# Biliary Atresia — GCMD Library living collection

Also covered as: cholestasis · cirrhosis · choledochal cyst · jaundice · portal hypertension · Alagille syndrome · alpha-1 antitrypsin deficiency · ascites

Experts: Dr. Todd Ponsky, Dr. Greg Tiao, Dr. Whit Holcomb, Dr. Em Gootee

Updated: n/a · 25 episodes · 499 cited statements

## Episodes
### Fundamentals
- [Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric...](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910) — video · 48:21 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910.md)
- [Choledochal Cyst Podcast](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310) — podcast · 22:07 · [machine version](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310.md)
- [Biliary Atresia with Dr. Greg Tiao](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518) — video · 11:34 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518.md)

### Diagnosis & Workup
- [Biliary Atresia Part I](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039) — podcast · 31:15 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039.md)
- [BOB Ped Surg 2023 - Maria Soledad Jara Valdivia, CIPESUR  - Presentation](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353) — video · [machine version](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353.md)
- [Update Course Rewind: MMP-7 & Biliary Atresia Diagnosis 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973) — video · 6:24 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973.md)

### Medical Management
- [Biliary Atresia Part II](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040) — podcast · 42:23 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040.md)

### Surgical Management
- [Biliary Atresia: Update Course 2015](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911) — video · 20:34 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911.md)
- [Error Traps and Culture of Safety in Biliary Atresia](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921) — video · 4:32 · [machine version](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921.md)
- [Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008) — video · 2:30 · [machine version](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008.md)

### Evidence & Research
- [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929) — podcast · 44:19 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929.md)
- [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308) — podcast · 44:19 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308.md)
- [Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405) — video · 23:20 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405.md)
- [Quick Literature Updates Episode 9](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770) — video · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770.md)
- [Heat 3 Winner: Shruthi Srinivas, MD - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018) — video · 1:47 · [machine version](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018.md)
- [Jingying Jiang, MD - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019) — video · 6:58 · [machine version](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019.md)
- [Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911) — video · 0:55 · [machine version](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911.md)
- [Características clínicas y pronóstico de la atresia de vías biliares con niveles bajos de metaloproteinasa 7 de la matriz sérica](https://qa.library.globalcastmd.com/watch/caracter-sticas-cl-nicas-y-pron-stico-de-la-atresia-de-v-as-biliares-con-niveles-bajos-de-metaloproteinasa-7-de-la-matriz-s-rica-8912) — video · 0:55 · [machine version](https://qa.library.globalcastmd.com/watch/caracter-sticas-cl-nicas-y-pron-stico-de-la-atresia-de-v-as-biliares-con-niveles-bajos-de-metaloproteinasa-7-de-la-matriz-s-rica-8912.md)
- [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154) — podcast · 17:03 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154.md)
- [Update Course Rewind: 2024 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md)

### Case-Based Learning
- [Biliary Atresia - Robert Parry: Update Course 2014](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662) — video · 24:55 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662.md)
- [Biliary Atresia-Case Presentation and Panel Discussion: Update Course 2014](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909) — video · 23:47 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909.md)
- [Biliary Atresia - Clinical Practice Updates](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000) — video · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000.md)

### In-Depth Reviews
- [Biliary Atresia](https://qa.library.globalcastmd.com/watch/biliary-atresia-859) — video · 20:57 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-859.md)

### Emerging & Future Directions
- [Prof. Shilpa Sharma - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004) — video · 5:46 · [machine version](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=0) Case Presentation and Optimal Timing for Kasai (Ep 3)
- [7:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=421) Contraindications and Redo Procedures (Ep 3)
- [13:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=801) Diagnostic Workup: HIDA, Phenobarbital, and Liver Biopsy (Ep 3)
- [18:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1101) Postoperative Steroids and Japanese Technical Refinements (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=0) MMP-7 as a Prognostic Marker in Biliary Atresia (Ep 21)
- [0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=0) Introduction and Liver Physiology Review (Ep 4)
- [4:59](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=299) Biliary Atresia Definition and Diagnostic Workup (Ep 4)
- [8:38](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=518) Pathology and Surgical Management (Ep 4)
- [13:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=820) Kasai Outcomes and Timing Considerations (Ep 4)
- [19:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1172) Postoperative Management Protocols (Ep 4)
- [26:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1608) Primary Care and Family Impact (Ep 4)
- [33:54](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2034) Case Study: Sandra (Ep 4)
- [39:36](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2376) Steroid Use and Future Directions (Ep 4)
- [43:05](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2585) Key Points Summary and Q&A (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=0) Case Presentation and Initial Workup of Cholestatic Infant (Ep 5)
- [3:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=183) Diagnostic Studies: Ultrasound, HIDA Scan, and Liver Biopsy (Ep 5)
- [7:36](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=456) Liver Biopsy Findings and Role of Cholangiography (Ep 5)
- [10:28](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=628) Surgical Technique: Extended Hilar Dissection (Ep 5)
- [13:13](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=793) Special Variants: Polysplenia and Cystic Biliary Atresia (Ep 5)
- [15:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=911) Operative Considerations: Roux Limb Length and Center Volume (Ep 5)
- [17:37](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1057) Postoperative Corticosteroids and Alagille Syndrome Differentiation (Ep 5)
- [0:00](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=0) Heat 3 Recap (Ep 19)
- [0:50](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=50) Winner Announcement (Ep 19)
- [0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=0) Case presentation and optimal age for Kasai procedure (Ep 1)
- [4:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=296) Age versus duration of symptoms and contraindications to Kasai (Ep 1)
- [8:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=520) Preoperative workup: HIDA scans and phenobarbital (Ep 1)
- [17:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1040) Role of percutaneous liver biopsy and cholangiography (Ep 1)
- [21:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1290) Postoperative steroids and Japanese technical modifications (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=0) Case Presentation and Differential Diagnosis (Ep 8)
- [4:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=284) Diagnostic Algorithm and Laboratory Workup (Ep 8)
- [11:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=701) Imaging and Laparoscopic Diagnosis Debate (Ep 8)
- [20:28](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1228) Liver Biopsy Controversy and Centralization (Ep 8)
- [24:33](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1473) Cystic Biliary Atresia Variant (Ep 8)
- [0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=0) Introduction and Background (Ep 15)
- [1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=60) Methodology (Ep 15)
- [3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=180) Results (Ep 15)
- [4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=240) Discussion and Conclusions (Ep 15)
- [0:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=0) Introduction and First Paper Setup (Ep 16)
- [1:10](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70) Transanastomotic Tubes and Patent Processus Vaginalis Studies (Ep 16)
- [2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133) Biliary Atresia Transplant Timing (Ep 16)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "French registry data show significantly better 5- and 10-year native liver survival when Kasai performed before 30 days versus after 90 days, with nearly twice the survival rate" (clinical) [Ep 3 · 2:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=164)
- "In a Michigan series, children who had Kasai after 3 months had the best drainage and long-term outcomes" (clinical) [Ep 3 · 1:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=63)
- "Under 60 days there was a clear difference in outcomes; procedures done on weekends if approaching day 60" (clinical) [Ep 3 · 1:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=110)
- "The critical factor determining outcome is the degree of cirrhosis developed in the liver, which varies among children and does not always correlate directly with age" (clinical) [Ep 3 · 3:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=204)
- "Biliary atresia does not start at day zero in all patients; some may begin at day 20 and progress from there" (clinical) [Ep 3 · 3:53](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=233)
- "A series from Rich Ricketts showed not statistically significant better results with Kasai performed at 76 days or older versus 0-75 days" (clinical) [Ep 3 · 4:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=243)
- "Peter Altman from Columbia, who had the largest US series, argued Kasai should be done between 60 and 75 days" (opinion) [Ep 3 · 5:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=357)
- "Reversal of portal flow is very concerning because patients can achieve good biliary drainage and normal bilirubin but portal hypertension continues to progress, leading to transplant need" (clinical) [Ep 3 · 9:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=559)
- "Performing Kasai can buy time and increase the donor pool potential, even if the liver looks horrible" (clinical) [Ep 3 · 10:05](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=605)
- "Transplant becomes technically easier in older children with lower risk of hepatic artery thrombosis" (clinical) [Ep 3 · 10:27](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=627)
- "Hepatologists can manage biliary atresia patients medically for about a year in the absence of Kasai or transplant, though nutritional status is not optimal" (clinical) [Ep 3 · 10:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=641)
- "If patients have signs of end-stage liver disease with profound fibrosis and reversal of portal flow, Kasai may not improve outcomes and the operation may stress them unnecessarily" (opinion) [Ep 3 · 10:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=656)
- "The Kasai operation itself is not technically demanding with low technical risk, so if uncertain, redo procedures are reasonable" (opinion) [Ep 3 · 11:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=704)
- "Some biliary atresia cases show a race between hepatocyte regeneration and fibrosis progression; one patient's bilirubin dropped to normal 5 months post-op" (clinical) [Ep 3 · 12:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=740)
- "If liver biopsy is suggestive of biliary atresia, additional testing is not needed" (opinion) [Ep 3 · 14:02](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=842)
- "HIDA scan with phenobarbital has high sensitivity and specificity for biliary atresia" (clinical) [Ep 3 · 15:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=921)
- "An effective HIDA requires at least 5 days of phenobarbital at therapeutic levels" (clinical) [Ep 3 · 15:47](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=947)
- "In cases where initial HIDA without adequate phenobarbital was negative, about one-third showed biliary atresia when repeated with proper phenobarbital levels" (clinical) [Ep 3 · 16:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1000)
- "A recent paper in Gastroenterology showed a scoring system combining liver biopsy with clinical parameters had almost 100% ability to predict biliary atresia" (clinical) [Ep 3 · 17:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1055)
- "Pathologists' understanding of what to look for in biliary atresia biopsies has improved compared to 20 years ago" (clinical) [Ep 3 · 18:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1081)
- "Interventional radiologists can perform percutaneous liver biopsies safely and routinely" (clinical) [Ep 3 · 18:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1090)
- "Patent gallbladder in true biliary atresia is super rare" (clinical) [Ep 3 · 18:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1121)
- "In Milwaukee, percutaneous cholangiography combined with biopsy can quickly provide answers when successful" (clinical) [Ep 3 · 18:59](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1139)
- "If percutaneous cholangiography shows contrast in the gallbladder and bowel, biliary atresia is ruled out without need for surgery" (clinical) [Ep 3 · 19:49](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1189)
- "Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent" (clinical) [Ep 3 · 20:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1244)
- "Japanese centers still recommend steroids either routinely or when drainage decreases after Kasai" (clinical) [Ep 3 · 21:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1306)
- "Japanese surgeons now perform Kasai with wider porta dissection than Dr. Kasai originally did" (clinical) [Ep 3 · 22:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1335)
- "Japanese technique uses more superficial sutures to avoid damaging ductules and avoids placing sutures at 10 o'clock and 3 o'clock positions where normal bile ducts bifurcate" (clinical) [Ep 3 · 22:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1359)
- "Japanese centers claim better results with modified technique, though numbers are not statistically valid" (clinical) [Ep 3 · 23:06](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1386)
- "Yamataka is attempting to show laparoscopic Kasai results are as good as open, contrary to IPEG recommendations" (clinical) [Ep 3 · 23:08](https://qa.library.globalcastmd.com/watch/biliary-atresia-case-presentation-and-panel-discussion-update-course-2014-909?t=1388)
- "The study was a retrospective cohort study conducted in China" — Cecilia Gigena (epidemiological) [Ep 21 · 0:11](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=11)
- "The study included 329 patients with biliary atresia" — Cecilia Gigena (epidemiological) [Ep 21 · 0:21](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=21)
- "40 of the 329 patients had low MMP-7 levels" — Cecilia Gigena (epidemiological) [Ep 21 · 0:21](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=21)
- "Patients with low MMP-7 had significantly lower 3-month jaundice clearance" — Cecilia Gigena (clinical) [Ep 21 · 0:27](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27)
- "Patients with low MMP-7 had significantly lower 6-month jaundice clearance" — Cecilia Gigena (clinical) [Ep 21 · 0:27](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27)
- "Patients with low MMP-7 had significantly lower 1-year native liver survival" — Cecilia Gigena (clinical) [Ep 21 · 0:27](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=27)
- "Measuring MMP-7 can help with prognosis in biliary atresia patients" — Cecilia Gigena (opinion) [Ep 21 · 0:40](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=40)
- "MMP-7 measurement may in the future help with treatment of biliary atresia patients" — Cecilia Gigena (opinion) [Ep 21 · 0:40](https://qa.library.globalcastmd.com/watch/clinical-characteristics-and-prognosis-of-biliary-atresia-with-low-serum-matrix-metalloproteinase-7-levels-8911?t=40)
- "Pathologic jaundice occurs in 1 in 2500 live births" (epidemiological) [Ep 4 · 2:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=144)
- "Biliary atresia is a progressive, obliterative, idiopathic cholangiopathy with two forms: perinatal/postnatal (80-90%) and fetal/embryonic (10-20%)" (clinical) [Ep 4 · 5:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=301)
- "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" (epidemiological) [Ep 4 · 5:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=342)
- "More females than males are affected by biliary atresia" (epidemiological) [Ep 4 · 6:05](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=365)
- "Seasonal clustering of biliary atresia cases suggests viruses or infectious processes may be triggers" (clinical) [Ep 4 · 6:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=369)
- "Biliary atresia is lethal if untreated" (clinical) [Ep 4 · 6:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=370)
- "If conjugated or direct bilirubin is greater than or equal to 2, the child needs closer evaluation" (guideline) [Ep 4 · 7:59](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=479)
- "Some babies with biliary atresia have normal ultrasounds" (clinical) [Ep 4 · 8:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=496)
- "The gold standard for biliary atresia diagnosis is the intraoperative cholangiogram" (guideline) [Ep 4 · 8:26](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=506)
- "At Children's Hospital Los Angeles, babies are pre-treated with 5 days of phenobarbital before HIDA scan" (clinical) [Ep 4 · 9:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=571)
- "Timing of diagnosis and Kasai procedure is extremely important, with the sweet spot being 6 to 8 weeks of age" (clinical) [Ep 4 · 15:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=914)
- "A French study showed 23% of Kasai patients had their native liver 20 years post-Kasai" (epidemiological) [Ep 4 · 15:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=950)
