# Chronic Pancreatitis — GCMD Library living collection

Everything in the library about chronic pancreatitis — built automatically from dossiers that name it.

Updated: n/a · 10 episodes · 249 cited statements

## Episodes
### Fundamentals
- [Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440) — video · 8:32 · [machine version](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440.md)

### Diagnosis & Workup
- [Function Tests & Pain Management: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968) — video · 26:27 · [machine version](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968.md)

### Surgical Management
- [Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973) — video · 47:20 · [machine version](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973.md)
- [Update Course Rewind: Management of Chronic Pancreatitis 2023](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546) — video · 8:30 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546.md)
- [Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540) — video · 10:19 · [machine version](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540.md)

### Evidence & Research
- [Pancreatitis in pediatric patients with pancreatic solid pseudopapillary neoplasms- a single center experience](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847.md)

### Case-Based Learning
- [Update Course Rewind: Management of Recurrent Pancreatitis](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663) — video · 6:37 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663.md)

### In-Depth Reviews
- [Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971) — video · 51:02 · [machine version](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971.md)
- [Update Course 2023 - Updates in Pancreatitis](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269) — video · 32:50 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269.md)
- [Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849) — video · 66:03 · [machine version](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=0) Direct pancreatic function testing: endoscopic collection protocol (Ep 1)
- [5:07](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=307) MR pancreatic function testing: quantitative fluid secretion (Ep 1)
- [10:39](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=639) Case outcome: genetic testing and enzyme therapy (Ep 1)
- [13:41](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=821) Multidisciplinary pain management: case of 13-year-old with annular pancreas (Ep 1)
- [19:50](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1190) Pain psychology integration and opioid stewardship (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=0) Introduction and Definitions: Acute Recurrent vs. Chronic Pancreatitis (Ep 2)
- [2:07](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=127) Natural History, Definitions, and Imaging Findings in Chronic Pancreatitis (Ep 2)
- [6:41](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=401) Case Presentation: 10-Year-Old with Extensive Calcifications (Ep 2)
- [10:16](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=616) Genetic Etiology and Testing in Pediatric Chronic Pancreatitis (Ep 2)
- [22:03](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1323) Penetrance, Genetic Counseling, and Combination Risk (Ep 2)
- [24:40](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1480) Pancreatic Function Testing: Endoscopic Collection Protocol (Ep 2)
- [29:42](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1782) MR Pancreatic Function Testing: Noninvasive Volumetric Assessment (Ep 2)
- [35:20](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2120) Case Follow-Up and Management Summary (Ep 2)
- [38:16](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2296) Multidisciplinary Pain Management: Team Composition and Case Example (Ep 2)
- [44:25](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2665) Psychological Intervention and Medication Management in Pain (Ep 2)
- [47:38](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2858) Closing Discussion: Communicating Psychological Care and Avoiding Stigma (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=0) Introduction and Overview of TPIAT Session (Ep 3)
- [1:30](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=90) Case Presentation: 13-Year-Old with Chronic Pancreatitis (Ep 3)
- [4:44](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=284) TPIAT Indications and Multidisciplinary Evaluation (Ep 3)
- [8:30](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=510) Endocrinology Assessment and Glucose Tolerance Testing (Ep 3)
- [13:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=794) Preoperative Pain Management Approach (Ep 3)
- [18:17](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1097) Surgical Evaluation and TPIAT Criteria (Ep 3)
- [25:49](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1549) Perioperative Pain Management Protocol (Ep 3)
- [26:44](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1604) Surgical Technique and Islet Isolation (Ep 3)
- [34:47](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2087) ICU Management and Early Postoperative Care (Ep 3)
- [39:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2354) Pain Management Outcomes and Weaning Strategy (Ep 3)
- [42:03](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2523) Glucose Management Protocols (Ep 3)
- [43:49](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2629) Summary and Closing Remarks (Ep 3)
- [0:04](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=4) Acute Pancreatitis Initial Management and Fluid Resuscitation (Ep 4)
- [5:39](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=339) Fluid Type Selection and Nutrition in Acute Pancreatitis (Ep 4)
- [10:42](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=642) Chronic Pancreatitis Diagnosis and Genetic Factors (Ep 4)
- [16:47](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1007) Surgical Decision-Making in Genetic Chronic Pancreatitis (Ep 4)
- [22:21](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1341) Total Pancreatectomy with Islet Autotransplantation Indications (Ep 4)
- [27:27](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1647) TPIAT Surgical Technique and Outcomes (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=0) Case Presentation and Surgical Decision-Making (Ep 5)
- [1:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=106) Multidisciplinary Approach and Goals of TPIAT (Ep 5)
- [3:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=198) Post-TPIAT Insulin Independence Outcomes (Ep 5)
- [4:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=253) Surgical Technique and Islet Cell Transplantation (Ep 5)
- [7:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=437) Summary and Conclusion (Ep 5)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=0) Introduction and case presentation (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Solid pseudopapillary neoplasms are one of the most frequent pancreatic tumors in pediatric patients" — Lizzie Lee (epidemiological) [Ep 9 · 0:09](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=9)
- "Surgery for solid pseudopapillary neoplasms is usually curative and outcomes are excellent" — Lizzie Lee (clinical) [Ep 9 · 0:15](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=15)
- "In a single center study, 10 adolescent girls underwent surgical resection for solid pseudopapillary neoplasms" — Lizzie Lee (clinical) [Ep 9 · 0:22](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=22)
- "3 out of 10 patients developed acute recurrent or chronic pancreatitis after resection" — Lizzie Lee (clinical) [Ep 9 · 0:25](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=25)
- "Every patient who developed ongoing pancreatitis had genetic risk factors like CFTR gene variants or pancreas divisum" — Lizzie Lee (clinical) [Ep 9 · 0:32](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=32)
- "Some patients with post-resection pancreatitis ultimately required completion pancreatectomy" — Lizzie Lee (clinical) [Ep 9 · 0:40](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=40)
- "Identifying genetic and anatomic risk factors before surgery may change management of patients with solid pseudopapillary neoplasms" — Lizzie Lee (opinion) [Ep 9 · 0:48](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=48)
- "Direct pancreatic function testing means obtaining function directly from the pancreas, not relying on stool testing for fecal elastase." (clinical) [Ep 1 · 0:05](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=5)
