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Cholestasis
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
A 2021 JPN publication defined cholestasis as conjugated bilirubin around 2 mg/dL or 34 micromoles/L for 2 weeks, not associated with a septic event. — Paul Wales, Intestinal Rehabilitation, Episode 6: Cholestasis · 1:20
Intestinal Rehabilitation, Episode 6: Cholestasis
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We’re back with a new episode from the intestinal rehabilitation center at Cincinnati Children’s Hospital.
This time we’re talking about Cholestasis with Drs. Helmrath and Wales.
Hosts: Cecilia Gigena & Ellen Encisco.
podcast15:25 · Jun 2023
When liver biopsy is highly consistent with biliary atresia, intraoperative cholangiography becomes less necessary; some centers perform it primarily for educational purposes. Biliary Atresia: Update Course 2015 · 8:30
Biliary Atresia: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. Greg M. Tiao, Chief of Pediatric Surgery at Cincinnati Children's Hospital, discusses biliary atresia. Dr. Tiao covers topics on cholestasis in infants, diag
video20:34 · Jan 2019
Atresia de Vias Biliares - Resumen de la 5ta sesión Nacional de Residentes de Mexico
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Hoy te traemos un nuevo formato de podcast. El resumen de Charlas de Expertos de los ultimos años
En esta edición hablamos sobre Atresia de Vías Biliares, y es un resumen sobre la quinta sesión nacional de residentes de cirugía pediátric
podcast16:20 · May 2023
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, Biliary Atresia - Robert Parry: Update Course 2014 · 10:56
Biliary Atresia - Robert Parry: Update Course 2014
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Dr. Robert Parry, Director of Pediatric Surgery, Akron Children's Hospital, presents a clinical case of biliary atresia diagnosis. Topics discussed include kasai procedure, HIDA scan for biliary atresia, postoperative corticosteroids, and r
video24:55 · Nov 2018
The American Academy of Pediatrics policy states all jaundiced infants at 2 weeks of age should have a fractionated bilirubin done Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric... · 32:54
Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric...
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At the Advanced Practice Providers Pediatric Surgery Update Course in 2014, many distinguished advanced practice providers from around the world address the current evidence based management of the common pediatric surgical conditions. The
video48:21 · Jan 2019
Intestinal Rehabilitation Webinar 2023 - Top 5 Key Takeaways
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In November 2023 we held the first Intestinal Rehabilitation webinar with Dr. Paul Wales & Dr. Michael Helmrath, 2 experts from the Intestinal Rehab center at Cincinnati Children's.
These are the top 5 key takeaways from this webinar!!
video12:14 · Jun 2024
Expert statements from the recordings in this collection.
Biliary Atresia: Where are we now? Advanced Practice Providers Pediatric...
Pathologic jaundice occurs in 1 in 2500 live births
Biliary atresia is a progressive, obliterative, idiopathic cholangiopathy with two forms: perinatal/postnatal (80-90%) and fetal/embryonic (10-20%)
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
More females than males are affected by biliary atresia
Seasonal clustering of biliary atresia cases suggests viruses or infectious processes may be triggers
Biliary atresia is lethal if untreated
If conjugated or direct bilirubin is greater than or equal to 2, the child needs closer evaluation
Cites a guideline7:59
Some babies with biliary atresia have normal ultrasounds
The gold standard for biliary atresia diagnosis is the intraoperative cholangiogram
Cites a guideline8:26
At Children's Hospital Los Angeles, babies are pre-treated with 5 days of phenobarbital before HIDA scan
Timing of diagnosis and Kasai procedure is extremely important, with the sweet spot being 6 to 8 weeks of age
A French study showed 23% of Kasai patients had their native liver 20 years post-Kasai
Factors affecting survival with native liver include age at Kasai, type of biliary atresia, liver histology (bridging fibrosis), and center caseload
In England, consolidating Kasai procedures to 3 centers increased success rates
At Children's Hospital Los Angeles, 6 to 12 biliary atresia cases are seen per year, considered a high rate
If cirrhosis is seen on liver biopsy or frozen section during intraoperative cholangiogram, the procedure is stopped and the patient is listed for transplant
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
Bigger babies at time of transplant have easier transplant procedures
Expert opinion21:24
Children's Hospital Los Angeles has a very large, possibly the largest, living donor liver transplant center in the country, offering an alternative to cadaveric transplant
Most centers put babies on antibiotic prophylaxis postoperatively until they are eating
Post-operative steroids for biliary atresia are unproven
At Children's Hospital Los Angeles, peripheral IV lines are used postoperatively rather than Broviacs, and babies are not sent home on IV antibiotics
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
Babies are placed on ursodeoxycholic acid twice daily post-Kasai
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
Probiotics, herbal remedies, and omega-3 supplements have not been proven beneficial for biliary atresia
The BARC (Biliary Atresia Research Consortium) protocol enrolled 140 babies in a randomized double-blind placebo-controlled study with steroids
When a post-Kasai baby has unexplained fever, ascending cholangitis is suspected
Multiple episodes of ascending cholangitis cause further liver damage and may lead to earlier need for transplant
Biliary atresia is the most common indication for pediatric liver transplant