- "Factors affecting survival with native liver include age at Kasai, type of biliary atresia, liver histology (bridging fibrosis), and center caseload" (clinical) [Ep 4 · 16:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=984)
- "In England, consolidating Kasai procedures to 3 centers increased success rates" (epidemiological) [Ep 4 · 16:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1008)
- "At Children's Hospital Los Angeles, 6 to 12 biliary atresia cases are seen per year, considered a high rate" (epidemiological) [Ep 4 · 17:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1040)
- "If cirrhosis is seen on liver biopsy or frozen section during intraoperative cholangiogram, the procedure is stopped and the patient is listed for transplant" (clinical) [Ep 4 · 19:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1197)
- "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" (clinical) [Ep 4 · 20:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1220)
- "Bigger babies at time of transplant have easier transplant procedures" (opinion) [Ep 4 · 21:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1284)
- "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" (clinical) [Ep 4 · 22:27](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1347)
- "Most centers put babies on antibiotic prophylaxis postoperatively until they are eating" (clinical) [Ep 4 · 23:23](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1403)
- "Post-operative steroids for biliary atresia are unproven" (clinical) [Ep 4 · 23:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1428)
- "At Children's Hospital Los Angeles, peripheral IV lines are used postoperatively rather than Broviacs, and babies are not sent home on IV antibiotics" (clinical) [Ep 4 · 24:06](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1446)
- "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" (clinical) [Ep 4 · 25:08](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1508)
- "Babies are placed on ursodeoxycholic acid twice daily post-Kasai" (clinical) [Ep 4 · 25:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1535)
- "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" (clinical) [Ep 4 · 25:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1541)
- "Probiotics, herbal remedies, and omega-3 supplements have not been proven beneficial for biliary atresia" (clinical) [Ep 4 · 26:29](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1589)
- "The BARC (Biliary Atresia Research Consortium) protocol enrolled 140 babies in a randomized double-blind placebo-controlled study with steroids" (clinical) [Ep 4 · 27:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1621)
- "When a post-Kasai baby has unexplained fever, ascending cholangitis is suspected" (clinical) [Ep 4 · 28:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1695)
- "Multiple episodes of ascending cholangitis cause further liver damage and may lead to earlier need for transplant" (clinical) [Ep 4 · 29:36](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1776)
- "Biliary atresia is the most common indication for pediatric liver transplant" (epidemiological) [Ep 4 · 31:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1869)
- "The American Academy of Pediatrics policy states all jaundiced infants at 2 weeks of age should have a fractionated bilirubin done" (guideline) [Ep 4 · 32:54](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=1974)
- "In England, Caucasian babies with biliary atresia were diagnosed at average 47 days of age, non-white babies at 52 days, and all babies diagnosed after 100 days were non-Caucasian" (epidemiological) [Ep 4 · 34:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2064)
- "In an English study of stool color identification, 37% of physicians and nurses did not correctly identify suspect stools using stool color cards" (epidemiological) [Ep 4 · 35:58](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2158)
- "The BARC trial of 140 randomized babies showed no benefit from steroid use in improving native liver survival, though steroids did produce more rapid bilirubin drop" (clinical) [Ep 4 · 38:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2321)
- "Multiple studies found increased jaundice clearance with steroids but none found prevention or lengthening of time until transplant" (clinical) [Ep 4 · 39:02](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2342)
- "In Taiwan and other Asian countries, stool cards are sent home with every discharged baby to help parents identify abnormal stool color" (clinical) [Ep 4 · 41:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2499)
- "Children's Hospital Los Angeles will be a site for a new trial using intravenous immunoglobulin following Kasai, hoping to inhibit immune-mediated bile duct injury" (clinical) [Ep 4 · 42:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2552)
- "The 30-30-30 rule for Kasai outcomes: 30% work great, 30% never work, 30% may work temporarily long enough to get a transplant but may fail" (host_summary) [Ep 4 · 46:43](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2803)
- "Postoperative stool color (brown or green) is more important than immediate postoperative bilirubin levels" (opinion) [Ep 4 · 48:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-where-are-we-now-advanced-practice-providers-pediatric-910?t=2881)
- "Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to advances in diagnosing inborn errors of bile acid metabolism and genotyping of progressive familial intrahepatic cholestasis (PFIC)." (epidemiological) [Ep 5 · 1:28](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=88)
- "The absence of a gallbladder on ultrasound does not conclusively diagnose biliary atresia." (clinical) [Ep 5 · 4:38](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=278)
- "The presence of a gallbladder on ultrasound does not exclude biliary atresia because modern ultrasound probes can visualize even small shrunken gallbladders." (clinical) [Ep 5 · 4:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=284)
- "The triangular cord sign on ultrasound represents a fibrous plate above the portal vein where bile ducts were supposed to be, showing inflammatory fibrous scarring with distinct radiographic characteristics." (clinical) [Ep 5 · 5:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=301)
- "HIDA scans benefit from 3-5 days of phenobarbital loading, which can delay intervention into a time period potentially detrimental to Kasai outcomes." (clinical) [Ep 5 · 5:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=350)
- "A scoring system combining liver biopsy and clinical parameters achieves 99% accuracy in diagnosing biliary atresia." (host_summary) [Ep 5 · 2:33](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=153)
- "The jaundice chip is a gene chip microarray analysis that tests for PFIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin deficiency, and JAG1 mutation, but takes 4-6 weeks to return results, too long to guide initial biliary atresia intervention decisions." (clinical) [Ep 5 · 3:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=191)
- "Liver biopsy findings of bile duct proliferation in portal triads and bile plugs within bile ducts are pathognomonic for biliary atresia with >90% diagnostic accuracy." (clinical) [Ep 5 · 8:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=490)
- "When liver biopsy is highly consistent with biliary atresia, intraoperative cholangiography becomes less necessary; some centers perform it primarily for educational purposes." (opinion) [Ep 5 · 8:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=510)
- "Alagille syndrome patients do not have the same degree of bile duct proliferation as biliary atresia patients and will not have the pathognomonic finding of bile duct plugs." (clinical) [Ep 5 · 10:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=614)
- "Extended hilar dissection in biliary atresia goes beyond the portal vein bifurcation to the first bifurcation of the hepatic arteries, as originally described by Kasai." (clinical) [Ep 5 · 12:13](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=733)
- "Japanese centers uniformly perform extended hilar dissections, which may explain their superior outcomes compared to U.S. centers." (opinion) [Ep 5 · 12:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=741)
- "Polysplenia syndrome patients with biliary atresia often have pre-duodenal portal veins and frequently have no bile duct remnant, making Kasai portoenterostomy difficult or impossible." (clinical) [Ep 5 · 13:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=811)
- "For cystic variants of biliary atresia, intervention before 30 days of age yields better outcomes, based on data from England." (host_summary) [Ep 5 · 14:43](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=883)
- "Cystic variant biliary atresia can be differentiated from choledochal cyst clinically: choledochal cyst patients have pigmented stool while cystic variant patients develop acholic stool." (clinical) [Ep 5 · 15:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=900)
- "A Roux limb length of 20 cm is inadequate because 5-8 cm of length is typically lost during hilar dissection at the time of liver transplantation." (clinical) [Ep 5 · 15:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=930)
- "The recommended Roux limb length for Kasai portoenterostomy is 30-40 cm to preserve adequate length for future liver transplantation." (clinical) [Ep 5 · 15:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=955)
- "Anti-reflux valves in Kasai portoenterostomy have not been proven effective and are no longer recommended." (clinical) [Ep 5 · 16:29](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=989)
- "UK data from 15 years ago showed that centers performing more than 5 Kasai procedures per year had significantly better outcomes (approximately 20% difference) than lower-volume centers." (host_summary) [Ep 5 · 16:53](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1013)
- "The British health service centralized all Kasai procedures to three high-volume centers based on outcome data, and only these centers receive payment for the procedure." (host_summary) [Ep 5 · 17:23](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1043)
- "Two European studies (King's Group using 2 mg/kg steroids and German group using 10 mg/kg for 5 days) showed no benefit of postoperative corticosteroids in biliary atresia." (host_summary) [Ep 5 · 17:49](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1069)
- "The Children's Network multi-center trial with approximately 70 patients in two arms showed no improvement in bile drainage with corticosteroid use and a slight increase in adverse events (primarily medical rather than surgical complications)." (host_summary) [Ep 5 · 18:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1089)
- "Some biliary atresia patients have an inflammatory gene profile in which corticosteroids might prove beneficial, despite overall trial results showing no benefit." (opinion) [Ep 5 · 18:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1124)
- "Performing Kasai portoenterostomy on Alagille syndrome patients will shorten the natural history of their native liver and lead to earlier transplantation." (clinical) [Ep 5 · 19:59](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1199)
- "For cholestatic infants where biliary atresia diagnosis is uncertain, workup for Alagille syndrome includes echocardiography to rule out pulmonic stenosis, spine X-rays to rule out butterfly vertebrae, and ophthalmologic examination." (clinical) [Ep 5 · 20:07](https://qa.library.globalcastmd.com/watch/biliary-atresia-update-course-2015-911?t=1207)
- "Dr. Mina Yeina discussed lipid nanoparticle delivery of microRNA 148A and attenuation of intestinal inflammation during NEC" (clinical) [Ep 19 · 0:04](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=4)
- "Dr. Joseph Davidson presented on sexual function and fertility outcomes in Hirschsprung's disease patients" (clinical) [Ep 19 · 0:20](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=20)
- "Dr. Shruthi Srinivas presented outcomes from colonic pull-through for cloacal atrophy" (clinical) [Ep 19 · 0:25](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=25)
- "Dr. Kala presented on single-cell guided prenatal derivation of fetal organoids" (clinical) [Ep 19 · 0:31](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=31)
- "Dr. Zheng presented on clinical characteristics and MMP-7 levels for biliary atresia" (clinical) [Ep 19 · 0:40](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=40)
- "Dr. Shruthi Srinivas won Heat 3 with her presentation on outcomes from colonic pull-through for cloacal atrophy, differentiated by colon length, in a multi-institutional study" (clinical) [Ep 19 · 1:15](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=75)
- "The competition between the second and third presentations was very tight" (opinion) [Ep 19 · 0:50](https://qa.library.globalcastmd.com/watch/heat-3-winner-shruthi-srinivas-md-best-of-the-best-in-pediatric-surgery-2024-8018?t=50)
- "French registry data show children who had Kasai at less than 1 month of age have nearly twice the 5- and 10-year native liver survival rate compared to those done after 90 days." (host_summary) [Ep 1 · 2:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=152)
- "In the Michigan series, children who had Kasai after 3 months had the best drainage and long-term outcome, though patient selection bias may explain this finding." (epidemiological) [Ep 1 · 1:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=63)
- "Under 60 days there was a clear difference in outcomes; procedures were done emergently on weekends if approaching that deadline." (clinical) [Ep 1 · 1:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=110)
- "The critical factor determining outcome may be the degree of cirrhosis present at the time of Kasai, which does not always correlate directly with chronologic age." (opinion) [Ep 1 · 3:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=204)
- "Rich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters." — Todd Ponsky (host_summary) [Ep 1 · 4:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=243)
- "In most biliary atresia cases, jaundice and pale stools are present from the first week of life; timing of referral to tertiary centers varies based on pediatrician vigilance." (clinical) [Ep 1 · 5:18](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=318)
- "Peter Altman recommended performing Kasai between 60 and 75 days based on the largest U.S. series from Columbia." (host_summary) [Ep 1 · 5:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=357)
- "Reversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension." — Todd Ponsky (clinical) [Ep 1 · 9:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=559)
- "Performing Kasai even in advanced disease may buy months of time, expanding the donor pool and making eventual transplant technically easier with lower hepatic artery thrombosis risk." (clinical) [Ep 1 · 10:05](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=605)
- "Hepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers." — Todd Ponsky (clinical) [Ep 1 · 10:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=641)
- "In patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition." — Todd Ponsky (opinion) [Ep 1 · 10:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=656)
- "The Kasai operation itself is not technically demanding or high-risk, so reoperation when uncertain about initial success is reasonable." (opinion) [Ep 1 · 11:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=704)
- "Some biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression." — Todd Ponsky (clinical) [Ep 1 · 12:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=740)
- "If a liver biopsy is suggestive of biliary atresia, additional workup tests are not needed." (opinion) [Ep 1 · 14:02](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=842)
- "HIDA scan with phenobarbital has high sensitivity and specificity for biliary atresia, requiring at least 5 days of phenobarbital at therapeutic levels." (host_summary) [Ep 1 · 15:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=921)
- "In the Children's National study, approximately one-third of initially negative HIDA scans converted to positive for biliary atresia when repeated with adequate phenobarbital levels." (host_summary) [Ep 1 · 16:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1000)
- "A recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia." — Todd Ponsky (host_summary) [Ep 1 · 17:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1055)
- "Pathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago." — Todd Ponsky (opinion) [Ep 1 · 18:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1081)
- "Interventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test." — Todd Ponsky (clinical) [Ep 1 · 18:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1090)
- "A patent gallbladder is extremely rare in true biliary atresia." (clinical) [Ep 1 · 18:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1122)
- "In Milwaukee, percutaneous cholangiography is combined with liver biopsy when a gallbladder is present, with one surgical complication in 46 attempts." (host_summary) [Ep 1 · 18:59](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1139)
- "Prenatal ultrasound diagnosis of biliary atresia based on absent gallbladder is unreliable and angle-dependent, with at least one reported case of near-abortion for a normal fetus." (clinical) [Ep 1 · 20:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1244)
- "Japanese surgeons still recommend postoperative steroids either routinely or when bile drainage decreases, despite studies questioning their efficacy." (host_summary) [Ep 1 · 21:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1302)
- "Yamataka's group at Juntendo University performs Kasai dissection much wider than the classic technique, uses more superficial sutures to avoid ductule damage, and avoids sutures at 10 and 3 o'clock positions where bile ducts bifurcate, claiming improved results." (host_summary) [Ep 1 · 22:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1335)
- "Japanese surgeons are attempting to refute IPEG's recommendation against laparoscopic Kasai by demonstrating equivalent results with laparoscopic technique." (host_summary) [Ep 1 · 23:08](https://qa.library.globalcastmd.com/watch/biliary-atresia-robert-parry-update-course-2014-662?t=1388)
- "In the US and Europe, alpha-1 antitrypsin deficiency is the most common cause of neonatal cholestasis in the differential diagnosis" — Jorge Bezerra (epidemiological) [Ep 8 · 3:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=202)
- "By two weeks of age, if the baby still has jaundice, the pediatrician needs to fractionate the bilirubin; if the direct or conjugated fraction is elevated, think about pathologic jaundice" — Jorge Bezerra (guideline) [Ep 8 · 4:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=256)
- "The Taiwanese published in the Journal of Pediatrics in 2006 that they send all their kids home with stool color cards" — Alex Bondoc (clinical) [Ep 8 · 6:13](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=373)
- "MMP7 was identified as a serum marker of epithelial injury in biliary atresia through large-scale proteomic analysis of 30 children with biliary atresia in 2017" — Alex Bondoc (clinical) [Ep 8 · 9:59](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=599)