- "Endoscopic pancreatic function testing replaced the duodenal-tube (drilling) method by the end of the 1990s/early 2000s." (clinical) [Ep 1 · 2:07](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=127)
- "Dr. Conwell and colleagues at Tyler Stevens launched endoscopic function testing, showing comparable results to duodenal-tube testing for bicarbonate and lipase measurement." (clinical) [Ep 1 · 2:13](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=133)
- "Endoscopic collection became the standard because duodenal-tube testing requires the patient to be awake, placement of two tubes, and interventional radiology." (clinical) [Ep 1 · 2:39](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=159)
- "The Cincinnati protocol uses secretin 0.2 mcg/kg or CCK 0.04 mcg/kg at time zero, then collects duodenal aspirates every 5 minutes for three samples using an ERCP tapered catheter." (clinical) [Ep 1 · 3:05](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=185)
- "The lab at Cincinnati Children's Hospital measures activities for four enzymes: trypsin, amylase, lipase, and chemotrypsin." (clinical) [Ep 1 · 3:46](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=226)
- "Pancreatic function can be abnormal if checked around an acute attack." (clinical) [Ep 1 · 4:25](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=265)
- "Exocrine pancreatic maturation occurs over the first 2 to 3 years of life." (clinical) [Ep 1 · 4:33](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=273)
- "MR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract." — Andrew Trout (clinical) [Ep 1 · 5:18](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=318)
- "The delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation." — Andrew Trout (clinical) [Ep 1 · 6:27](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=387)
- "MR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume." — Andrew Trout (clinical) [Ep 1 · 7:38](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=458)
- "Phantom studies have proven that MR can accurately quantitate fluid volume." — Andrew Trout (clinical) [Ep 1 · 8:13](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=493)
- "Preliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing." — Andrew Trout (clinical) [Ep 1 · 8:28](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=508)
- "Qualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency." — Andrew Trout (opinion) [Ep 1 · 8:49](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=529)
- "In chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct." — Andrew Trout (opinion) [Ep 1 · 9:41](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=581)
- "Low-fat diet, pancreatic enzyme replacement therapy (PERT), antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes." (clinical) [Ep 1 · 12:05](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=725)
- "The case patient was PRSS1-positive on genetic testing." (clinical) [Ep 1 · 12:43](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=763)
- "The case patient had low fecal elastase on two occasions and endoscopic PFTs showed low amylase and lipase, borderline low trypsin and chemotrypsin." (clinical) [Ep 1 · 12:47](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=767)
- "The case patient had normal hemoglobin A1C and normal mixed meal test for endocrine function." (clinical) [Ep 1 · 13:01](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=781)
- "The case patient showed evidence of ductal changes on ERCP, confirming chronic pancreatitis based on imaging and ERCP findings." (clinical) [Ep 1 · 13:09](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=789)
- "The case patient has been pain-free on PERT treatment for several months with catch-up growth." (clinical) [Ep 1 · 13:17](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=797)
- "The multidisciplinary pain consult at Cincinnati comprises three disciplines: pain physician (medical/psychosocial assessment, medication, interventional management), psychologist (100% of the time, not optional), and nurses." — Goldschneider (clinical) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=900)
- "Cognitive-behavioral therapy is the standard, state-of-the-art therapy for pain management." — Goldschneider (guideline) [Ep 1 · 18:16](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1096)
- "The 13-year-old pain case had extensive psychiatric disabilities: bipolar disorder, attention deficit disorder, oppositional defiant disorder." — Goldschneider (clinical) [Ep 1 · 16:37](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=997)
- "The 13-year-old's recurrent pancreatitis episodes were timed almost specifically with visits to his father, when he went off all medical regimen (diet, enzyme therapy)." — Goldschneider (clinical) [Ep 1 · 17:23](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1043)
- "Topiramate was used for the 13-year-old's migraines and may have a role for visceral hyperalgesia where the gut has become sensitized by repeated inflammatory processes." — Goldschneider (clinical) [Ep 1 · 20:02](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1202)
- "Low-dose methadone was used for about 2 years in the 13-year-old case, and weaning off was not a problem when the time was right." — Goldschneider (clinical) [Ep 1 · 20:22](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1222)
- "In Ohio, informed consent is required for the use of opioids for chronic purposes in minors (law about a year old at time of recording)." — Goldschneider (guideline) [Ep 1 · 21:28](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1288)
- "The 13-year-old's pain resolved for a couple of years without any surgical or endoscopic intervention, came off all pain medications, returned to school, and surgery was deferred indefinitely." — Goldschneider (clinical) [Ep 1 · 22:21](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1341)
- "Discussing the neurobiology and neuropsychology of pain with families—using anecdotes like the paper-cut example (opening a lottery ticket vs. a bad report card)—helps destigmatize psychology referral." — Goldschneider (opinion) [Ep 1 · 24:04](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1444)
- "TPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work." — Joe Palermo (guideline) [Ep 3 · 5:28](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=328)
- "The main indication for TPIAT is chronic pain, not the transplant outcome; the primary goal is pain relief and full function, with insulin independence being secondary." — Jamie (opinion) [Ep 3 · 20:31](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1231)
- "TPIAT criteria include diagnosis of acute recurrent pancreatitis or chronic pancreatitis, chronic pain of greater than 6 months duration with either daily opioid use or severely impaired quality of life, absence of reversible cause, failure of medical or endoscopic intervention, and adequate beta cell function." — Jamie (guideline) [Ep 3 · 23:20](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1400)
- "Contraindications to islet autotransplantation include pre-existing insulin dependent diabetes mellitus, liver disease with portal hypertension or portal vein thrombosis." — Jamie (guideline) [Ep 3 · 23:59](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1439)
- "Patients with central sensitization of pain, functional pain disorders, drug seeking behavior, or severe psychosocial maladaptation do not do as well after TPIAT." — Jamie (clinical) [Ep 3 · 24:35](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1475)
- "Prior ductal drainage procedures and distal pancreatectomy compromise islet yield." — Jamie (clinical) [Ep 3 · 29:41](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1781)
- "Surgical drainage procedures are avoided in patients anticipated to require future TPIAT, particularly those with genetic etiologies." — Jamie (guideline) [Ep 3 · 29:50](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1790)
- "Portal vein pressures exceeding 25 centimeters of water pressure are associated with higher risk of portal vein thrombosis post TPIAT." — Jamie (clinical) [Ep 3 · 31:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1905)
- "Tight glucose control between 80 and 120 is critical postoperatively to protect from toxic hyperglycemia, as islets do not resume function immediately and rely on diffusion of nutrients and oxygen until neovascularization occurs over weeks to months." — Jamie (clinical) [Ep 3 · 32:43](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1963)
