicalLuke Neff1:31 ↗
Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.
host_summaryEm Gootee1:49 ↗
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