- "MMP7 using a cutoff value of 52-53 nanograms per ml demonstrated a sensitivity of diagnosing biliary atresia of about 98% with a specificity of about 95% in 135 consecutive infants in China" — Alex Bondoc (clinical) [Ep 8 · 10:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=640)
- "The MMP7 assay is run every other day and is a six-hour assay" — Jorge Bezerra (clinical) [Ep 8 · 12:51](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=771)
- "MMP7 has the potential to eliminate a lot of other testing and eliminate things like a liver biopsy if confidence grows in its impact" — Alex Bondoc (opinion) [Ep 8 · 13:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=790)
- "Cutoff values for MMP7 changed depending on reports from Asia, with much lower cutoff levels reported from Taiwan and China" — Jorge Bezerra (clinical) [Ep 8 · 12:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=740)
- "A combination of blood tests and laparoscopy can diagnose biliary atresia promptly and accurately" — Alex Bondoc (clinical) [Ep 8 · 14:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=884)
- "Nearly all patients with biliary atresia have a hard liver, whereas hepatitis and Alagille syndrome patients have livers that are not as hard" — Yamataka (clinical) [Ep 8 · 17:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1077)
- "Bile duct proliferation and portal edema may not appear on very early liver biopsies and may delay diagnosis by up to 30 days" — Alex Bondoc (clinical) [Ep 8 · 17:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1029)
- "In Yamataka's series, 16 cases were not typical biliary atresia on laparoscopy, and all 16 were confirmed not to be biliary atresia, including 8 cases of Alagille syndrome" — Yamataka (clinical) [Ep 8 · 19:13](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1153)
- "If you do a Kasai operation on Alagille patients, you just shorten that patient's natural liver life and convert those patients to needing transplant at a much earlier age" (clinical) [Ep 8 · 18:24](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1104)
- "Infants coming to surgery for other matters who later turned out to have biliary atresia in the first week of life all had normal livers, so you can't diagnose early biliary atresia on liver biopsy" — Mark Davenport (clinical) [Ep 8 · 22:18](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1338)
- "Liver histology looking at inflammation and fibrosis has not shown great discrimination for prognosis in babies coming to surgery before 100 days" — Mark Davenport (clinical) [Ep 8 · 23:08](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1388)
- "Liver biopsy has additional value to quantify inflammation and use that information to personalize treatment" — Jorge Bezerra (opinion) [Ep 8 · 24:04](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1444)
- "The key differential for a prenatally detected cyst is between cystic biliary atresia and a choledochal cyst" — Mark Davenport (clinical) [Ep 8 · 24:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1497)
- "If the baby is not jaundiced and not raising conjugated bilirubin, then it's not cystic biliary atresia and you can wait to do the laparotomy" — Mark Davenport (clinical) [Ep 8 · 25:51](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1551)
- "Cystic biliary atresia patients get to surgery earlier, potentially because of prenatal diagnosis and heightened level of suspicion" — Alex Bondoc (clinical) [Ep 8 · 26:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-clinical-practice-updates-3000?t=1580)
- "Biliary atresia leads to liver cirrhosis without early treatment" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=0)
- "The diagnosis of BA can be challenging as its histopathologic features overlap with those of other pediatric cholestatic liver diseases" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:20](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=20)
- "The most helpful hallmark of BA on histology is portal fibrosis and bile duct proliferation" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:40](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=40)
- "A similar pattern to BA can be found in other causes of cholestasis such as familiar intrahepatic cholestasis, neonatal hepatitis, and Alagille syndrome" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 0:50](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=50)
- "During cirrhosis, biliary epithelial structure express immunohistochemical markers of immaturity such as CD56" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 1:10](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=70)
- "639 biopsies were performed between 2013 and 2019" — Maria Soledad Jara Valdivia (epidemiological) [Ep 15 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=180)
- "Final groups were distributed as: group BA equals 30 patients, group NC equals 28 patients, group C no BA equals 31" — Maria Soledad Jara Valdivia (epidemiological) [Ep 15 · 3:05](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=185)
- "CD56 plus had sensitivity of 74% for BA versus 16% and 9% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:20](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=200)
- "CD56 plus had specificity of 87.7% for BA versus 61% and 50% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:35](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=215)
- "The PPV was 76% for BA versus 18% and 9% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:45](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=225)
- "The NPV was 80% for BA versus 57% and 50% for other groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 3:55](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=235)
- "The AUC was 0.81" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:05](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=245)
- "The labeling quantile from 6 to 25% had a higher sensitivity and adequate specificity" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:10](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=250)
- "CD56 in more than 5% of the ductular epithelial cells has a sensitivity of 74.2% versus 16.1% and 9.68% in non-BA groups" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=270)
- "CD56 has specificity of 87.7% and LHR+ of 6.04 compared to 0.42 and 0.20 in non BA group to diagnose biliary atresia" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:45](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=285)
- "An NPV of 86.2% shows that if CD56 is negative, biliary atresia is unlikely" — Maria Soledad Jara Valdivia (clinical) [Ep 15 · 4:55](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=295)
- "CD56 IHC stain is helpful as a complementary test in liver biopsies to rule out biliary atresia as an etiology for neonates presenting with cholestasis" — Maria Soledad Jara Valdivia (opinion) [Ep 15 · 5:05](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-maria-soledad-jara-valdivia-cipesur-presentation-6353?t=305)
- "Patients with a transanastomotic tube had a 2.72 times higher risk of developing a stricture post-operatively after esophageal atresia with tracheoesophageal fistula repair" (clinical) [Ep 16 · 1:10](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70)
- "The Midwest Pediatric Surgery Consortium study examined every patient who had a laparoscopic pyloric myotomy to identify patent processus vaginalis and followed them annually" (clinical) [Ep 16 · 1:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=90)
- "Of 526 patients enrolled in the PPV study, 283 had a patent processus vaginalis (bilateral, right, or left)" (epidemiological) [Ep 16 · 2:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=120)
- "Of 208 patients with at least one year follow-up, only three underwent inguinal hernia repair, all within the first year" (clinical) [Ep 16 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133)
- "Most patent processus vaginalis do not turn into inguinal hernias based on four-year interim analysis data" (clinical) [Ep 16 · 2:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=155)
- "Liver transplantation for biliary atresia can be performed as initial treatment (primary) or after failed Kasai hepatoportoenterostomy (salvage)" (clinical) [Ep 16 · 2:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=165)
- "The current standard in the US for biliary atresia is Kasai first and liver transplant only if that fails" (guideline) [Ep 16 · 3:05](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=185)
- "Children who had an early salvage liver transplant (before age one) and children who had a primary liver transplant had similar outcomes" (clinical) [Ep 16 · 3:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=210)
- "Children who had a late salvage liver transplant had improved graft survival compared to other groups" (clinical) [Ep 16 · 3:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=225)
- "Some children who undergo the Kasai procedure will never end up needing a liver transplant" (clinical) [Ep 16 · 4:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=240)
- "Social risk screening in pediatrics involves screening for risk factors including food and housing insecurity, financial strain, and unsafe environments" (clinical) [Ep 16 · 4:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=270)
- "There is low concordance between screening results showing who might need resources and who is actually asking for more resources" (epidemiological) [Ep 16 · 5:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=300)
- "Families may feel uncomfortable with social risk screening and may think there might be downstream repercussions based on their answers" (opinion) [Ep 16 · 5:15](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=315)
- "There may be racial biases in screening practices, with non-white patients potentially being asked social risk questions more often" (epidemiological) [Ep 16 · 5:28](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=328)
- "Current social risk screening protocols may not be effective and may actually lead to more inequities" (opinion) [Ep 16 · 4:50](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=290)
- "The START trial randomized 140 infants with biliary atresia to high-dose steroids (IV for 2 weeks, oral for 2 weeks, taper over 9 weeks) versus placebo within 72 hours of Kasai portoenterostomy." — Daniel von Allmen (host_summary) [Ep 10 · 2:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=168)
- "The primary outcome was serum total bilirubin <1.5 mg/dL with native liver at 6 months post-Kasai; the study was powered to detect a 25% absolute treatment difference." — Daniel von Allmen (host_summary) [Ep 10 · 3:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=212)
- "High-dose steroid therapy after Kasai did not result in a statistically significant treatment difference in bile drainage at 6 months: 58.6% in the steroid group versus 48.6% in placebo." — Daniel von Allmen (host_summary) [Ep 10 · 4:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=241)
- "Survival without liver transplant at 24 months was not statistically different: 58.7% for steroids versus 49.4% for placebo." — Daniel von Allmen (host_summary) [Ep 10 · 4:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=279)
- "Adverse events were common in both groups (near 80%), largely reflecting severe underlying liver dysfunction; steroid treatment was associated with earlier onset of serious adverse events." — Daniel von Allmen (host_summary) [Ep 10 · 4:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=295)
- "Dr. von Almen personally used steroids after Kasai in the past but has stopped based on the START trial results." — Daniel von Allmen (opinion) [Ep 10 · 5:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=331)
- "The authors of the START trial believe anything less than a 25% difference in bile drainage is not worth the potential early complications of steroids." — Daniel von Allmen (host_summary) [Ep 10 · 7:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=431)
- "Two proposed mechanisms for steroid benefit in biliary atresia: reducing ongoing inflammation to preserve ductules, and acting as a choleretic to maintain bile flow (analogous to diuresis after kidney transplant)." — Daniel von Allmen (clinical) [Ep 10 · 9:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=549)
- "The START trial specifically tested a 13-week course of high-dose steroids; the lack of benefit applies to that regimen." — Daniel von Allmen (clinical) [Ep 10 · 10:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=609)
- "A Washington State registry study of clean-contaminated adult general surgery cases (60% colorectal, 34% bariatric) found no single skin antiseptic agent associated with lower SSI risk than any other." — Whit Holcomb (host_summary) [Ep 10 · 11:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=680)
- "Isopropyl alcohol as part of the antiseptic mixture conferred no benefit: unadjusted SSI rate 4.5% without alcohol versus 4.6% with alcohol." — Whit Holcomb (host_summary) [Ep 10 · 13:49](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=829)
- "The registry could not identify SSI diagnosed after discharge, likely underestimating the true SSI rate; a recent report showed 50% or more SSIs are diagnosed after discharge." — Whit Holcomb (host_summary) [Ep 10 · 14:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=860)
- "Most SSIs occur 3–10 days after operation; average length of stay in the study was 6–7 days." — Whit Holcomb (host_summary) [Ep 10 · 14:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=888)
- "Dr. Holcomb's institution switched to chlorhexidine with isopropyl alcohol (chloraprep) except for mucous membrane preps (e.g., circumcision)." — Whit Holcomb (clinical) [Ep 10 · 16:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=990)
- "Most pediatric surgery cases are clean (not clean-contaminated), so the Washington State study does not directly address pediatric practice." — Whit Holcomb (opinion) [Ep 10 · 17:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1023)
- "Chloraprep or similar agents dry faster than betadine/iodine preps, allowing cases to start sooner; this matters when doing 6–7 cases per day." — Whit Holcomb (clinical) [Ep 10 · 18:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1096)
- "A pilot randomized trial in children aged 5–15 with non-perforated appendicitis (based on imaging) compared non-operative antibiotic treatment versus laparoscopic appendectomy; follow-up was one year." — Whit Holcomb (host_summary) [Ep 10 · 20:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1235)
- "Of 225 children with appendicitis, 50 were randomized (26 to surgery, 24 to antibiotics); 77 families declined participation." — Whit Holcomb (host_summary) [Ep 10 · 22:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1362)
- "In the antibiotic group, 2 of 24 underwent appendectomy during primary treatment, 1 had recurrent appendicitis at 9 months, and 6 more had appendectomy for recurrent pain or parental desire (none with histologic appendicitis)—total 9 of 24 (38% failure rate)." — Whit Holcomb (host_summary) [Ep 10 · 23:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1394)
- "Median time to discharge was significantly shorter in the surgical group, but the antibiotic group had a stipulated 48-hour minimum hospitalization." — Whit Holcomb (host_summary) [Ep 10 · 24:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1475)
- "Cost for the initial inpatient stay was significantly lower in the antibiotic group despite longer hospitalization, highlighting the cost of undergoing an operation." — Whit Holcomb (host_summary) [Ep 10 · 24:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1495)
- "The pilot study demonstrates that a definitive randomized trial comparing antibiotics and laparoscopic appendectomy for non-perforated appendicitis is safe and feasible; a multi-center study is planned." — Whit Holcomb (host_summary) [Ep 10 · 25:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1520)
- "Dr. Holcomb has not treated acute appendicitis non-operatively at his institution but knows of poor operative candidates treated successfully with antibiotics." — Whit Holcomb (opinion) [Ep 10 · 26:33](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1593)
- "Immunosuppressed cancer patients with typhlitis (not appendicitis but similar) are sometimes treated non-operatively, and most resolve with antibiotics." — Whit Holcomb (clinical) [Ep 10 · 27:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1620)
- "The challenge will be identifying which population of appendicitis patients can be treated successfully non-operatively versus which should undergo early operation." — Whit Holcomb (opinion) [Ep 10 · 27:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1642)
- "Long-term follow-up is critical; even a 10-year follow-up leaves patients only 15–20 years old, with 40–50 years of life remaining at risk for recurrent appendicitis." — Whit Holcomb (opinion) [Ep 10 · 27:52](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1672)
- "Some parents in the pilot study wanted their child's appendix removed to avoid future worry, even after successful antibiotic treatment." — Whit Holcomb (host_summary) [Ep 10 · 29:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1759)
- "If appendectomy can be done as an outpatient same-day procedure, it may be difficult to argue for 1–2 days of antibiotics with uncertain long-term recurrence risk." — Whit Holcomb (opinion) [Ep 10 · 29:45](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1785)
- "A PIFCON multi-center cohort study of 272 children with intestinal failure (median follow-up 33 months) found enteral autonomy was achieved in 43%, 13% remained PN-dependent, and 43% died or underwent transplant." — Aaron Lipskar (host_summary) [Ep 10 · 31:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1891)
- "Necrotizing enterocolitis as the underlying diagnosis, care at an intestinal rehab facility without a transplant center, and presence of an ileocecal valve were all statistically significantly associated with higher rates of enteral autonomy." — Aaron Lipskar (host_summary) [Ep 10 · 32:58](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1978)
- "Residual small bowel length was also a statistically significant predictor of enteral autonomy, though less impressive than the other three variables." — Aaron Lipskar (host_summary) [Ep 10 · 33:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1999)
- "The protective effect of necrotizing enterocolitis on enteral autonomy is surprising and goes against understanding of that inflammatory illness, showing how much remains to be learned." — Aaron Lipskar (opinion) [Ep 10 · 33:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2035)
- "A companion paper in the same journal (Journal of Pediatrics, July 2015) found necrotizing enterocolitis was a poor predictor of growth outcome in infants with short bowel syndrome." — Aaron Lipskar (host_summary) [Ep 10 · 34:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2086)