- "Up to 85-90% of TPIAT patients can achieve opioid independence, with most improvement occurring over the first several months." — Jamie (epidemiological) [Ep 3 · 36:56](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2216)
- "In children, 40% of TPIAT patients achieve insulin independence (typically over the first 12 months), 30% have partial graft function requiring basal insulin only, and 30% require basal-bolus insulin." — Jamie (epidemiological) [Ep 3 · 37:37](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2257)
- "Data from Minnesota shows the best outcomes in patients under 12 years old, with up to 55% insulin independence rate." — Jamie (epidemiological) [Ep 3 · 37:57](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2277)
- "Higher replicatory capacity of islets in younger children and possible islet neogenesis of ductal origin may explain better outcomes in younger patients." — Jamie (clinical) [Ep 3 · 38:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2294)
- "Islet function has been shown to be durable in children for as long as 10 years post TPIAT and is especially good for patients under 21 or with a short history of pancreatic disease." — Jamie (epidemiological) [Ep 3 · 38:26](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2306)
- "All TPIAT patients have delayed gastric emptying that resolves in several weeks, typically by 3-5 weeks." — Jamie (clinical) [Ep 3 · 30:41](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1841)
- "Complications occur in 15-20% of TPIAT cases, including bleeding (5-7%), abscesses, wound infections, bowel obstructions, portal vein thrombosis, and anastomotic leaks." — Jamie (epidemiological) [Ep 3 · 36:16](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2176)
- "Type 3C diabetes describes a pancreatic form of diabetes that is insulin deficient (unlike type 1 autoimmune or type 2 insulin resistant), must meet ADA criteria for diabetes, has negative islet antibodies, and requires insulin therapy not oral hypoglycemic agents." — Deb Elder (clinical) [Ep 3 · 11:05](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=665)
- "A normal peak insulin response to oral glucose tolerance load is typically at 30 minutes; a delayed peak at 60 minutes with blood sugar rising to 150 indicates subtle abnormalities in insulin secretion." — Deb Elder (clinical) [Ep 3 · 12:21](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=741)
- "Brittle diabetes, describing unpredictable extreme highs and lows, is reported in less than 1% of type 1 diabetes patients, and recent studies comparing total pancreatectomy patients with type 1 patients show no difference in complications." — Deb Elder (epidemiological) [Ep 3 · 21:33](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1293)
- "Tramadol is useful for mild to moderate pain because it does not generally slow gut motility as much as conventional opioids." — Ken Goldschneider (clinical) [Ep 3 · 16:42](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1002)
- "Sensitization in both the enteric and central nervous system from repeated inflammatory insults can lead to pain when all enzymes are normal, which is treated with neuropathic medications like tricyclic antidepressants and gabapentin, not opioids." — Ken Goldschneider (clinical) [Ep 3 · 17:33](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1053)
- "Splenectomy is performed routinely for TPIAT; attempts to preserve the spleen risk warm ischemia to islets during dissection and potential splenic infarction if relying only on short gastric vessels." — Jamie (clinical) [Ep 3 · 27:22](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1642)
- "Significant thrombocytosis occurs after TPIAT, likely not just related to splenectomy but possibly due to increased thrombopoietin levels produced by hepatocytes." — Jamie (clinical) [Ep 3 · 35:49](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2149)
- "Insulin independence is dependent on the number of islet equivalents transplanted, and there is a relationship between islet yield and severity of chronic pancreatitic changes by imaging or histopathology." — Jamie (clinical) [Ep 3 · 29:19](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1759)
- "Heparin anticoagulation is maintained intraoperatively and for one week postoperatively to prevent portal vein thrombosis from islet infusion." — Jamie (guideline) [Ep 3 · 31:38](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1898)
- "Dexamethasone infusion is used for the first 2 days postoperatively to decrease the instant blood mediated inflammatory response which has a potentially detrimental effect on islets." — Jamie (guideline) [Ep 3 · 33:17](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1997)
- "Acetaminophen is not used postoperatively because some continuous glucose monitoring systems will read falsely with it." — Ken Goldschneider (clinical) [Ep 3 · 34:31](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2071)
- "The expectation is to wean patients off opioids postoperatively because there is no pancreas to have acute inflammatory disorders, and visceral hyperalgesia from sensitization should not be treated with opioids." — Ken Goldschneider (opinion) [Ep 3 · 41:34](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2494)
- "Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes." — Joe Palermo (host_summary) [Ep 2 · 2:54](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=174)
- "Acute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes." — Joe Palermo (host_summary) [Ep 2 · 3:12](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=192)
- "Chronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP." — Joe Palermo (host_summary) [Ep 2 · 3:37](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=217)
- "Chronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency." — Joe Palermo (host_summary) [Ep 2 · 4:30](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=270)
- "Patients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss." — Joe Palermo (clinical) [Ep 2 · 5:48](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=348)
- "In adults, up to 70% of chronic pancreatitis cases are caused by alcohol." — Joe Palermo (host_summary) [Ep 2 · 11:37](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "In the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes." — Joe Palermo (epidemiological) [Ep 2 · 11:37](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=697)
- "PRSS1 (cationic trypsinogen gene) is a gain-of-function gene causing hereditary pancreatitis, autosomal dominant, with 80% penetrance for acute pancreatitis, 50% for chronic pancreatitis, and more than 40% risk of pancreatic cancer." (host_summary) [Ep 2 · 12:29](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=749)
- "SPINK1 (trypsin inhibitor gene) is a modifier gene, autosomal recessive, but heterozygous patients can also develop disease." (host_summary) [Ep 2 · 13:32](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=812)
- "Severe CFTR mutations (e.g., delta 508) cause exocrine pancreatic insufficiency; patients who are pancreatic sufficient with CF mutations are at risk for pancreatitis and chronic pancreatitis." (host_summary) [Ep 2 · 13:59](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=839)
- "CTRC gene has been shown through functional studies to be linked to development of chronic pancreatitis and acute recurrent pancreatitis." (host_summary) [Ep 2 · 14:35](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=875)
- "In a local cohort of 50 patients (34 ARP, 16 CP), 55% of ARP patients and 68% of CP patients tested positive for mutations in CFTR, PRSS1, CTRC, or SPINK1." (epidemiological) [Ep 2 · 14:52](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=892)
- "Chronic pancreatitis patients were diagnosed earlier with the first attack, had more additional attacks, and were more likely to be exocrine insufficient compared to ARP patients." (epidemiological) [Ep 2 · 15:45](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=945)
- "CFTR gene was more commonly found in chronic pancreatitis patients compared to acute recurrent patients, and patients were more likely to have two genes affected than one." (epidemiological) [Ep 2 · 15:56](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=956)
- "Six additional genes beyond the original four (PRSS1, SPINK1, CFTR, CTRC) are now known to be associated with ARP and CP." (host_summary) [Ep 2 · 16:17](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=977)
- "A next-generation sequencing pancreas panel covering 10 genes will launch in October at Cincinnati Children's, offering efficient, low-cost testing with faster turnaround than whole exome sequencing." (clinical) [Ep 2 · 16:42](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1002)
- "PRSS1 penetrance is incomplete: half of patients with the gene develop chronic pancreatitis, not all." (host_summary) [Ep 2 · 19:31](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1171)
- "Heterozygous CFTR (one gene copy) increases the risk for chronic pancreatitis in children." (clinical) [Ep 2 · 19:56](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1196)
- "Combination of SPINK1 and CFTR mutations confers an approximately 800-fold relative risk of chronic pancreatitis." (epidemiological) [Ep 2 · 20:18](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1218)
- "The CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations." — Joe Palermo (clinical) [Ep 2 · 20:56](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1256)
- "Some patients with pancreas divisum do not develop pancreatitis, suggesting a two-hit or multi-hit hypothesis where additional risk factors (e.g., genetic mutations) increase disease propensity." (opinion) [Ep 2 · 23:07](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1387)
- "Direct pancreatic function testing means directly obtaining pancreatic function from the pancreas, not relying on stool testing like fecal elastase." (guideline) [Ep 2 · 24:40](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1480)
- "The endoscopic pancreatic function test protocol uses secretin (0.2 mcg/kg) or CCK (0.4 mcg/kg) at time zero, then collects duodenal aspirates via ERCP catheter every 5 minutes for three samples." (clinical) [Ep 2 · 27:40](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1660)
- "Samples are sent to Women's Children's Hospital lab to measure activities of trypsin, amylase, lipase, and chymotrypsin." (clinical) [Ep 2 · 28:21](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1701)
- "Pancreatic function can be abnormal if checked around an acute attack." (clinical) [Ep 2 · 29:08](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1748)
- "Pancreatic enzyme maturation occurs over the first 2 to 3 years of life." (clinical) [Ep 2 · 29:14](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1754)
- "MR pancreatic function testing (MRPFT) acquires identical fluid-sensitive imaging pre- and post-secretin, then quantifies the volume of fluid secreted into the gastrointestinal tract." — Andrew Trout (clinical) [Ep 2 · 29:42](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1782)
- "In the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation." — Andrew Trout (clinical) [Ep 2 · 31:02](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1862)
- "MRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid." — Andrew Trout (clinical) [Ep 2 · 32:13](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1933)
- "Correlation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients." — Andrew Trout (clinical) [Ep 2 · 32:43](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=1963)
- "Qualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency." — Andrew Trout (opinion) [Ep 2 · 33:24](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2004)
- "In chronic pancreatitis patients with dilated and abnormal ducts at baseline, secretin may not add diagnostic value for duct visualization, though it is used primarily for exocrine assessment." — Andrew Trout (opinion) [Ep 2 · 34:15](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2055)
- "Low-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes." — Joe Palermo (host_summary) [Ep 2 · 36:40](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2200)
- "Pancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks." — Joe Palermo (clinical) [Ep 2 · 37:02](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2222)
- "The multidisciplinary pain team comprises a pain physician (medical/psychosocial assessment, medication, interventional procedures), a psychologist (cognitive behavioral therapy, school reintegration, family intervention), and a nurse." — Goldschneider (clinical) [Ep 2 · 39:31](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2371)
- "Psychology involvement is 100% of the time in the pain clinic, not optional, to address pain coping, functional and emotional impact, and school reintegration." — Goldschneider (clinical) [Ep 2 · 40:02](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2402)
- "Cognitive behavioral therapy is the standard, state-of-the-art therapy for pain management." — Goldschneider (host_summary) [Ep 2 · 42:51](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2571)
- "Opioids are a tool requiring risk assessment, mitigation, informed consent (mandated by Ohio law for chronic use in minors), controlled substance agreements, prescription history tracking, and use of the lowest effective dose." — Goldschneider (clinical) [Ep 2 · 45:38](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2738)
- "In the case of a 13-year-old with annular pancreas and chronic pancreatitis, multidisciplinary pain management (topiramate for migraines, low-dose methadone for 2 years, psychology, family intervention) resulted in pain resolution, return to school and activities, and indefinite deferral of Whipple surgery." — Goldschneider (clinical) [Ep 2 · 46:56](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-function-tests-pain-management-pancreatic-disease-971?t=2816)
- "Acute pancreatitis management has shifted from NPO and aggressive IV fluids causing pulmonary edema to early feeding and measured fluid resuscitation." — Juan Gurria (clinical) [Ep 4 · 0:35](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=35)
- "For acute pancreatitis with tachycardia (HR 160) and hypotension in a 9-year-old, appropriate management is ICU admission with bolus ×2, maintenance IV fluids 1.5×, no antibiotics, and pain control." — Juan Gurria (clinical) [Ep 4 · 3:55](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=235)
- "Early fluid resuscitation is key to re-establish intravascular flow to the pancreas and prevent hypoxia, necrosis, and atrophic pancreatic insufficiency." — Juan Gurria (clinical) [Ep 4 · 4:19](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=259)
- "Excessive fluid resuscitation in pancreatitis leads to worse outcomes including fluid overload and multi-system organ failure." — Juan Gurria (clinical) [Ep 4 · 4:39](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=279)
- "There is no indication for routine antibiotics in acute pancreatitis, even with necrosis or necrotizing pancreatitis, unless there are signs of sepsis or infected pancreatitis." — Juan Gurria (guideline) [Ep 4 · 4:42](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=282)
- "The North American Society of Pancreatitis, GI Pathology and Nutrition recommends bolus 10-20 mL/kg up to 3 L in the first 24 hours, with reassessment at 12 hours preferred." — Juan Gurria (host_summary) [Ep 4 · 5:45](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=345)
- "Maintenance fluids should be 1.5 to 2 times normal maintenance, with reassessment at 12-24 hour mark to avoid fluid overload." — Juan Gurria (guideline) [Ep 4 · 6:21](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=381)
- "Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline in pancreatitis." — Juan Gurria (host_summary) [Ep 4 · 6:32](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=392)
- "The WATERFALL trial by Enrique de Madaria is a multi-center, multi-country RCT comparing lactated Ringer's versus normal saline in pancreatitis, with results expected in 1-2 years." — Juan Gurria (host_summary) [Ep 4 · 8:33](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=513)
- "Aggressive fluid resuscitation in the first 24 hours (better in first 12) is associated with shorter length of stay, less severe complications, and fewer ICU admissions." — Juan Gurria (host_summary) [Ep 4 · 9:07](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=547)
- "Enteral nutrition as soon as the patient can tolerate PO is significantly better compared to TPN or NPO in acute pancreatitis." — Juan Gurria (clinical) [Ep 4 · 9:24](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=564)
- "Gastric feeding is preferred over jejunal feeding in pancreatitis when the patient can tolerate it." — Juan Gurria (host_summary) [Ep 4 · 9:47](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=587)
- "Some vomiting can be tolerated when feeding pancreatitis patients, similar to gastroschisis management, because feeding the gut produces dramatically better outcomes." — Juan Gurria (clinical) [Ep 4 · 10:19](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=619)