- "The PIFCON study underscores the importance of managing children with intestinal failure in multidisciplinary intestinal rehab programs, where catheter-associated bloodstream infection elimination and cholestasis prevention have changed outcomes." — Aaron Lipskar (opinion) [Ep 10 · 36:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2171)
- "Animal studies show that commonly used anesthetics and sedatives (propofol, etomidate, sevoflurane, isoflurane, ketamine) that increase GABA receptor activity or block glutamate receptors produce neurotoxic effects in laboratory animals from nematodes to nonhuman primates." — Aaron Lipskar (host_summary) [Ep 10 · 38:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2289)
- "Observational studies in children undergoing early anesthesia offer conflicting results and are confounded by multiple factors, but suggest some children may have deficits—association, not causation." — Aaron Lipskar (host_summary) [Ep 10 · 38:43](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2323)
- "SmartTots June 2014 statement concluded that animal data is sufficiently convincing to warrant large-scale clinical studies and recommended avoiding anesthesia in children under 3 unless urgent or potentially harmful if not attended to." — Aaron Lipskar (host_summary) [Ep 10 · 39:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2351)
- "Dr. Lipskar has not yet delayed an inguinal hernia repair for anesthetic concerns." — Aaron Lipskar (opinion) [Ep 10 · 40:53](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2453)
- "At Cohen Children's Medical Center, circumcisions outside the neonatal period are done with general plus regional anesthesia." — Aaron Lipskar (clinical) [Ep 10 · 41:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2469)
- "Regional anesthesia and agents like precedex may help decrease the amount of potentially neurotoxic general anesthesia; almost every laparoscopic, thoracoscopic, or open operation has a regional block option." — Aaron Lipskar (opinion) [Ep 10 · 41:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2491)
- "Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year." — Todd Ponsky (clinical) [Ep 10 · 42:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2536)
- "Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants." — Todd Ponsky (opinion) [Ep 10 · 42:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2551)
- "A survey of ~150 parents in a primary care pediatrics office found the vast majority did not know anesthetic neurotoxicity was a major issue (Dr. Lipskar's unpublished study, to be presented at AAP)." — Aaron Lipskar (clinical) [Ep 10 · 43:17](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2597)
- "The START trial randomized 140 infants with biliary atresia to high-dose steroids (IV for 2 weeks, oral for 2 weeks, taper over 9 weeks) versus placebo within 72 hours of Kasai portoenterostomy." — Daniel von Allmen (host_summary) [Ep 6 · 2:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=168)
- "The primary outcome was serum total bilirubin <1.5 mg/dL with native liver at 6 months post-Kasai; the study was powered to detect a 25% absolute treatment difference." — Daniel von Allmen (host_summary) [Ep 6 · 3:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=212)
- "High-dose steroid therapy after Kasai did not result in a statistically significant treatment difference in bile drainage at 6 months: 58.6% in the steroid group versus 48.6% in placebo." — Daniel von Allmen (host_summary) [Ep 6 · 4:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=241)
- "Survival without liver transplant at 24 months was not statistically different: 58.7% for steroids versus 49.4% for placebo." — Daniel von Allmen (host_summary) [Ep 6 · 4:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=279)
- "Adverse events were common in both groups (near 80%), largely reflecting severe underlying liver dysfunction; steroid treatment was associated with earlier onset of serious adverse events." — Daniel von Allmen (host_summary) [Ep 6 · 4:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=295)
- "Dr. von Almen personally used steroids after Kasai in the past but has stopped based on the START trial results." — Daniel von Allmen (opinion) [Ep 6 · 5:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=331)
- "The authors of the START trial believe anything less than a 25% difference in bile drainage is not worth the potential early complications of steroids." — Daniel von Allmen (host_summary) [Ep 6 · 7:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=431)
- "Two proposed mechanisms for steroid benefit in biliary atresia: reducing ongoing inflammation to preserve ductules, and acting as a choleretic to maintain bile flow (analogous to diuresis after kidney transplant)." — Daniel von Allmen (clinical) [Ep 6 · 9:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=549)
- "The START trial specifically tested a 13-week course of high-dose steroids; the lack of benefit applies to that regimen." — Daniel von Allmen (clinical) [Ep 6 · 10:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=609)
- "A Washington State registry study of clean-contaminated adult general surgery cases (60% colorectal, 34% bariatric) found no single skin antiseptic agent associated with lower SSI risk than any other." — Whit Holcomb (host_summary) [Ep 6 · 11:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=680)
- "Isopropyl alcohol as part of the antiseptic mixture conferred no benefit: unadjusted SSI rate 4.5% without alcohol versus 4.6% with alcohol." — Whit Holcomb (host_summary) [Ep 6 · 13:49](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=829)
- "The registry could not identify SSI diagnosed after discharge, likely underestimating the true SSI rate; a recent report showed 50% or more SSIs are diagnosed after discharge." — Whit Holcomb (host_summary) [Ep 6 · 14:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=860)
- "Most SSIs occur 3–10 days after operation; average length of stay in the study was 6–7 days." — Whit Holcomb (host_summary) [Ep 6 · 14:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=888)
- "Dr. Holcomb's institution switched to chlorhexidine with isopropyl alcohol (chloraprep) except for mucous membrane preps (e.g., circumcision)." — Whit Holcomb (clinical) [Ep 6 · 16:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=990)
- "Most pediatric surgery cases are clean (not clean-contaminated), so the Washington State study does not directly address pediatric practice." — Whit Holcomb (opinion) [Ep 6 · 17:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1023)
- "Chloraprep or similar agents dry faster than betadine/iodine preps, allowing cases to start sooner; this matters when doing 6–7 cases per day." — Whit Holcomb (clinical) [Ep 6 · 18:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1096)
- "A pilot randomized trial in children aged 5–15 with non-perforated appendicitis (based on imaging) compared non-operative antibiotic treatment versus laparoscopic appendectomy; follow-up was one year." — Whit Holcomb (host_summary) [Ep 6 · 20:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1235)
- "Of 225 children with appendicitis, 50 were randomized (26 to surgery, 24 to antibiotics); 77 families declined participation." — Whit Holcomb (host_summary) [Ep 6 · 22:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1362)
- "In the antibiotic group, 2 of 24 underwent appendectomy during primary treatment, 1 had recurrent appendicitis at 9 months, and 6 more had appendectomy for recurrent pain or parental desire (none with histologic appendicitis)—total 9 of 24 (38% failure rate)." — Whit Holcomb (host_summary) [Ep 6 · 23:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1394)
- "Median time to discharge was significantly shorter in the surgical group, but the antibiotic group had a stipulated 48-hour minimum hospitalization." — Whit Holcomb (host_summary) [Ep 6 · 24:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1475)
- "Cost for the initial inpatient stay was significantly lower in the antibiotic group despite longer hospitalization, highlighting the cost of undergoing an operation." — Whit Holcomb (host_summary) [Ep 6 · 24:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1495)
- "The pilot study demonstrates that a definitive randomized trial comparing antibiotics and laparoscopic appendectomy for non-perforated appendicitis is safe and feasible; a multi-center study is planned." — Whit Holcomb (host_summary) [Ep 6 · 25:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1520)
- "Dr. Holcomb has not treated acute appendicitis non-operatively at his institution but knows of poor operative candidates treated successfully with antibiotics." — Whit Holcomb (opinion) [Ep 6 · 26:33](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1593)
- "Immunosuppressed cancer patients with typhlitis (not appendicitis but similar) are sometimes treated non-operatively, and most resolve with antibiotics." — Whit Holcomb (clinical) [Ep 6 · 27:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1620)
- "The challenge will be identifying which population of appendicitis patients can be treated successfully non-operatively versus which should undergo early operation." — Whit Holcomb (opinion) [Ep 6 · 27:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1642)
- "Long-term follow-up is critical; even a 10-year follow-up leaves patients only 15–20 years old, with 40–50 years of life remaining at risk for recurrent appendicitis." — Whit Holcomb (opinion) [Ep 6 · 27:52](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1672)
- "Some parents in the pilot study wanted their child's appendix removed to avoid future worry, even after successful antibiotic treatment." — Whit Holcomb (host_summary) [Ep 6 · 29:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1759)
- "If appendectomy can be done as an outpatient same-day procedure, it may be difficult to argue for 1–2 days of antibiotics with uncertain long-term recurrence risk." — Whit Holcomb (opinion) [Ep 6 · 29:45](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1785)
- "A PIFCON multi-center cohort study of 272 children with intestinal failure (median follow-up 33 months) found enteral autonomy was achieved in 43%, 13% remained PN-dependent, and 43% died or underwent transplant." — Aaron Lipskar (host_summary) [Ep 6 · 31:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1891)
- "Necrotizing enterocolitis as the underlying diagnosis, care at an intestinal rehab facility without a transplant center, and presence of an ileocecal valve were all statistically significantly associated with higher rates of enteral autonomy." — Aaron Lipskar (host_summary) [Ep 6 · 32:58](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1978)
- "Residual small bowel length was also a statistically significant predictor of enteral autonomy, though less impressive than the other three variables." — Aaron Lipskar (host_summary) [Ep 6 · 33:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=1999)
- "The protective effect of necrotizing enterocolitis on enteral autonomy is surprising and goes against understanding of that inflammatory illness, showing how much remains to be learned." — Aaron Lipskar (opinion) [Ep 6 · 33:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2035)
- "A companion paper in the same journal (Journal of Pediatrics, July 2015) found necrotizing enterocolitis was a poor predictor of growth outcome in infants with short bowel syndrome." — Aaron Lipskar (host_summary) [Ep 6 · 34:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2086)
- "The PIFCON study underscores the importance of managing children with intestinal failure in multidisciplinary intestinal rehab programs, where catheter-associated bloodstream infection elimination and cholestasis prevention have changed outcomes." — Aaron Lipskar (opinion) [Ep 6 · 36:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2171)
- "Animal studies show that commonly used anesthetics and sedatives (propofol, etomidate, sevoflurane, isoflurane, ketamine) that increase GABA receptor activity or block glutamate receptors produce neurotoxic effects in laboratory animals from nematodes to nonhuman primates." — Aaron Lipskar (host_summary) [Ep 6 · 38:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2289)
- "Observational studies in children undergoing early anesthesia offer conflicting results and are confounded by multiple factors, but suggest some children may have deficits—association, not causation." — Aaron Lipskar (host_summary) [Ep 6 · 38:43](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2323)
- "SmartTots June 2014 statement concluded that animal data is sufficiently convincing to warrant large-scale clinical studies and recommended avoiding anesthesia in children under 3 unless urgent or potentially harmful if not attended to." — Aaron Lipskar (host_summary) [Ep 6 · 39:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2351)
- "Dr. Lipskar has not yet delayed an inguinal hernia repair for anesthetic concerns." — Aaron Lipskar (opinion) [Ep 6 · 40:53](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2453)
- "At Cohen Children's Medical Center, circumcisions outside the neonatal period are done with general plus regional anesthesia." — Aaron Lipskar (clinical) [Ep 6 · 41:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2469)
- "Regional anesthesia and agents like precedex may help decrease the amount of potentially neurotoxic general anesthesia; almost every laparoscopic, thoracoscopic, or open operation has a regional block option." — Aaron Lipskar (opinion) [Ep 6 · 41:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2491)
- "Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year." — Todd Ponsky (clinical) [Ep 6 · 42:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2536)
- "Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants." — Todd Ponsky (opinion) [Ep 6 · 42:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2551)
- "A survey of ~150 parents in a primary care pediatrics office found the vast majority did not know anesthetic neurotoxicity was a major issue (Dr. Lipskar's unpublished study, to be presented at AAP)." — Aaron Lipskar (clinical) [Ep 6 · 43:17](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-929?t=2597)
- "MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis" — Em Gootee (host_summary) [Ep 23 · 1:25](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=85)
- "Higher levels of MMP-7 are associated with the diagnosis of biliary atresia" — Em Gootee (host_summary) [Ep 23 · 1:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=103)
- "In a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7" — Em Gootee (host_summary) [Ep 23 · 1:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=116)
- "Low levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin" — Em Gootee (host_summary) [Ep 23 · 2:36](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=156)
- "GGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts" — Em Gootee (host_summary) [Ep 23 · 3:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=182)
- "Biliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes" — Em Gootee (host_summary) [Ep 23 · 3:19](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=199)
- "Having lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis" — Em Gootee (host_summary) [Ep 23 · 4:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=249)
- "The mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown" — Em Gootee (host_summary) [Ep 23 · 4:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=281)
- "In a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants" — Em Gootee (host_summary) [Ep 23 · 7:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=422)
- "Of 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula" — Em Gootee (host_summary) [Ep 23 · 7:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=463)
- "Patients with uncomplicated gastroschisis who had some exposure to formula in the first 28 days of life did not have increased risk of necrotizing enterocolitis or major differences in reaching full enteral feeds" — Mike Livingston (clinical) [Ep 23 · 8:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=492)
- "There were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis" — Em Gootee (host_summary) [Ep 23 · 8:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=507)
- "Patients with uncomplicated gastroschisis who received some formula appeared to have slightly faster time getting to full feeds, likely related to timing of closure rather than feeding type" — Mike Livingston (clinical) [Ep 23 · 8:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=514)
- "Patients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure" — Em Gootee (host_summary) [Ep 23 · 8:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=533)
- "A systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease" — Em Gootee (host_summary) [Ep 23 · 12:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=766)
- "There is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)" — Em Gootee (host_summary) [Ep 23 · 13:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=796)
- "The life course progression of anorectal malformation and Hirschsprung disease is not well understood" — Em Gootee (opinion) [Ep 23 · 13:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=810)
- "Barriers and enablers of successful transition for surgical colorectal patients showed agreement with those for medical patients that existing guidelines were based on" — Sebastian King (clinical) [Ep 23 · 13:42](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "Patients felt that clinicians did not always understand the need for transitioning their child's care from pediatric to adult settings, including the reasons, processes, and how to make transitions smooth" — Sebastian King (clinical) [Ep 23 · 13:42](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "There was little evidence that transfer of colorectal patients from pediatric to adult care happened in a timely or coordinated manner" — Whit Holcomb (clinical) [Ep 23 · 14:22](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=862)
- "No models of transfer of care for colorectal patients from pediatric to adult settings were identified in the systematic review" — Whit Holcomb (clinical) [Ep 23 · 14:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=878)
- "MMP7 could be used to distinguish biliary atresia from other cholestatic diseases." (host_summary) [Ep 11 · 3:47](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "Intraoperative ICG can be used to determine biliary flow or identify a transaction in biliary atresia surgery." (host_summary) [Ep 11 · 3:47](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it." — Todd Ponsky (epidemiological) [Ep 11 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=285)
- "MMP7 is a send-out test at many non-freestanding children's hospitals, limiting its clinical utility for time-sensitive biliary atresia diagnosis in children presenting at five weeks of age." (clinical) [Ep 11 · 5:48](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348)