- "No patient needs TPN in the first 7 days of acute illness." — Juan Gurria (clinical) [Ep 4 · 11:02](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=662)
- "The inflammatory head mass commonly seen in adult pancreatitis is rarely seen in children; pediatric patients typically have minimal duct change disease with small, usually non-dilated ducts." — Juan Gurria (clinical) [Ep 4 · 12:13](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=733)
- "Genetic testing is key in pediatric pancreatitis and should be obtained for all patients with chronic or recurrent pancreatitis, and even considered after a first severe attack." — Juan Gurria (guideline) [Ep 4 · 14:59](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=899)
- "The most common cause of pancreatitis in children is medication-induced, but the most common risk factor is genetic factors." — Juan Gurria (epidemiological) [Ep 4 · 15:23](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=923)
- "PRSS1 (trypsinogen activator) is the most common genetic mutation in pediatric pancreatitis and the most aggressive, causing auto-attack by activating trypsin inside the pancreas." — Juan Gurria (clinical) [Ep 4 · 15:32](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=932)
- "Cincinnati Children's genetic panel tests 10 different genetic markers for pancreatitis including PRSS1, CTRC, CFTR, and CPA1." — Juan Gurria (clinical) [Ep 4 · 15:48](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=948)
- "Genetics have fundamentally changed the approach to pediatric chronic pancreatitis treatment." — Juan Gurria (opinion) [Ep 4 · 16:06](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=966)
- "In children with genetic mutations causing pancreatitis, conventional drainage procedures (Frey, Puestow) fail in up to 50% because the parenchyma continues to be attacked by the mutation despite duct drainage." — Juan Gurria (clinical) [Ep 4 · 16:33](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=993)
- "With every attack of pancreatitis, islet cells are lost, so repeated ERCPs that fail to prevent attacks result in progressive loss of beta-cell mass." — Juan Gurria (clinical) [Ep 4 · 14:38](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=878)
- "ERCP does not change the islet yield available for transplantation, but pancreatitis attacks cause cell loss." — Juan Gurria (clinical) [Ep 4 · 14:44](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=884)
- "Cincinnati Children's has a running list of 800 pancreatitis patients and receives over 100 TPIAT referrals per year, but only performs 20-25 procedures annually because not all patients are candidates." — Juan Gurria (epidemiological) [Ep 4 · 14:59](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=899)
- "MRCP is the best non-invasive imaging study for the pancreas, superior to ultrasound and CT." — Juan Gurria (clinical) [Ep 4 · 20:59](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1259)
- "ERCP is more therapeutic than diagnostic in chronic pancreatitis." — Juan Gurria (clinical) [Ep 4 · 21:07](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1267)
- "Patients with chronic pancreatitis always have micronutrient and macronutrient deficiencies requiring nutritional support." — Juan Gurria (clinical) [Ep 4 · 21:12](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1272)
- "Patients with chronic pancreatitis lose exocrine function first, then endocrine function, requiring screening and often pancreatic enzyme replacement therapy." — Juan Gurria (clinical) [Ep 4 · 21:36](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1296)
- "Walled-off necrosis should be drained only if symptomatic (gastric outlet obstruction or pain) after the wall matures at 4-6 weeks; asymptomatic collections will self-resolve and do not require drainage or antibiotics." — Juan Gurria (clinical) [Ep 4 · 21:48](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1308)
- "Chronic pancreatitis increases the risk of pancreatic cancer up to thirteenfold." — Juan Gurria (epidemiological) [Ep 4 · 22:08](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1328)
- "Up to 50% of patients with chronic pancreatitis will eventually require surgery." — Juan Gurria (epidemiological) [Ep 4 · 24:08](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1448)
- "The main indication for TPIAT is chronic debilitating pain in children who have lost their quality of life—not attending school, withdrawn, unable to participate in activities." — Juan Gurria (clinical) [Ep 4 · 19:08](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1148)
- "The secondary goal of TPIAT is to prevent brittle diabetes by returning beta cells to the patient." — Juan Gurria (clinical) [Ep 4 · 19:22](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1162)
- "TPIAT requires a multidisciplinary team including surgery, GI pancreatologists, social workers, geneticists, psychology, and pain management." — Juan Gurria (clinical) [Ep 4 · 24:40](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1480)
- "Patients with chronic pain develop hyperalgesia and central sensitization—their brains learn to function in pain—so removing the organ may eliminate 90% of pain but 10% may linger, requiring behavioral therapy." — Juan Gurria (clinical) [Ep 4 · 25:07](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1507)
- "TPIAT exchanges chronic pancreatitis for potential diabetes, which must be clearly communicated to families." — Juan Gurria (clinical) [Ep 4 · 27:05](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1625)
- "TPIAT surgery takes an average of 8-10 hours: 3-4 hours for pancreatectomy, 4-4.5 hours for islet isolation in the lab, and 2 hours for reconstruction." — Juan Gurria (clinical) [Ep 4 · 27:32](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1652)
- "Routine splenectomy is performed with TPIAT because the pancreas and spleen share blood supply via tiny branches from the splenic vessels; preserving the spleen adds ischemia time and causes islet cell loss." — Juan Gurria (clinical) [Ep 4 · 29:33](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1773)
- "There are four critical points where islet cells can be lost: (1) recurrent pancreatitis causing cell death, (2) ischemia during surgical dissection, (3) cell death during processing and injection, and (4) post-operative stress if glucose is not carefully managed." — Juan Gurria (clinical) [Ep 4 · 29:59](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1799)
- "All TPIAT patients are kept on insulin in the ICU post-operatively to let the islet cells rest without working until they implant and establish new vascular supply from the liver." — Juan Gurria (clinical) [Ep 4 · 30:20](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1820)
- "Islet equivalent per kilogram of body weight is used as a prognostic marker; at approximately 5000 islet equivalents/kg there is a 50% chance of insulin independence." — Juan Gurria (clinical) [Ep 4 · 26:32](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1592)
- "TPIAT outcomes: 50% of patients achieve insulin independence, 20% require small insulin doses, and 30% remain diabetic." — Juan Gurria (clinical) [Ep 4 · 27:00](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1620)
- "The liver is the best site for islet cell implantation via portal vein injection; extrahepatic sites (omentum, retroperitoneum, rectus muscle, gastric submucosa) have been tried but work less well." — Juan Gurria (clinical) [Ep 4 · 31:10](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1870)
- "Portal vein thrombosis after islet injection occurs in less than 1% of cases; portal pressure is monitored during injection." — Juan Gurria (clinical) [Ep 4 · 31:58](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1918)
- "The duodenum is resected at D1 post-pyloric during TPIAT because of shared blood supply with the pancreas; attempting to preserve it adds ischemia time." — Juan Gurria (clinical) [Ep 4 · 32:23](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1943)
- "Pylorus-preserving resection with pyloric Botox injection is performed during TPIAT reconstruction to address gastroparesis that all pancreatitis patients have; Roux-en-Y reconstruction also helps with gastroparesis." — Juan Gurria (clinical) [Ep 4 · 28:47](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1727)
- "Every ERCP carries a risk of post-ERCP pancreatitis, and with every pancreatitis attack, islet cells are lost." — Juan Gurria (clinical) [Ep 6 · 1:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=100)
- "PRSS1 is the most common genetic mutation in recurrent pancreatitis and is a trypsinogen activator that activates trypsin inside the pancreas." — Juan Gurria (clinical) [Ep 6 · 1:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=117)
- "The genetic panel at Cincinnati Children's tests 10 different genetic markers for pancreatitis (including PRSS1, CTRC, CFTR, CPA1)." — Juan Gurria (clinical) [Ep 6 · 2:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=126)
- "Genetic factors are changing the approach to pediatric chronic pancreatitis treatment." — Juan Gurria (opinion) [Ep 6 · 2:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=137)
- "If a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies." — Cecilia Gigena (host_summary) [Ep 6 · 2:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=146)
- "There is currently no medication to mitigate trypsin activation in genetic pancreatitis mutations." — Juan Gurria (clinical) [Ep 6 · 2:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=168)
- "In a Frey procedure (partial head pancreatectomy with pancreaticojejunostomy), the top half of the pancreas is removed to open the duct, which results in loss of islet cells." — Juan Gurria (clinical) [Ep 6 · 3:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=189)
- "In patients with PRSS1 mutation, draining the duct (e.g., via Frey) temporizes attacks but does not fix the problem, as the parenchyma continues to be attacked by the mutation and pancreatitis will likely recur." — Juan Gurria (clinical) [Ep 6 · 3:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=199)
- "Genetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant." — Cecilia Gigena (host_summary) [Ep 6 · 3:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=217)
- "There is no set number of ERCPs that defines when to escalate care; the sooner the referral for evaluation, the better." — Juan Gurria (opinion) [Ep 6 · 4:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=249)
- "Surgical management of the pancreas is not offered unless medical and endoscopic management have been maximized." — Juan Gurria (guideline) [Ep 6 · 4:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=256)
- "If the endoscopist has no further options (nothing to balloon dilate, open, or drain) and the patient continues to have pancreatitis despite stenting, there is no reason to continue ERCPs." — Juan Gurria (clinical) [Ep 6 · 4:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=263)
- "Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation)." — Cecilia Gigena (host_summary) [Ep 6 · 4:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=277)
- "MRCP is the best non-invasive imaging study for the pancreas, particularly with T2 sequences." — Juan Gurria (clinical) [Ep 6 · 4:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=298)
- "ERCP is more therapeutic than diagnostic." — Juan Gurria (clinical) [Ep 6 · 5:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=307)
- "For pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences." — Cecilia Gigena (host_summary) [Ep 6 · 5:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=311)
- "Pancreatic fluid collections should be drained once the wall is mature (4 to 6 weeks) only if the patient is symptomatic (e.g., gastric outlet obstruction or pain); asymptomatic collections will self-resolve and do not require drainage or antibiotics." — Juan Gurria (clinical) [Ep 6 · 5:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=322)
- "Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations." — Cecilia Gigena (host_summary) [Ep 6 · 5:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=340)
- "If genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails." — Cecilia Gigena (host_summary) [Ep 6 · 5:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-recurrent-pancreatitis-8663?t=350)
- "Up to 50% of patients with chronic pancreatitis will eventually require surgery." — Juan Gurria (epidemiological) [Ep 5 · 1:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=100)
- "Most of the pancreatic parenchyma is in the head and the uncinate process." — Juan Gurria (clinical) [Ep 5 · 1:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=88)
- "If a patient has a PRSS1 mutation and only the pancreatic head is removed, recurrent attacks will occur." — Juan Gurria (clinical) [Ep 5 · 1:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=88)
- "TPIAT requires a multidisciplinary team including surgery, GI pancreatologists, social worker, geneticists, psychiatry, and pain control." — Juan Gurria (guideline) [Ep 5 · 2:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=130)
- "Patients with chronic pancreatitis always have micro and macronutrient deficiencies." — Juan Gurria (clinical) [Ep 5 · 2:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=138)
- "Chronic pancreatitis patients sometimes need pancreatic enzyme replacement therapy." — Juan Gurria (clinical) [Ep 5 · 2:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=153)
- "In chronic pancreatitis, exocrine function is lost first, then endocrine function." — Juan Gurria (clinical) [Ep 5 · 2:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=160)
- "The primary goal of TPIAT is to restore the child's quality of life and return them to normal activities." — Juan Gurria (clinical) [Ep 5 · 2:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=169)
- "The secondary goal of TPIAT is to prevent brittle diabetes by preserving beta cell function." — Juan Gurria (clinical) [Ep 5 · 2:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=179)
- "All TPIAT patients require enzyme replacement therapy post-operatively." — Juan Gurria (clinical) [Ep 5 · 3:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=186)
- "With an islet cell count of 5000, there is a 50% chance of not requiring insulin post-TPIAT." — Juan Gurria (clinical) [Ep 5 · 3:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=203)
- "With an islet cell count of 5000, there is a 20% chance of requiring a small dose of insulin post-TPIAT." — Juan Gurria (clinical) [Ep 5 · 3:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=216)
- "With an islet cell count of 5000, 30% of patients remain diabetic post-TPIAT." — Juan Gurria (clinical) [Ep 5 · 3:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=220)
- "TPIAT potentially exchanges chronic pancreatitis for diabetes, and families must be counseled about this trade-off." — Juan Gurria (clinical) [Ep 5 · 3:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=222)
- "TPIAT surgery takes an average of 8 to 10 hours." — Juan Gurria (clinical) [Ep 5 · 4:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=265)
- "The pancreas is cemented in the retroperitoneum with neovascularization and collateralization, making removal the most problematic part of TPIAT." — Juan Gurria (clinical) [Ep 5 · 4:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=274)
- "Some chronic pancreatitis patients have thrombosis in the portal vein or splenic vein." — Juan Gurria (clinical) [Ep 5 · 4:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=274)
- "Pancreatectomy during TPIAT takes 3 to 4 hours." — Juan Gurria (clinical) [Ep 5 · 4:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=291)
- "Islet cell isolation takes 4 to 4.5 hours." — Juan Gurria (clinical) [Ep 5 · 5:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=335)
- "During TPIAT, biliary and intestinal reconstruction is performed using a Roux-en-Y technique while islet isolation is occurring." — Juan Gurria (clinical) [Ep 5 · 5:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=309)
- "Islet cells are injected into the portal vein inside the liver." — Juan Gurria (clinical) [Ep 5 · 5:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=339)
- "The spleen is removed along with the pancreas during TPIAT." — Juan Gurria (clinical) [Ep 5 · 5:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=328)
- "In the acute post-operative period, glucose must be managed externally to prevent stress on transplanted islet cells." — Juan Gurria (clinical) [Ep 5 · 6:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=365)
- "All TPIAT patients are on insulin in the ICU to allow islet cells to implant without stress." — Juan Gurria (clinical) [Ep 5 · 6:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=372)
- "Islet cells need to find new vessels from the liver to survive after transplantation." — Juan Gurria (clinical) [Ep 5 · 6:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=374)
- "Islet cells implant in the end branches of the portal vein inside the liver." — Juan Gurria (clinical) [Ep 5 · 6:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=387)