- "For a hypotensive, tachycardic pediatric blunt trauma patient who has received 20 cc/kg crystalloid, the next steps should be early blood therapy and potentially massive transfusion protocol with balanced resuscitation, consistent with ATLS guidelines." (guideline) [Ep 11 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "There is currently no great definition of what constitutes a massive transfusion protocol (MTP) in pediatric patients; approximately 40 cc/kg blood triggers consideration of balanced resuscitation." (clinical) [Ep 11 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "For rectal prolapse sclerotherapy, 46% of respondents use hypertonic saline, while 10-16% use phenol, ethyl alcohol, or dextrose in water." (epidemiological) [Ep 11 · 10:35](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=635)
- "Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions." — Todd Ponsky (clinical) [Ep 11 · 10:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "There are case reports showing mucosal sloughing with phenol sclerotherapy." — Todd Ponsky (host_summary) [Ep 11 · 10:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "3% sotradecal is used as a sclerotherapy agent for rectal prolapse." (clinical) [Ep 11 · 11:48](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=708)
- "D50 (dextrose 50% from the code cart) is used as a hypertonic sclerotherapy agent and may be easier to acquire in the operating room than 3% saline." (clinical) [Ep 11 · 11:56](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=716)
- "Deflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy." — Todd Ponsky (host_summary) [Ep 11 · 10:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "Approximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it." — Todd Ponsky (epidemiological) [Ep 11 · 12:23](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743)
- "The adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously." — Todd Ponsky (epidemiological) [Ep 11 · 12:23](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743)
- "ERAS (Enhanced Recovery After Surgery) is a bundle of interventions to help patients get through the hospital faster with less pain and fewer narcotics, including early mobilization." (clinical) [Ep 11 · 15:59](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=959)
- "ERAS protocols include giving patients a carbohydrate drink two hours before surgery, replacing traditional NPO requirements." (clinical) [Ep 11 · 16:14](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974)
- "Implementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively." — Todd Ponsky (clinical) [Ep 11 · 16:42](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1002)
- "ERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy, unlike single-procedure changes like sutureless gastroschisis closure." (opinion) [Ep 11 · 17:55](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1075)
- "Starting ERAS implementation with surgical pathways standardizes care and has led to decreased cost, antibiotic utilization, and length of stay; hospitalists and pediatric residents use surgical pathways more than other pathways." (clinical) [Ep 11 · 19:09](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149)
- "A strategy for ERAS implementation is to chip away at individual components (such as decreasing opioid use intraoperatively and perioperatively) before building a larger protocol." (clinical) [Ep 11 · 19:42](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1182)
- "For bleeding from a pulmonary vessel during thoracoscopic lobectomy, start with an energy/sealing device (effective in low-pressure systems), then escalate to clips or sutures if needed." (clinical) [Ep 11 · 21:18](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1278)
- "Multiple hemostasis options (energy, clips, sutures) should be available during thoracoscopic procedures." (clinical) [Ep 11 · 21:38](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1298)
- "Most institutions are either taking steps to address social determinants of health or working on it; few report no action." — Todd Ponsky (epidemiological) [Ep 11 · 21:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1310)
- "Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to recognition of inborn errors of bile acid metabolism and genotyping of progressive familial intrahepatic cholestasis (PFIC)." — Greg Tiao (epidemiological) [Ep 2 · 1:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=102)
- "The jaundice chip is a microarray gene chip that tests for PFIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin, and JAG-1 mutation, but takes 4-6 weeks to return results." — Greg Tiao (clinical) [Ep 2 · 3:25](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=205)
- "The absence of a gallbladder on ultrasound does not conclusively show biliary atresia, and the presence of a gallbladder does not exclude biliary atresia due to sophisticated ultrasound probe sensitivity." — Greg Tiao (clinical) [Ep 2 · 4:51](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=291)
- "The triangular cord sign is a radiographic finding representing the fibrous plate above the portal vein where bile ducts were supposed to be, now showing inflammatory fibrous scar." — Greg Tiao (clinical) [Ep 2 · 5:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=314)
- "At Cincinnati Children's Hospital, HIDA scans are not routinely used because the 3-5 day phenobarbital loading period can delay intervention into a time period potentially detrimental to Kasai outcome." — Greg Tiao (opinion) [Ep 2 · 5:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=341)
- "A paper published approximately one year prior demonstrated that a scoring system combining liver biopsy and clinical parameters achieves 99% accuracy in diagnosing biliary atresia." (clinical) [Ep 2 · 2:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=166)
- "Pathognomonic findings on liver biopsy for biliary atresia include significant bile duct proliferation in portal triads and bile plugs within bile ducts, with likelihood of biliary atresia exceeding 90% when these are present." — Greg Tiao (clinical) [Ep 2 · 8:23](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=503)
- "At Cincinnati, liver biopsies are reviewed with pathologists before taking patients to the operating room, making intraoperative decision-making easier and sometimes reducing the necessity of intraoperative cholangiogram." — Greg Tiao (clinical) [Ep 2 · 8:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=530)
- "Alagille syndrome patients do not have the same bile duct proliferation as biliary atresia patients and will not have the pathognomonic finding of a bile duct plug." — Greg Tiao (clinical) [Ep 2 · 10:28](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=628)
- "At Cincinnati, the workup for biliary atresia is limited to liver biopsy, labs, and ultrasound before posting the patient for surgery." — Greg Tiao (clinical) [Ep 2 · 11:27](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=687)
- "The extended hilar dissection technique, going to the first bifurcation of vessels beyond the portal vein, is the proper way Kasai originally described the procedure." — Greg Tiao (clinical) [Ep 2 · 12:07](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=727)
- "Japanese centers uniformly perform extended dissections, which may explain why their Kasai outcomes are better than those in the United States." — Greg Tiao (opinion) [Ep 2 · 12:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=755)
- "Polysplenia syndrome patients with biliary atresia are the most difficult cases because they often have pre-duodenal portal veins and frequently have no bile duct remnant, making Kasai nearly impossible in this population." — Greg Tiao (clinical) [Ep 2 · 13:26](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=806)
- "Data from England by Mark Davenport showed that cystic variants of biliary atresia have better outcomes if intervention occurs before 30 days of age." — Greg Tiao (host_summary) [Ep 2 · 14:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=897)
- "Choledochal cyst patients will have pigmented stool, while cystic variant biliary atresia patients will become acholic, providing a simple clinical differentiation." — Greg Tiao (clinical) [Ep 2 · 15:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=914)
- "A Roux limb length of 20 cm is inadequate because 5-8 cm of length is almost always lost during hilar dissection at the time of transplant." — Greg Tiao (clinical) [Ep 2 · 15:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=942)
- "The target Roux limb length should be 30-40 cm to preserve adequate length for transplant teams, as one advantage of transplanting biliary atresia patients is having a pre-existing Roux limb." — Greg Tiao (clinical) [Ep 2 · 16:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=969)
- "Anti-refluxing valves for the Roux limb have not been proven effective." — Greg Tiao (clinical) [Ep 2 · 16:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=992)
- "UK data from approximately 15 years ago showed that centers performing more than 5 biliary atresia cases per year had statistically significantly better outcomes (approximately 20% difference) than those performing fewer cases." — Greg Tiao (host_summary) [Ep 2 · 17:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1031)
- "The British health service focused all Kasai procedures at three high-volume centers, which are the only centers that can be reimbursed for the procedure." — Greg Tiao (guideline) [Ep 2 · 17:38](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1058)
- "Two European studies (King's Group using 2 mg/kg steroids and Klaus Peterson's German group using 10 mg/kg for 5 days) showed no benefit from postoperative corticosteroids in biliary atresia." — Greg Tiao (host_summary) [Ep 2 · 18:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1083)
- "The Children's Network biliary atresia Research Consortium multi-center trial with approximately 70 patients in two arms showed no improvement in bile drainage with corticosteroid use and a slight increase in adverse events (primarily medical rather than surgical complications)." — Greg Tiao (host_summary) [Ep 2 · 18:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1102)
- "Despite negative trial results, there is a subset of biliary atresia patients with an inflammatory gene profile in which steroids might prove beneficial." — Greg Tiao (opinion) [Ep 2 · 18:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1137)
- "Cincinnati does not use MRCP for biliary atresia diagnosis due to having a high-capacity pathology team." — Greg Tiao (clinical) [Ep 2 · 19:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1179)
- "Performing Kasai on Alagille syndrome patients will shorten the natural history of their native liver and result in earlier transplantation." — Greg Tiao (clinical) [Ep 2 · 20:12](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1212)
- "For patients with cholestasis where biliary atresia diagnosis is uncertain, workup includes echocardiogram to rule out pulmonic stenosis, spine X-rays to rule out butterfly vertebrae, and eye exams, all to evaluate for Alagille syndrome." — Greg Tiao (clinical) [Ep 2 · 20:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-859?t=1221)
- "The first potential error trap in biliary atresia is not considering biliary atresia in the differential diagnosis of any newborn greater than 2 weeks of life with hyperbilirubinemia." — Jonathan Roach (clinical) [Ep 7 · 0:30](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=30)
- "A direct bilirubin greater than 20% of the total or greater than 1.0 prompts further workup for biliary atresia." — Jonathan Roach (guideline) [Ep 7 · 0:40](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=40)
- "Alpha-1 antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively." — Jonathan Roach (clinical) [Ep 7 · 0:58](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=58)
- "Ultrasounds are obtained on all biliary atresia patients to look for abnormalities in the gallbladder as well as the triangular cord sign." — Jonathan Roach (clinical) [Ep 7 · 1:07](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=67)
- "Findings on liver biopsy pathology such as bridging fibrosis, bile duct plugging, and proliferation of bile ducts are all suggestive of biliary atresia." — Jonathan Roach (clinical) [Ep 7 · 1:21](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=81)
- "If workup is suggestive of biliary atresia, there is no need to wait for the result of every esoteric test prior to proceeding to the operating room." — Jonathan Roach (opinion) [Ep 7 · 1:41](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=101)
- "Age at the time of Kasai is the primary determinant of outcome in biliary atresia patients." — Jonathan Roach (clinical) [Ep 7 · 1:50](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=110)
- "Some gallbladders in biliary atresia do not have lumen, and in these patients further exploration and likely Kasai will proceed." — Jonathan Roach (clinical) [Ep 7 · 2:04](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=124)
- "To avoid contrast extravasation during cholangiogram, the technique involves mobilizing the gallbladder off the gallbladder fossa, amputating the dome of the gallbladder, inserting the cholangiography catheter directly into the lumen, and tying it off with a silk ligature." — Jonathan Roach (clinical) [Ep 7 · 2:19](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=139)
- "Vascular variants in biliary atresia may include a preduodenal portal vein, which is rare." — Jonathan Roach (clinical) [Ep 7 · 2:40](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=160)
- "More commonly but still rare are confusing branching patterns of the hepatic artery and the portal vein in biliary atresia." — Jonathan Roach (clinical) [Ep 7 · 2:43](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=163)
- "It is recommended to carry out dissection to the secondary branching of the right and left hepatic arteries, but sometimes this branching can be quite early and dissection needs to occur up to the substance of the liver." — Jonathan Roach (clinical) [Ep 7 · 2:51](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=171)
- "The most reliable determinant of where the hilar plate exists is between the bifurcation of the right and left portal vein." — Jonathan Roach (clinical) [Ep 7 · 3:10](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=190)
- "It is important to dissect the fibrous cone of the biliary remnants down into the bifurcation of the portal vein where small portal branches must be tied off." — Jonathan Roach (clinical) [Ep 7 · 3:19](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=199)
- "The transection plane of the biliary remnants should be flush with the capsule of the liver so as not to dissect into the substance of the liver nor remain too shallow into the fibrous cone." — Jonathan Roach (clinical) [Ep 7 · 3:37](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=217)
- "Due to the results of the START trial, steroids are no longer routinely used in post-Kasai care." — Jonathan Roach (guideline) [Ep 7 · 4:00](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=240)
- "The use of antibiotics prophylactically to prevent cholangitis after Kasai is a controversial topic." — Jonathan Roach (opinion) [Ep 7 · 4:08](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=248)
- "Prophylactic antibiotics are currently used on all patients after Kasai at the speaker's institution." — Jonathan Roach (clinical) [Ep 7 · 4:15](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=255)
- "Biliary atresia patients require long-term follow-up care either with the pediatric surgeon or with the pediatric hepatologist." — Jonathan Roach (clinical) [Ep 7 · 4:23](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-biliary-atresia-1921?t=263)
- "Choledochal cyst is a congenital cystic dilation of the biliary tree." — Alex Bondoc (clinical) [Ep 9 · 0:29](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=29)
- "Incidence of choledochal cysts in the Western world is about 1 in 100,000." — Alex Bondoc (epidemiological) [Ep 9 · 0:36](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "In Eastern Asia, choledochal cyst incidence is 1 in 13,000." — Alex Bondoc (epidemiological) [Ep 9 · 0:36](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "Choledochal cysts are three to four times more likely in females than in males." — Alex Bondoc (epidemiological) [Ep 9 · 0:36](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "There is no genetic predisposition to choledochal cysts, but some genes including PKD1 have been identified in limited studies for type 5 choledochal cysts." — Alex Bondoc (clinical) [Ep 9 · 0:36](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36)
- "The most common classification system for choledochal cysts was developed by a surgeon named Tadani in Japan and includes five types." — Alex Bondoc (clinical) [Ep 9 · 1:10](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "For types 1 and 4 choledochal cysts, the etiology is likely embryologic, relating to pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel of the pancreaticobiliary duct." — Alex Bondoc (clinical) [Ep 9 · 1:10](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes in types 1 and 4 choledochal cysts." — Alex Bondoc (clinical) [Ep 9 · 1:10](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "In type 5 choledochal cysts, genetic mutation might predispose to more diffuse dilation of both the intra- and extrahepatic biliary trees." — Alex Bondoc (clinical) [Ep 9 · 1:10](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70)
- "Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular." — Alex Bondoc (clinical) [Ep 9 · 2:05](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 2 choledochal cyst is a small diverticulum off of the common bile duct." — Alex Bondoc (clinical) [Ep 9 · 2:05](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 3 choledochal cyst is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum." — Alex Bondoc (clinical) [Ep 9 · 2:05](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 4a choledochal cyst consists of multiple cysts in both the intra- and extrahepatic biliary tree." — Alex Bondoc (clinical) [Ep 9 · 2:05](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 4b choledochal cyst consists of multiple cysts in the extrahepatic biliary tree only." — Alex Bondoc (clinical) [Ep 9 · 2:05](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "Type 5 choledochal cyst is intrahepatic only and diffusely throughout, called Caroli's disease, which can be diffuse or limited to one lobe or one hemi-liver." — Alex Bondoc (clinical) [Ep 9 · 2:05](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125)
- "In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Patients with choledochal cysts can have a palpable right upper quadrant mass." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "The triad of jaundice, fever, and palpable right upper quadrant mass (Charcot's triad) is incredibly uncommon as a presentation of choledochal cysts." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Giant choledochal cysts in small children can perforate and present with biliary ascites." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Prenatally diagnosed choledochal cysts require fetal consultation at a fetal surgery center for establishment of care and counseling, because cystic biliary atresia must be ruled out postnatally." — Alex Bondoc (guideline) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "A recent citation demonstrated that if a choledochal cyst was diagnosed prenatally and was larger than 4.5 centimeters at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention." — Alex Bondoc (clinical) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205)