- "Extrahepatic islet cell reimplantation does not work as well as intrahepatic placement." — Juan Gurria (clinical) [Ep 5 · 6:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=394)
- "Extrahepatic islet cells produce a better glucagon response for hypoglycemia compared to intrahepatic cells." — Juan Gurria (clinical) [Ep 5 · 6:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=403)
- "The liver is the best site for islet cell transplantation." — Juan Gurria (clinical) [Ep 5 · 6:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=411)
- "The risk of portal vein thrombosis after intrahepatic islet injection is less than 1%." — Juan Gurria (clinical) [Ep 5 · 6:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=414)
- "Portal pressure is monitored during islet cell injection to prevent complications." — Juan Gurria (clinical) [Ep 5 · 6:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=414)
- "During TPIAT, the duodenum is removed at D1 post-pyloric level along with the pancreas." — Juan Gurria (clinical) [Ep 5 · 7:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=425)
- "The duodenum and pancreas share blood supply, making duodenal preservation difficult during TPIAT." — Juan Gurria (clinical) [Ep 5 · 7:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=430)
- "Chronic pancreatitis is a chronic inflammatory condition where inflammation over time results in damage and destruction of the pancreas, potentially causing replacement of healthy tissue with fibrosis." — Maisaabel Haija (clinical) [Ep 7 · 0:34](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=34)
- "Ongoing damage in chronic pancreatitis affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin." — Em Gootee (host_summary) [Ep 7 · 0:54](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=54)
- "When acinar cells are diseased or destructed in chronic pancreatitis, there is less production of pancreatic enzymes." — Maisaabel Haija (clinical) [Ep 7 · 1:15](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=75)
- "When islet cells which produce insulin are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes." — Em Gootee (host_summary) [Ep 7 · 1:25](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=85)
- "Chronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function." — Em Gootee (host_summary) [Ep 7 · 1:33](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=93)
- "Diagnosis of chronic pancreatitis mostly relies on imaging findings." — Maisaabel Haija (clinical) [Ep 7 · 1:43](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=103)
- "Diagnosis of chronic pancreatitis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction." — Em Gootee (host_summary) [Ep 7 · 1:48](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=108)
- "For CT imaging of chronic pancreatitis, a single phase with portal venous contrast is adequate." — Andrew Trout (clinical) [Ep 7 · 2:15](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=135)
- "MRI has advantages over CT in terms of soft tissue contrast from multiple different MRI sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis." — Andrew Trout (clinical) [Ep 7 · 2:19](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=139)
- "In adults, CT with IV contrast often includes multiple phases (non-contrast, arterial, and portal venous), but this is avoided in children because it markedly increases radiation dose without providing much additional diagnostic information." — Em Gootee (host_summary) [Ep 7 · 2:33](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=153)
- "Non-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases of imaging." — Andrew Trout (clinical) [Ep 7 · 2:50](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=170)
- "According to Dr. Trout, arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses." — Em Gootee (host_summary) [Ep 7 · 3:02](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=182)
- "The key MRI sequences for chronic pancreatitis are the 3D MRCP sequence to characterize the duct and its relationship to the bile duct, and a T1 weighted sequence to understand parenchymal health." — Andrew Trout (clinical) [Ep 7 · 3:13](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=193)
- "At initial characterization of a patient with acute recurrent or chronic pancreatitis, IV contrast can be useful to understand vascular complications or fluid collections, but in many cases MRI exams can be done without IV contrast." — Em Gootee (host_summary) [Ep 7 · 3:25](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=205)
- "Cincinnati Children's has an in-house 10-gene pancreatitis risk panel to screen for genetic links to pancreatitis." — Em Gootee (host_summary) [Ep 7 · 3:56](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=236)
- "Before sending genetic testing, it is advised to work closely with a genetic counselor to help the family choose the test and interpret it afterwards." — Maisaabel Haija (guideline) [Ep 7 · 4:06](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=246)
- "In chronic pancreatitis, exocrine and endocrine function need to be assessed because they can decline over time." — Maisaabel Haija (clinical) [Ep 7 · 4:32](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=272)
- "Problems associated with chronic pancreatitis include macro and micronutrient deficiencies, growth problems, small intestinal bacterial overgrowth, and risk for tumors later in adult life." — Maisaabel Haija (clinical) [Ep 7 · 4:49](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=289)
- "Treatment of chronic pancreatitis starts with assessing the stage of disease, finding out the extent of exocrine or endocrine problems, and correcting nutrient abnormalities, nutrition, and growth." — Maisaabel Haija (clinical) [Ep 7 · 5:18](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=318)
- "For pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing, and enzymes are reserved only for cases with documented exocrine pancreatic insufficiency." — Em Gootee (host_summary) [Ep 7 · 5:33](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=333)
- "When medical management has failed and the patient continues to have symptoms, endoscopic management can be considered." — Maisaabel Haija (clinical) [Ep 7 · 5:46](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=346)
- "Endoscopic therapy for chronic pancreatitis relies on two methods: endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)." — Em Gootee (host_summary) [Ep 7 · 5:55](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=355)
- "ERCP is an imaging and interventional modality where the endoscopist can evaluate the pancreatic duct or biliary ducts and treat problems with scarring or strictures that are part of chronic pancreatitis." — Maisaabel Haija (clinical) [Ep 7 · 6:02](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=362)
- "Pain management in chronic pancreatitis follows a stepwise ladder approach, starting with opiate-sparing medications and reserving opiates for severe pain cases." — Em Gootee (host_summary) [Ep 7 · 6:22](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=382)
- "Opiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist as part of multidisciplinary management." — Em Gootee (host_summary) [Ep 7 · 6:25](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=385)
- "Multidisciplinary pain management includes a pain specialist, psychologist, and physical therapist to address all aspects that pain can have on a patient's body." — Maisaabel Haija (clinical) [Ep 7 · 6:47](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=407)
- "At Cincinnati Children's, cognitive behavioral therapy (CBT) is incorporated in multidisciplinary pain management and has been shown in other chronic conditions to be helpful in managing pain." — Em Gootee (host_summary) [Ep 7 · 7:10](https://qa.library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=430)
- "TPIAT is one of the most complex abdominal surgical procedures performed in children." — Juan Gurria (opinion) [Ep 8 · 0:48](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=48)
- "Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis." — Juan Gurria (clinical) [Ep 8 · 0:54](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=54)
- "Patients are candidates for TPIAT when all medical and endoscopic therapy has failed." — Juan Gurria (guideline) [Ep 8 · 1:02](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=62)
- "TPIAT patients usually have a genetic mutation that drives the disease." (host_summary) [Ep 8 · 1:08](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health." (host_summary) [Ep 8 · 1:08](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "The Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia, and pain team." — Juan Gurria (clinical) [Ep 8 · 1:23](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=83)