- "Differential diagnosis for a one-year-old presenting with jaundice includes problems with the pancreatic or biliary tree, stone disease (choledocholithiasis, cholelithiasis), gallstone pancreatitis, and choledochal cyst." — Alex Bondoc (clinical) [Ep 9 · 5:12](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- "A one-year-old with jaundice is a little old for biliary atresia, which is usually considered in an infant." — Alex Bondoc (clinical) [Ep 9 · 5:12](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312)
- "Physical exam findings to look for in suspected choledochal cyst include jaundice or scleral icterus and, in younger children, a palpable abdominal mass." — Alex Bondoc (clinical) [Ep 9 · 5:46](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- "Labs to check for suspected choledochal cyst include liver function tests (total, direct, and indirect bilirubin levels) and possibly a CBC to look for evidence of cholangitis or infection." — Alex Bondoc (clinical) [Ep 9 · 5:46](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- "The major initial screening imaging test for choledochal cyst is an abdominal ultrasound." — Alex Bondoc (clinical) [Ep 9 · 5:46](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346)
- "Liver biopsy is not typically needed for older patients with reliable ultrasound imaging, but becomes critical in neonates or newborns to rule out cystic biliary atresia variant." — Alex Bondoc (clinical) [Ep 9 · 6:25](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=385)
- "CT scan is commonly used for choledochal cyst workup because of the ease with which young children can be scanned." — Alex Bondoc (clinical) [Ep 9 · 6:47](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- "MRCP is useful for choledochal cysts with hilar or intrahepatic disease to understand the extent of cystic change and to identify variant biliary anatomy, which occurs in 15 to 20% of patients." — Alex Bondoc (clinical) [Ep 9 · 6:47](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- "ERCP can be used for both diagnostic and therapeutic purposes in choledochal cysts, depending on prior scan findings and the type of cyst." — Alex Bondoc (clinical) [Ep 9 · 6:47](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407)
- "There are no non-surgical treatment options for choledochal cysts." — Alex Bondoc (clinical) [Ep 9 · 8:00](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Choledochal cysts require surgery due to the risk of recurrent cholangitis from biliary stasis and superinfection." — Alex Bondoc (clinical) [Ep 9 · 8:00](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Type 1 and type 4 choledochal cysts with pancreaticobiliary malunion carry approximately an 8% lifetime risk of hepatobiliary malignancy, most specifically cholangiocarcinoma and gallbladder cancer." — Alex Bondoc (clinical) [Ep 9 · 8:00](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Studies estimate the lifetime risk of malignancy in choledochal cysts to be anywhere from 6% to 30%." — Alex Bondoc (clinical) [Ep 9 · 8:00](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "Even after surgical resection of choledochal cysts, some studies suggest there is still about a 4% lifetime risk of malignancy, requiring lifelong surveillance." — Alex Bondoc (clinical) [Ep 9 · 8:00](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480)
- "If a patient with choledochal cyst presents with active infection, pancreatitis, or cholangitis, the best approach is to cool the patient off and treat the underlying process before scheduling surgery after sufficient recovery." — Alex Bondoc (clinical) [Ep 9 · 9:16](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- "For incidentally found choledochal cysts, surgery should be scheduled sooner rather than later, when it makes sense for the family schedule." — Alex Bondoc (opinion) [Ep 9 · 9:16](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556)
- "Preoperative workup for choledochal cyst surgery includes laboratory values to ensure no other disease process is impairing liver function, and imaging (ultrasound and CT scan are often sufficient)." — Alex Bondoc (clinical) [Ep 9 · 10:14](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- "MRCP is recommended preoperatively if there is any question about the patient's anatomy or if the patient has a very proximal choledochal cyst or dilation into the hepatic ducts." — Alex Bondoc (clinical) [Ep 9 · 10:14](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=614)
- "The surgical goal for choledochal cyst repair is complete excision of the cyst." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "For type 1 and type 4 choledochal cysts, the goal is to remove as much of the duct as possible, taking the duct all the way down behind or into the head of the pancreas to where it tapers, to avoid leaving remnant cyst." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "For type 1 and type 4 choledochal cysts, biliary drainage reconstruction often includes a Roux-en-Y hepaticojejunostomy, but a hepaticoduodenostomy is also an option." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "Type 2 choledochal cyst can be treated by simple removal of the diverticulum at its neck with repair of the common bile duct." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "Type 3 choledochal cyst (limited choledochocele) can be treated with ERCP and sphincterotomy." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "If type 3 choledochal cyst involves the wall of the duodenum, transduodenal resection options exist, and biopsy of the choledochocele mucosa is important because biliary epithelium exposed to intestinal secretions could become malignant." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "Type 5 choledochal cyst (Caroli's disease) management depends on disease extent: if limited to an anatomic part of the liver, resection may be appropriate; if diffuse throughout the liver without adequate functional remnant, transplantation may be necessary." — Alex Bondoc (clinical) [Ep 9 · 11:13](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673)
- "For choledochal cyst surgery in children less than 2 years old, a transverse incision or right subcostal incision is preferred; for older children, an upper midline incision is a viable option." — Alex Bondoc (clinical) [Ep 9 · 13:19](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "During choledochal cyst dissection, hepatic arteries are medial and the portal vein is posterior to the cyst." — Alex Bondoc (clinical) [Ep 9 · 13:19](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "Dr. Bondock performs an intraoperative cholangiogram through the gallbladder to understand where the tapering of the distal cyst occurs to avoid leaving remnant cyst." — Alex Bondoc (clinical) [Ep 9 · 13:19](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "For Roux-en-Y hepaticojejunostomy reconstruction, Dr. Bondock goes about 15 to 20 centimeters distal from the ligament of Treitz, performs a two-layer jejunojejunostomy, and does a hepaticojejunostomy with interrupted 5-0 or 6-0 Maxon suture." — Alex Bondoc (clinical) [Ep 9 · 13:19](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "Dr. Bondock performs the Roux-en-Y limb retrocolic and closes the small bowel mesentery." — Alex Bondoc (clinical) [Ep 9 · 13:19](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799)
- "For type 2 choledochal cyst, once the cyst is tapered down to the common bile duct, the neck is resected and the common bile duct is repaired with interrupted absorbable suture without leaving a T-tube." — Alex Bondoc (clinical) [Ep 9 · 16:47](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- "Type 3 choledochal cyst can be approached endoscopically with ERCP and sphincterotomy, but if the lesion is large and obstructing the common duct, a transduodenal approach is needed, sometimes with preoperative stents to separate it from the duodenum." — Alex Bondoc (clinical) [Ep 9 · 16:47](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- "Type 5 choledochal cyst (Caroli's disease) can be addressed surgically with liver resection if cystic disease is limited to one hemi-liver with adequate liver remnant and preserved biliary outflow, but if diffuse throughout the liver, liver transplantation may be necessary." — Alex Bondoc (clinical) [Ep 9 · 16:47](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007)
- "Postoperative considerations for choledochal cyst surgery include enteric drainage and awaiting return of bowel function." — Alex Bondoc (clinical) [Ep 9 · 18:45](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Dr. Bondock typically places an NG tube postoperatively because of the new jejunojejunostomy, but tries to remove it the day after surgery." — Alex Bondoc (clinical) [Ep 9 · 18:45](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Drains are placed postoperatively to assess for biliary leaks from the new hepatoenteric anastomosis and are typically removed once the patient is tolerating a regular diet." — Alex Bondoc (clinical) [Ep 9 · 18:45](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Institutionally, patients are placed on a choleretic like Actigall and cholangitis prophylaxis (daily Bactrim) for three to six months after choledochal cyst surgery." — Alex Bondoc (clinical) [Ep 9 · 18:45](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Short-term to long-term surgical complications of choledochal cyst surgery include anastomotic stricture, small bowel obstruction from intra-abdominal surgery, reflux gastritis, and recurrent cholangitis." — Alex Bondoc (clinical) [Ep 9 · 18:45](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Lifelong follow-up is needed for choledochal cyst patients because of the possibility of developing future malignancy even after resection of the cyst." — Alex Bondoc (clinical) [Ep 9 · 18:45](https://qa.library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125)
- "Biliary atresia is the most common cause of end-stage liver failure in the pediatric patient population" — Em Gootee (host_summary) [Ep 12 · 0:12](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=12)
- "Biliary atresia is the number one reason for pediatric liver transplant" — Em Gootee (host_summary) [Ep 12 · 0:12](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=12)
- "Biliary atresia is an uncommon disease that results in an obstructive cholangiopathy of the biliary system" — Greg Tiao (clinical) [Ep 12 · 0:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=40)
- "Biliary atresia is unique to infancy" — Greg Tiao (clinical) [Ep 12 · 0:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=40)
- "Biliary atresia is the most common cause for end-stage liver disease in children" — Greg Tiao (epidemiological) [Ep 12 · 0:40](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=40)
- "The etiology of biliary atresia is uncertain" — Greg Tiao (clinical) [Ep 12 · 0:54](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=54)
- "Biliary atresia causes a biliary epithelial injury process that causes biliary obstruction" — Greg Tiao (clinical) [Ep 12 · 0:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=56)
- "Untreated biliary atresia causes progressive cholestasis, portal fibrosis, eventually cirrhosis, portal hypertension, and can cause death by the age of 2 years" — Greg Tiao (clinical) [Ep 12 · 1:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=70)
- "In the Far East, biliary atresia incidence is estimated at 1 in 8000 live births" — Greg Tiao (epidemiological) [Ep 12 · 1:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=91)
- "In the United States, biliary atresia incidence is 1 in 15,000 live births" — Greg Tiao (epidemiological) [Ep 12 · 1:43](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=103)
- "Infants with biliary atresia typically present with jaundice as the first clinical manifestation" — Greg Tiao (clinical) [Ep 12 · 2:02](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=122)
- "Patients with biliary atresia have acholic or very pale gray stools" — Greg Tiao (clinical) [Ep 12 · 2:08](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=128)
- "Patients with biliary atresia have dark urine" — Greg Tiao (clinical) [Ep 12 · 2:13](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=133)
- "The liver in biliary atresia becomes quite firm and is usually palpable in the right costochondral margin" — Greg Tiao (clinical) [Ep 12 · 2:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=134)
- "Biliary atresia typically presents between 1 to 2 months of age" — Greg Tiao (clinical) [Ep 12 · 2:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=141)
- "Screening can pick up biliary atresia at an earlier stage and has been demonstrated to improve outcomes" — Greg Tiao (clinical) [Ep 12 · 2:26](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=146)
- "The most common reason an infant has jaundice is physiologic jaundice of the newborn" — Greg Tiao (clinical) [Ep 12 · 2:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=166)
- "Indirect hyperbilirubinemia indicates physiologic jaundice" — Greg Tiao (clinical) [Ep 12 · 2:53](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=173)
- "Direct hyperbilirubinemia indicates a more pathologic process" — Greg Tiao (clinical) [Ep 12 · 2:58](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=178)
- "Anatomic causes of direct hyperbilirubinemia include biliary atresia, choledochal cysts, and inspissated bile syndrome" — Greg Tiao (clinical) [Ep 12 · 3:18](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=198)
- "Hepatocellular causes of direct hyperbilirubinemia include viral hepatitis, sepsis, PFIC syndromes, alpha-1 antitrypsin deficiency, tyrosinemia, and transport abnormalities" — Greg Tiao (clinical) [Ep 12 · 3:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=219)
- "Workup for biliary atresia includes liver profile with GGT, alpha-1 antitrypsin genotype, and TORCH workup" — Greg Tiao (clinical) [Ep 12 · 4:23](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=263)
- "Patients are screened for cystic fibrosis, hypothyroidism, and galactosemia as part of perinatal screening" — Greg Tiao (clinical) [Ep 12 · 5:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=300)
- "Matrix metalloproteinase 7 (MMP-7) is a new biochemical marker with very high diagnostic sensitivity and specificity for biliary atresia" — Greg Tiao (clinical) [Ep 12 · 5:13](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=313)
- "Ultrasound is the first imaging test typically obtained for biliary atresia workup" — Greg Tiao (clinical) [Ep 12 · 5:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=332)
- "HIDA scan is fairly sensitive but has quite low specificity for biliary atresia and can delay workup and diagnosis" — Greg Tiao (clinical) [Ep 12 · 5:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=342)
- "Liver biopsy is the gold standard for diagnosing biliary atresia" — Greg Tiao (clinical) [Ep 12 · 6:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=369)
- "Classic biopsy findings of biliary atresia include expansion of the periportal space with mononuclear cells, bile duct proliferation, and bile duct plugs within proliferating periportal biliary ducts" — Greg Tiao (clinical) [Ep 12 · 6:18](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=378)
- "Bile duct plugs are the pathognomonic finding of biliary atresia on biopsy" — Greg Tiao (clinical) [Ep 12 · 6:18](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=378)
- "Treatment options for biliary atresia are surgical and include Kasai portoenterostomy or liver transplantation" — Greg Tiao (clinical) [Ep 12 · 6:45](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=405)
- "As long as the patient reaches the OR before 70-75 days, the success rate of Kasai procedure justifies the small morbidity risks" — Greg Tiao (clinical) [Ep 12 · 7:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=420)
- "In older patients with manifestations of cirrhosis including ascites and coagulopathy, consideration for primary transplant is warranted" — Greg Tiao (clinical) [Ep 12 · 7:12](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=432)
- "Both Kasai and transplant procedures require an intraoperative cholangiogram to establish anatomy and visualize patency of the common hepatic duct and intrahepatic components" — Greg Tiao (clinical) [Ep 12 · 7:34](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=454)
- "In Kasai procedure, the gallbladder is mobilized to identify the common bile duct and common hepatic duct, with dissection carried laterally to where arteries branch" — Greg Tiao (clinical) [Ep 12 · 7:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=475)
- "The hilar plate in biliary atresia has a triangle-like appearance extending from the common hepatic duct to a broader base" — Greg Tiao (clinical) [Ep 12 · 8:08](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=488)
- "The hilar plate is divided in one sharp transection right proximal to Glisson's capsule" — Greg Tiao (clinical) [Ep 12 · 8:25](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=505)
- "A 30 to 35 centimeter Roux-en-Y limb is created and brought up in a retrocolic fashion for hilar plate reconstruction" — Greg Tiao (clinical) [Ep 12 · 8:34](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=514)
- "The most worrisome complication of Kasai is vascular injury to the portal vein or hepatic artery" — Greg Tiao (clinical) [Ep 12 · 9:04](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=544)
- "During Kasai, anything that is easily demonstrable should not be divided; if you think it's a vessel, don't divide it because it may be a segmental artery of importance" — Greg Tiao (opinion) [Ep 12 · 9:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=551)
- "Other complications of Kasai include bowel obstruction and wound issues" — Greg Tiao (clinical) [Ep 12 · 9:27](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=567)
- "Cholangitis is a longer-term concern after Kasai, but requires adequate bile flow to occur" — Greg Tiao (clinical) [Ep 12 · 9:34](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=574)
- "Cholangitis after Kasai is presumed to be an ascending process and can be suppressed with antibiotics" — Greg Tiao (clinical) [Ep 12 · 9:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=582)
- "In the United States, most Kasai patients are discharged home within 5 to 7 days after the procedure" — Greg Tiao (clinical) [Ep 12 · 9:57](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=597)
- "Post-Kasai patients require multidisciplinary care with both surgeon and gastroenterologist follow-up" — Greg Tiao (clinical) [Ep 12 · 10:06](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=606)
- "Post-Kasai patients are on prophylactic antibiotics, Actigall, and require nutritional support including fat-soluble vitamins and elemental diets" — Greg Tiao (clinical) [Ep 12 · 10:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=614)
- "A successful Kasai is defined as direct bilirubin under 2 at 3 months of age" — Greg Tiao (clinical) [Ep 12 · 10:28](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=628)
- "Immediate post-operative success indicator is a pigmented stool, which indicates the patient is draining" — Greg Tiao (clinical) [Ep 12 · 10:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-with-dr-greg-tiao-5518?t=635)
- "Biliary atresia is the leading cause for liver transplant in the United States." (host_summary) [Ep 13 · 0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=0)
- "At 50 days of age, physiologic jaundice from the newborn period would have resolved." — Greg Tiao (clinical) [Ep 13 · 6:37](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=397)
- "The key diagnostic finding is conjugated hyperbilirubinemia." — Mark Davenport (clinical) [Ep 13 · 6:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=416)
- "A high GGT is more consistent with an obstructive process and helps guide toward eliminating PFIC (progressive familial intrahepatic cholestasis) diagnoses." — Greg Tiao (clinical) [Ep 13 · 6:06](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=366)
- "Infants who initially had yellow stool that became clay-colored have better prognosis than those with clay-colored stool immediately after passing meconium." — Atsuyuki Yamataka (clinical) [Ep 13 · 7:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=452)
- "Ultrasound separates out other surgical issues including inspissated bile syndrome and spontaneous perforation of bile ducts, which should have ultrasound-positive features." — Mark Davenport (clinical) [Ep 13 · 8:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=519)
- "The triangular cord sign on ultrasound is not particularly discriminatory for biliary atresia." — Mark Davenport (opinion) [Ep 13 · 8:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=519)
- "Cincinnati Children's Hospital has not used HIDA scans for biliary atresia diagnosis in approximately 25 years." — Greg Tiao (clinical) [Ep 13 · 9:45](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=585)
- "Experienced pathologists can diagnose biliary atresia from percutaneous liver biopsy in almost 90% of cases." — Mark Davenport (clinical) [Ep 13 · 10:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=641)
- "NASPGHAN guidelines recommend not obtaining HIDA scans because phenobarbital loading delays treatment by 5-6 days, pushing closer to the window where Kasai efficacy deteriorates." — Greg Tiao (host_summary) [Ep 13 · 13:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=826)
- "King's College Hospital uses ERCP for approximately 10% of biliary atresia cases when biopsy findings are equivocal." — Mark Davenport (clinical) [Ep 13 · 15:17](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=917)
- "Histologic findings diagnostic of biliary atresia include ductular proliferation, small cell infiltrate, and bile duct plugs in proliferating bile ducts." — Mark Davenport (clinical) [Ep 13 · 15:47](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=947)
- "By 50 days of age, all histologic features of biliary atresia should be established on biopsy, whereas earlier biopsies (10-20 days) may not show consistent diagnostic findings." — Mark Davenport (clinical) [Ep 13 · 15:47](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=947)
- "Significant fibrosis on liver biopsy reflects disease progression and may guide surgical decision-making." — Greg Tiao (clinical) [Ep 13 · 16:28](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=988)
- "Liver exteriorization during Kasai portoenterostomy can create denser, more vascularized adhesions that complicate future liver transplantation." — Greg Tiao (clinical) [Ep 13 · 20:26](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1226)
- "Liver exteriorization with a small incision can cause kinking of hepatic veins." — Atsuyuki Yamataka (clinical) [Ep 13 · 21:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1301)
- "IPEG placed a moratorium on laparoscopic Kasai portoenterostomy because of poor outcomes." — Todd Ponsky (host_summary) [Ep 13 · 22:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1375)
- "Recent data from Juntendo shows liver function might be worse in the midterm follow-up for patients who had laparoscopic Kasai compared to open surgery." — Atsuyuki Yamataka (clinical) [Ep 13 · 23:17](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1397)
- "Peterson ran a prospective randomized trial comparing laparoscopic to open Kasai and stopped the trial early." — Greg Tiao (host_summary) [Ep 13 · 24:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1471)
- "The only chance a child with biliary atresia has to avoid early transplant is a well-done Kasai portoenterostomy." — Greg Tiao (opinion) [Ep 13 · 24:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1471)
- "Even in the best hands, long-term drainage rate after Kasai portoenterostomy is only 70-75%." — Greg Tiao (clinical) [Ep 13 · 24:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1471)
- "Damage to hepatic artery branches during Kasai dissection can exacerbate the underlying liver disease process." — Greg Tiao (clinical) [Ep 13 · 25:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550)
- "The hilar plate should be transected at the level of Glisson's capsule, leaving it intact, without cutting into the liver parenchyma itself." — Greg Tiao (clinical) [Ep 13 · 25:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550)
- "Dr. Neo published a paper describing different depths of hilar plate transection in Kasai portoenterostomy." — Greg Tiao (host_summary) [Ep 13 · 25:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550)
- "In the Children's Network surgical committee, approximately one-third of centers cut into the liver during Kasai, while the rest transect at 1-2 mm of fibrous remnant." — Greg Tiao (clinical) [Ep 13 · 25:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1550)
- "Coring into the liver creates an unstable interface that has never achieved good results in the literature, as biliary ductules that transgress simply scar over." — Mark Davenport (clinical) [Ep 13 · 28:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1701)
- "Standard Roux limb length for Kasai portoenterostomy is 40 centimeters, though Cincinnati uses 35-40 cm and measures with silk suture to 45 cm." — Mark Davenport (clinical) [Ep 13 · 29:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1788)
- "The Roux anastomosis suture choice does not make a difference in outcomes." — Greg Tiao (opinion) [Ep 13 · 30:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1810)
- "For the portoenterostomy anastomosis, 6-0 Maxon suture is used with all knots tied on the outside." — Greg Tiao (clinical) [Ep 13 · 30:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1810)
- "Yamataka uses a shorter Roux limb than standard because he does not like redundant Roux loops." — Atsuyuki Yamataka (clinical) [Ep 13 · 30:34](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-i-6039?t=1834)
- "American Academy of Pediatrics recommends fractionation of bilirubin for any baby with persistent jaundice beyond two weeks of age, with referral to pediatric gastroenterologist if direct bilirubin is elevated" — Jorge Bezerra (guideline) [Ep 14 · 1:50](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=110)
- "Cincinnati protocol: ultrasound and blood work same day, alpha-1 antitrypsin testing, liver biopsy if alpha-1 normal and acholic stool present, decision on Kasai within 5-7 days" — Jorge Bezerra (clinical) [Ep 14 · 2:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=151)
- "Parents reporting normal stool color must show the stool for verification, as many parents misidentify acholic stools as normal" — Jorge Bezerra (clinical) [Ep 14 · 3:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=210)
- "MMP7 (matrix metalloprotein 7) ELISA on serum predicts biliary atresia with 96% positive predictive value and 98% negative predictive value in Wuhan cohort study (in press)" — Jorge Bezerra (epidemiological) [Ep 14 · 4:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=243)
- "START trial (US multicenter, double-blind, placebo-controlled): no significant difference in jaundice clearance at 6 months between steroid and placebo groups in all comers (58% vs 48%, p>0.05)" — Jorge Bezerra (host_summary) [Ep 14 · 5:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=348)
- "Davenport UK trial showed improvement in jaundice clearance and decrease in bilirubin and liver enzymes with high-dose steroids versus no steroid" — Jorge Bezerra (host_summary) [Ep 14 · 5:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=348)
- "START trial subset analysis for patients <70 days old: placebo arm 57% jaundice clearance, steroid arm 72% clearance—difference not statistically significant due to insufficient numbers (type 2 error)" — Mark Davenport (epidemiological) [Ep 14 · 7:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=439)
- "King's College initial low-dose steroid trial (2mg/kg/day prednisone): no difference in jaundice clearance between groups, but statistically significant lower bilirubin at one month in steroid group" — Mark Davenport (epidemiological) [Ep 14 · 9:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=596)
- "King's College high-dose steroid protocol (5mg/kg/day): 67% jaundice clearance vs 52% in controls, difference reached statistical significance with larger numbers" — Mark Davenport (epidemiological) [Ep 14 · 9:56](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=596)
- "Tokyo protocol: start prednisone 4mg/kg/day after CRP normalizes post-op, taper over 15 days (4→3→2→1→0.5mg/kg, 3 days each), return to higher dose if stool becomes acholic" — Atsuyuki Yamataka (clinical) [Ep 14 · 11:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=675)
- "King's College current protocol: 5mg/kg/day prednisone starting day 4 post-op when oral feeds begin" — Mark Davenport (clinical) [Ep 14 · 12:02](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=722)
- "Cincinnati molecular profiling identified two biliary atresia phenotypes: inflammatory (potentially steroid-responsive) and fibrotic (less likely to respond)" — Greg Tiao (clinical) [Ep 14 · 12:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=751)
- "START trial design was adequately powered as designed; randomized phase had N=70 per arm, larger than Davenport's randomized phase (N=18 steroid, N=19 placebo)" — Jorge Bezerra (epidemiological) [Ep 14 · 14:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=872)
- "START trial documented that serious adverse events occurred earlier in steroid group compared to placebo during the period of steroid administration, but no difference in total SAE frequency" — Jorge Bezerra (epidemiological) [Ep 14 · 16:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=990)
- "GI bleeding is a potential steroid complication; King's College always gives ranitidine with steroids, which may not have been standard in START trial" — Mark Davenport (clinical) [Ep 14 · 17:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1055)
- "START trial started steroids on post-op day 1, whereas Tokyo and King's protocols wait 4-7 days until CRP normalizes—this timing difference may affect safety profile" — Atsuyuki Yamataka (opinion) [Ep 14 · 18:10](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1090)
- "Early post-operative cholangitis is a bad prognostic sign for long-term native liver survival" — Atsuyuki Yamataka (clinical) [Ep 14 · 19:05](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1145)
- "King's College antibiotic protocol: IV tazocin-gentamicin for 5 days, then oral cephalosporin for 1 month" — Mark Davenport (clinical) [Ep 14 · 19:34](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1174)
- "Cincinnati antibiotic protocol: cephalosporin until taking PO, then Bactrim or amoxicillin for minimum 3 months post-op" — Greg Tiao (clinical) [Ep 14 · 19:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1188)
- "START trial antibiotic protocol: treatment dose for 2 weeks, then prophylaxis for 6 months" — Greg Tiao (host_summary) [Ep 14 · 19:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1188)
- "Aggressive nutrition management is key: maintain adequate weight gain with concentrated formula or NG supplementation as needed, plus fat-soluble vitamin replacement" — Jorge Bezerra (clinical) [Ep 14 · 20:12](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1212)
- "For patients presenting at 100+ days with cirrhosis on ultrasound (heterogeneous surface, ascites), consider primary transplant rather than Kasai; primary transplant rate in England/Wales is approximately 5%" — Mark Davenport (clinical) [Ep 14 · 21:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1280)
- "King's College data from 2001: 100+ day Kasai patients achieved approximately 40% five-year native liver survival" — Mark Davenport (epidemiological) [Ep 14 · 21:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1280)
- "Tokyo approach to late presenters: decision based on timing of acholic stool onset, not chronological age—if acholic from birth, consider primary transplant; if yellow stool for first month of life, proceed to Kasai even at 100 days" — Atsuyuki Yamataka (clinical) [Ep 14 · 23:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1389)
- "For cystic biliary atresia with visible intrahepatic ducts on cholangiogram, prognosis is better even in late presenters" — Atsuyuki Yamataka (clinical) [Ep 14 · 23:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1389)
- "Cincinnati approach: clinical assessment with consideration of biopsy fibrosis; will explore surgically unless significant cirrhosis on pre-op biopsy; some 120-day patients have done well while some 60-day patients had advanced disease" — Greg Tiao (clinical) [Ep 14 · 24:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1454)
- "King's College data with high-dose steroids: 100% of patients who underwent Kasai before 30 days of age cleared their jaundice" — Mark Davenport (epidemiological) [Ep 14 · 25:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1541)
- "Tokyo data shows age at Kasai is not significantly related to outcome; duration of acholic stool (disease duration) is the most important prognostic factor" — Atsuyuki Yamataka (clinical) [Ep 14 · 26:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1579)
- "Cholangitis management: early recognition critical, families instructed to seek immediate medical attention for fever, not wait at home" — Greg Tiao (clinical) [Ep 14 · 27:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1641)
- "Cincinnati cholangitis protocol: IV antibiotics, consider short course of steroids if no response after several days" — Greg Tiao (clinical) [Ep 14 · 27:21](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1641)
- "King's College does not use steroids for cholangitis treatment and does not perform early revision Kasai" — Mark Davenport (clinical) [Ep 14 · 28:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1696)
- "Tokyo cholangitis protocol: intensive IV antibiotics until CRP and white count normalize, then steroids; revision Kasai not performed due to poor outcomes" — Atsuyuki Yamataka (clinical) [Ep 14 · 28:51](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1731)
- "Cincinnati performs revision Kasai only in highly selected patients: those who previously cleared jaundice and normalized bilirubin, then became acholic after cholangitis; 25-patient series showed native liver salvage possible, some patients 5-10 years out with native liver" — Greg Tiao (clinical) [Ep 14 · 29:07](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1747)
- "For patients who never clear jaundice post-Kasai: focus on aggressive nutrition and proceed to liver transplant evaluation; nutritional support is key driver in determining post-transplant complications" — Jorge Bezerra (clinical) [Ep 14 · 30:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1820)
- "Transplant referral timing: if bilirubin has not dropped below 2 at 3 months post-Kasai, refer to transplant center for evaluation even if not immediately listing" — Greg Tiao (clinical) [Ep 14 · 31:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1882)
- "CMV IgM-positive biliary atresia represents approximately 10% of cases in Western Europe and North America; prevalence higher in China and Japan" — Mark Davenport (epidemiological) [Ep 14 · 32:54](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1974)
- "King's College retrospective data (2010-11): CMV IgM-positive patients were older at Kasai, had different histology, and cleared jaundice in less than 10% of cases without antiviral treatment" — Mark Davenport (epidemiological) [Ep 14 · 34:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2055)
- "King's College prospective antiviral treatment (valganciclovir): 7 of 9 (approximately 78%) CMV-positive patients cleared jaundice, dramatic improvement from historical <10%" — Mark Davenport (clinical) [Ep 14 · 34:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2055)
- "CMV PCR levels in biliary atresia show inverse relationship with age and AST levels; highest viral loads in younger babies, suggesting body clears virus over time" — Mark Davenport (clinical) [Ep 14 · 34:15](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2055)
- "Cincinnati mouse model identified peptide sequence common to rotavirus, CMV, and EBV that may govern host immune response in biliary atresia" — Greg Tiao (clinical) [Ep 14 · 32:54](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=1974)
- "Increasing proportion of biliary atresia patients require transplant despite modest bilirubin elevation due to progressive fibrosis and portal hypertension complications" — Mark Davenport (clinical) [Ep 14 · 38:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2302)
- "King's College colchicine trial (1970s-80s) for liver fibrosis showed no difference in long-term fibrosis levels or clinical outcomes between treatment and placebo groups" — Mark Davenport (epidemiological) [Ep 14 · 38:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2302)
- "Cincinnati has unpublished animal model data showing targeted anti-fibrotic therapy produces remarkable decrease in collagen deposition and hepatic fibrosis" — Jorge Bezerra (clinical) [Ep 14 · 40:38](https://qa.library.globalcastmd.com/watch/biliary-atresia-part-ii-6040?t=2438)
- "Dr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia" — Em Gootee (host_summary) [Ep 18 · 0:04](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=4)
- "Dr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca" — Em Gootee (host_summary) [Ep 18 · 0:20](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=20)
- "Dr. Dariusz Patkowski presented thoracoscopic approach for long gap esophageal atresia using internal traction technique with slipknots" — Rennie (host_summary) [Ep 18 · 0:39](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=39)
- "Dr. Johanna Gerardo presented an epidemiological study of pediatric robotic surgery at their institution" — Rennie (host_summary) [Ep 18 · 0:53](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=53)
- "Dr. Dariusz Patkowski won Heat 1 of the competition" — Em Gootee (clinical) [Ep 18 · 1:25](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=85)
- "The thoracoscopic procedure for long gap esophageal atresia using sliding knots is beneficial to learn" — Todd Ponsky (opinion) [Ep 18 · 1:30](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=90)
- "Data was presented suggesting that resecting liver cuts mortality down by 50% in biliary atresia, though the judge expressed uncertainty about the data" — Todd Ponsky (host_summary) [Ep 18 · 1:49](https://qa.library.globalcastmd.com/watch/heat-1-winner-dariusz-patkowski-md-phd-best-of-the-best-in-pediatric-surgery-2024-8008?t=109)
- "Biliary atresia is a progressive cholangiopathy that leads to morbidity and end stage cirrhosis." — Shilpa Sharma (clinical) [Ep 17 · 1:06](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=66)
- "In developing countries with delayed presentation, advanced cirrhosis, and hepatic failure, most infants with biliary atresia succumb to hepatopulmonary syndrome, portal hypertension, intraventricular hemorrhage, and aspiration due to massive ascites." — Shilpa Sharma (epidemiological) [Ep 17 · 1:10](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=70)
- "The liver may regenerate after physiological insults and resection, with hepatic resection acting as a trigger for regeneration." — Shilpa Sharma (clinical) [Ep 17 · 1:33](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=93)
- "The liver can regenerate only to a size that is proportional to its original size." — Shilpa Sharma (clinical) [Ep 17 · 1:41](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=101)
- "In biliary atresia, hepatic stellate cells activate and lead to a pro-fibrogenic pathway involving transforming growth factor, platelet derived growth factor, and interleukins." — Shilpa Sharma (clinical) [Ep 17 · 1:53](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=113)
- "In hepatic resection, hematopoietic stem cells lead to proliferation with the help of hepatocyte growth factor receptor, epidermal growth factor receptor, and cytokines like tumor necrosis factor." — Shilpa Sharma (clinical) [Ep 17 · 2:09](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=129)
- "Starting in 2015, the team began resecting segments 2 and 3 of the liver in a non-anatomical fashion to stimulate an alternative pathway of stem cell proliferation for hepatic regeneration." — Shilpa Sharma (clinical) [Ep 17 · 2:26](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=146)
- "The study compared outcomes of segmentectomy combined with Kasai procedure versus Kasai alone, measuring bilirubin and APRI at preoperative, day 7, and 1st, 3rd, 6th, and 12th month time points." — Shilpa Sharma (clinical) [Ep 17 · 2:45](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=165)
- "The median age at presentation was similar in both groups: 96 days in one group and 89 days in the other." — Shilpa Sharma (clinical) [Ep 17 · 3:16](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=196)
- "Serum bilirubin levels were significantly different between the Kasai-plus-resection group and Kasai-alone group at 1 month and 3 months postoperatively." — Shilpa Sharma (clinical) [Ep 17 · 3:26](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=206)
- "APRI (AST to Platelet Ratio Index) was significantly different between groups on postoperative day 7." — Shilpa Sharma (clinical) [Ep 17 · 3:35](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=215)
- "Mortality was lower in the study group (Kasai plus resection) at 56% compared to 93% in the control group (Kasai alone)." — Shilpa Sharma (clinical) [Ep 17 · 3:41](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=221)
- "The jaundice-free percentage was 91% in the study group compared to 25% in the control group." — Shilpa Sharma (clinical) [Ep 17 · 3:49](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=229)
- "Resection of a part of the liver may trigger an alternative pathway of stem cell proliferation for hepatic regeneration with reduced fibrosis and improved survival." — Shilpa Sharma (opinion) [Ep 17 · 3:58](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=238)
- "The team resected the left liver (segments 2 and 3) to leave enough liver to regenerate, particularly in patients presenting late after 80 days of life." — Cecilia Gigena (host_summary) [Ep 17 · 5:08](https://qa.library.globalcastmd.com/watch/prof-shilpa-sharma-best-of-the-best-in-pediatric-surgery-2024-8004?t=308)
- "Biliary atresia is a severe liver disease characterized by fibro-inflammatory destruction of bile ducts." — Zhang Jing (clinical) [Ep 20 · 0:42](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=42)
- "MMP-7 can help precisely discriminate BA from other cholestatic diseases at a cutoff value of around 20 ng/mL." — Zhang Jing (host_summary) [Ep 20 · 0:48](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=48)
- "5 to 10% of BA patients have false negative MMP-7 levels." — Zhang Jing (host_summary) [Ep 20 · 1:00](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=60)
- "The study reviewed 329 BA patients who underwent Kasai procedure from 2020 to 2022." — Zhang Jing (clinical) [Ep 20 · 1:24](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=84)
- "Patients were divided into low MMP-7 and high MMP-7 groups based on preoperative MMP-7 levels of 20-25 ng/mL." — Zhang Jing (clinical) [Ep 20 · 1:34](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=94)
- "The median MMP-7 level for low MMP-7 group was 20.19 ng/mL compared with 66.55 ng/mL for the high MMP-7 group." — Zhang Jing (clinical) [Ep 20 · 2:03](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=123)
- "Preoperative gamma-GT and direct bilirubin in the low MMP-7 group were significantly lower than those in the high MMP-7 group." — Zhang Jing (clinical) [Ep 20 · 2:16](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=136)
- "Fibrosis stages were significantly different between the low and high MMP-7 groups." — Zhang Jing (clinical) [Ep 20 · 2:26](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=146)
- "Three-month jaundice clearance rate was 46.91% for the high MMP-7 group and 29.73% for the low MMP-7 group." — Zhang Jing (clinical) [Ep 20 · 2:34](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=154)
- "Six-month jaundice clearance rate was 54.51% for the high MMP-7 group and 32.14% for the low MMP-7 group." — Zhang Jing (clinical) [Ep 20 · 2:50](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=170)
- "A total of 90 patients in the low MMP-7 group and 112 patients in the high MMP-7 group died or underwent liver transplantation by the latest follow-up." — Zhang Jing (clinical) [Ep 20 · 3:03](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=183)
- "One-year native liver survival rate was 29.63% for the low MMP-7 group and 53.02% for the high MMP-7 group." — Zhang Jing (clinical) [Ep 20 · 3:16](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=196)
- "Around 10% of BA patients have low MMP-7 levels." — Zhang Jing (epidemiological) [Ep 20 · 3:29](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=209)
- "Low gamma-GT levels correlated with more severe liver injury and poor outcomes in a previous study." — Zhang Jing (host_summary) [Ep 20 · 3:41](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=221)
- "BA patients in the low MMP-7 group had a lower jaundice clearance rate and native liver survival rate." — Zhang Jing (clinical) [Ep 20 · 3:50](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=230)
- "The follow-up period ranged from 3 months to 3 years." — Zhang Jing (clinical) [Ep 20 · 4:11](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=251)
- "Some patients lost to follow-up within 3 months were excluded from final analysis." — Zhang Jing (clinical) [Ep 20 · 4:11](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=251)
- "Patients did not take MMP-7 measurements post-Kasai procedure in this study." — Zhang Jing (clinical) [Ep 20 · 4:30](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=270)
- "MMP-7 measurement is based on ELISA method." — Zhang Jing (clinical) [Ep 20 · 5:26](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=326)
- "MMP-7 testing is not very popular in every hospital in China, just in some institutions." — Zhang Jing (clinical) [Ep 20 · 5:36](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=336)
- "MMP-7 testing costs about 1000 RMB per patient in China." — Zhang Jing (clinical) [Ep 20 · 5:44](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=344)
- "Kasai procedure is still the first line treatment for biliary atresia." — Zhang Jing (guideline) [Ep 20 · 6:14](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=374)
- "Some BA patients could not achieve jaundice clearance and could not live long with their native liver after Kasai." — Zhang Jing (clinical) [Ep 20 · 6:14](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=374)
- "If the mechanism of MMP-7 in biliary atresia becomes clear, patients with low MMP-7 might go directly for liver transplantation in the future." — Zhang Jing (opinion) [Ep 20 · 6:34](https://qa.library.globalcastmd.com/watch/jingying-jiang-md-best-of-the-best-in-pediatric-surgery-2024-8019?t=394)
- "Timely diagnosis of biliary atresia is critical to prolong native liver survival" — Greg Tiao (clinical) [Ep 24 · 0:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=53)
- "MMP-7 was identified about 10 years ago by Doctor Georgia Bezarra as a diagnostic biomarker for biliary atresia" — Em Gootee (host_summary) [Ep 24 · 1:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=76)
- "The sooner the Kasai is performed, the more likely native liver will be saved" — Em Gootee (host_summary) [Ep 24 · 1:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=97)
- "For every 10-day delay in treatment, outcomes worsen by 20% according to a recent Midwest study" — Em Gootee (host_summary) [Ep 24 · 2:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=175)
- "Doctor Bezarra screened about 1000 proteins in the Children's Network registry and found 70 or so that were elevated in the biliary atresia population, of which MMP-7 was the most clear" — Greg Tiao (clinical) [Ep 24 · 3:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=197)
- "The Children's Network has only 200 to 300 biliary atresia cases per year, making validation studies difficult" — Em Gootee (host_summary) [Ep 24 · 3:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=224)
- "Doctor Bezarra validated MMP-7 findings in just 2 years through a study in mainland China where biliary atresia frequency is much higher" — Em Gootee (host_summary) [Ep 24 · 4:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=241)
- "MMP-7 is now a validated biomarker for biliary atresia but is not perfect" — Greg Tiao (clinical) [Ep 24 · 4:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=262)
- "The sensitivity of MMP-7 is pretty good, but cutoffs vary because the assay is still evolving" — Greg Tiao (clinical) [Ep 24 · 4:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=267)
- "At Cincinnati Children's, the commitment is to perform Kasai within 7 days of a biliary atresia patient showing up" — Greg Tiao (clinical) [Ep 24 · 4:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=284)
- "The average age at Kasai for biliary atresia patients in North America is around 75 days according to a Children's Network study" — Em Gootee (host_summary) [Ep 24 · 4:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=292)
- "A European study showed that performing Kasai before 45 days reduces the incidence of transplant need" — Greg Tiao (clinical) [Ep 24 · 5:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=303)
- "Kasai portoenterostomy done before 45 days is the goal" — Greg Tiao (guideline) [Ep 24 · 5:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=322)
- "Cincinnati Children's will perform Kasai before 30 days if diagnosis can be established" — Greg Tiao (clinical) [Ep 24 · 5:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=327)
- "A direct bilirubin over 1 in the newborn period is very sensitive for biliary atresia" — Greg Tiao (clinical) [Ep 24 · 5:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=337)
- "Cincinnati Children's stopped doing HIDA scans about 25 years ago" — Greg Tiao (clinical) [Ep 24 · 2:47](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=167)
- "HIDA scan adds about 5 days to the diagnostic workup" — Greg Tiao (clinical) [Ep 24 · 2:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-mmp-7-biliary-atresia-diagnosis-2024-9973?t=170)
- "At Cincinnati Children's, interventional radiologists teach pediatric surgery fellows how to use ultrasound guidance for vascular access." (host_summary) [Ep 25 · 0:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53)
- "You don't have to have a hybrid OR to do image-guided surgery collaboration; it can occur in a regular OR by bringing in an ultrasound machine." (host_summary) [Ep 25 · 1:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62)
- "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT." (clinical) [Ep 25 · 1:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85)
- "ChatGPT can screen thousands of articles in systematic reviews by analyzing Excel sheets and screening included articles based on title and abstract." (host_summary) [Ep 25 · 2:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140)
- "In cryoanalgesia for pectus procedures, a double lumen endotracheal tube is used in all patients to deflate the lung on the side of cryoablation." (host_summary) [Ep 25 · 4:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275)
- "Cryoanalgesia targets nerves from T3 to T8 with a 2-minute freeze cycle starting at the third rib and working down." (host_summary) [Ep 25 · 4:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286)
- "Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with cryo nerve block." (host_summary) [Ep 25 · 4:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296)
- "Cryoanalgesia blocks fail when surgeons use a single lumen tube and perform the block too far anteriorly." (host_summary) [Ep 25 · 5:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313)
- "The SER Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed survival was equivalent between groups." (host_summary) [Ep 25 · 6:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403)
- "Every unilateral isolated CDH should be pursued with ECMO if there was good prenatal counseling with the parents." (host_summary) [Ep 25 · 6:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=418)
- "With bivalrudin, you can operate after 8 hours of putting patients on ECMO as long as levels are stable, and it's a much easier surgical repair." (host_summary) [Ep 25 · 7:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446)
- "Early repair while on ECMO is safe and can offer physiological benefits, with the optimal window between 8 to 24 hours." (host_summary) [Ep 25 · 7:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=461)
- "CO2 laser emits infrared light in the spectrum of 920 to 1400 nanometers, which is well absorbed by water." (host_summary) [Ep 25 · 8:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494)
- "In 56 circumcision cases using CO2 laser with the sleeve technique, dorsal slit, and cyanoacrylate adhesive, the complication rate was only 3%." (host_summary) [Ep 25 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510)
- "CO2 laser was used for frenulectomy in 47 patients with low pain profile and no suture required." (host_summary) [Ep 25 · 8:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520)
- "Autofluorescence has shown to reduce rates of hypoparathyroidism and hypocalcemia following thyroidectomy in a randomized controlled trial from France." (host_summary) [Ep 25 · 9:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577)
- "With autofluorescence, parathyroids naturally autofluoresce at a specific wavelength without injecting anything." (clinical) [Ep 25 · 9:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593)
- "Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it." (epidemiological) [Ep 25 · 10:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607)
- "A surgery-first pathway for pediatric biliary stones reduces resource utilization, including MRCP, according to recently published work." (epidemiological) [Ep 25 · 11:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=692)
- "With ERCP, you're going to get pancreatitis 10% of the time no matter how good you are." (epidemiological) [Ep 25 · 12:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722)
- "With a surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%." (host_summary) [Ep 25 · 12:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734)
- "If you just did flushing or got the catheter a little more into the common bile duct or reamed the sphincter, the success rate was in the 90s." (epidemiological) [Ep 25 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745)
- "MMP-7 was identified about 10 years ago by Georgia Bezarra as a diagnostic biomarker for biliary atresia." (host_summary) [Ep 25 · 13:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=787)
- "Data from a recent Midwest study shows that every 10-day delay in biliary atresia treatment worsens outcomes by 20%." (host_summary) [Ep 25 · 13:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821)
- "MMP-7 is not a validated biomarker for biliary atresia; it's not perfect, and the sensitivity is pretty good, but cutoffs vary because the assay is still evolving." (host_summary) [Ep 25 · 13:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838)
- "The institutional commitment is to perform Kasai procedure within 7 days of patients showing up if they have biliary atresia." (host_summary) [Ep 25 · 14:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=855)
- "REBOA can be used in children if you have it at your center and you're good at it, though it's not done a lot in pediatric hospitals." (host_summary) [Ep 25 · 15:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=908)
- "REBOA seems to take longer than opening the abdomen or chest if you're just needing to cross-clamp the aorta." (host_summary) [Ep 25 · 15:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948)
- "Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always get to the finish line fully healed with a minimally invasive approach." (host_summary) [Ep 25 · 16:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983)
- "John Armstrong, while serving in the US Army, ran a clinic where patients were shaved weekly, and they observed a dramatic improvement, significantly reducing the need for surgical intervention in pilonidal disease." (host_summary) [Ep 25 · 16:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000)
- "If you're not pushing hair removal and meticulous hygiene, you're probably going to end up operating on some people that might not need an operation for pilonidal disease." (host_summary) [Ep 25 · 16:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1015)
- "For pilonidal disease hair removal, if there's a parent or active caregiver involved, clipping is probably the easiest and simplest approach, with once-a-week recommended." (host_summary) [Ep 25 · 17:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Aug 31: 31 doctors auto-found from episode dossiers
- Aug 30: 25 doctors auto-found from episode dossiers
- Aug 30: 20 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 34 doctors auto-found from episode dossiers
- Aug 29: Checked against source: collection
- Aug 29: Checked against source: collection
- Aug 29: 33 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 37 items, 26 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 27 items, 26 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 27 items, 26 dossiers, summaries for 3 audience(s)

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