- "The entire team reviews and votes patients in for surgery to determine if they are candidates for TPIAT." — Juan Gurria (clinical) [Ep 8 · 1:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=105)
- "Patients are prepared with vaccinations for potential splenectomy before TPIAT surgery." — Juan Gurria (clinical) [Ep 8 · 1:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=105)
- "Pain catheters are placed in the transversus abdominis muscle by pain specialists." — Juan Gurria (clinical) [Ep 8 · 2:40](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=160)
- "A central venous catheter is placed using ultrasound for vein puncture and fluoroscopy for appropriate insertion." (host_summary) [Ep 8 · 2:46](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=166)
- "The pancreas in TPIAT patients has been injured for sometimes years, which makes the procedure quite challenging." — Juan Gurria (clinical) [Ep 8 · 3:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=194)
- "The procedure begins by mobilizing all organs from the left side of the abdomen, including the colon, stomach, and spleen." (host_summary) [Ep 8 · 3:21](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=201)
- "On the right side, the small intestine (duodenum) and liver hilum are mobilized, with careful identification of bile ducts and blood supply to the liver." — Juan Gurria (clinical) [Ep 8 · 3:29](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=209)
- "The pancreas is disconnected from the GI tract at two places: after the pyloric muscle in the duodenum and downstream in the jejunum." (host_summary) [Ep 8 · 3:43](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=223)
- "Blood supply to the head and entire body of the pancreas is preserved very carefully until the very last moment to avoid hypoxia of islet cells." — Juan Gurria (clinical) [Ep 8 · 4:06](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=246)
- "The lab cleans the pancreas by removing blood vessels, fat tissue, adipose tissue, and connective tissue." — Rita Bottino (clinical) [Ep 8 · 4:51](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Pancreatic ducts are isolated and cannulated to inject exocrine enzymes like collagenases and neutral proteases that break down the extracellular matrix holding cells together." — Rita Bottino (clinical) [Ep 8 · 4:51](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Injecting digestive enzymes into the pancreatic duct disintegrates the extracellular matrix, releasing islet cells and exocrine cells and turning the organ from solid to liquid form." (host_summary) [Ep 8 · 5:24](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=324)
- "Islets can be further separated from acinar cells if necessary." — Rita Bottino (clinical) [Ep 8 · 5:39](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=339)
- "The main goal is to bring back to the operating table the highest number of islets possible because islet number correlates with good outcome." — Rita Bottino (clinical) [Ep 8 · 5:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=345)
- "The maximum infusion volume is 5 mL per bag and 3 bags per patient to control the amount infused into the portal vein." (host_summary) [Ep 8 · 5:59](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=359)
- "The lab brings back to the operating room 1, 2, or 3 bags containing cells suspended in medium with albumin, heparin, and antibiotics." — Rita Bottino (clinical) [Ep 8 · 6:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=374)
- "During islet processing, the surgical team performs reconstruction of the gastrointestinal tract by bringing a loop of duodenum up to the bile duct and reconnecting another loop of intestine to the duodenum past the pyloric muscle." — Juan Gurria (clinical) [Ep 8 · 6:33](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=393)
- "A feeding tube is placed to allow patients to be fed while important connections heal." — Juan Gurria (clinical) [Ep 8 · 6:53](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=413)
- "Drains are left where the spleen was removed and on top of the connection with the biliary tract." — Juan Gurria (clinical) [Ep 8 · 7:02](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=422)
- "Islet cells are transfused into the portal vein with the hope that they will implant in the liver and start producing insulin." — Juan Gurria (clinical) [Ep 8 · 7:15](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=435)
- "Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis, which could cause significant morbidity." — Juan Gurria (clinical) [Ep 8 · 7:25](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Patients are placed in the intensive care unit post-operatively to control hemodynamics and fluid shift balance." — Juan Gurria (clinical) [Ep 8 · 8:01](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=481)
- "Islet cells need to heal in a very homeostatic environment, requiring close monitoring of vital signs." — Juan Gurria (clinical) [Ep 8 · 8:08](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=488)
- "Glucose and insulin are controlled via exogenous infusions post-operatively." — Juan Gurria (clinical) [Ep 8 · 8:18](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=498)
- "Close attention to nutrition is key in the healing of connections between the bile tract and gastrointestinal tract." — Juan Gurria (clinical) [Ep 8 · 8:22](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=502)
- "Patients are deemed ready for discharge when pain is well controlled, they are on full feeds (via tube or by mouth), glucose is well controlled via continuous glucose monitoring, and they have received full education." — Juan Gurria (clinical) [Ep 8 · 8:39](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=519)
- "After discharge, local GI physicians continue to follow patients along with the Cincinnati Children's team." — Juan Gurria (clinical) [Ep 8 · 8:47](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=527)
- "Diagnosis of acute pancreatitis requires serum lipase at least 3 times the upper limit of normal, plus imaging findings (ultrasound, MRI/MRCP, or CT)." — Juan Gurria (guideline) [Ep 10 · 5:44](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=344)
- "In the Cincinnati Children's cohort of 1000 pediatric pancreatitis patients, 85% have genetic mutations." — Juan Gurria (epidemiological) [Ep 10 · 7:23](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=443)
- "PRSS1 mutation causes very aggressive attacks very early in life (ages 1–3 years) because it autoactivates trypsinogen inside the pancreas." — Juan Gurria (clinical) [Ep 10 · 8:01](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=481)
- "Medications including L-asparaginase, steroids, valproic acid, and diuretics (Lasix) can cause pancreatitis in children." — Juan Gurria (clinical) [Ep 10 · 8:37](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=517)
- "Hereditary pancreatitis increases the risk of pancreatic cancer by a huge fold, which is a major concern in children diagnosed at age 5–6 who may live 95 more years." — Juan Gurria (clinical) [Ep 10 · 9:32](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=572)
- "Most fluid collections in pediatric acute pancreatitis are self-limited and should not be touched unless absolutely necessary." — Juan Gurria (clinical) [Ep 10 · 10:15](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=615)
- "Position papers from the European Pancreas Club and American Pancreas Association state there is no role for early pancreatectomies or early drainage procedures in acute pancreatitis." — Juan Gurria (host_summary) [Ep 10 · 18:17](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1097)
- "Early necrosectomies (before 4 weeks) usually increase mortality." — Juan Gurria (clinical) [Ep 10 · 18:40](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1120)
- "Following lipase levels tells you nothing about how the pancreas is behaving in acute pancreatitis; cross-sectional imaging is required." — Juan Gurria (clinical) [Ep 10 · 19:49](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1189)
- "The step-up approach for necrotizing pancreatitis—starting with transgastric endoscopic necrosectomy—reduces major complications compared to open surgery." — Juan Gurria (host_summary) [Ep 10 · 20:06](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1206)
- "Asymptomatic pseudocysts, regardless of size, do not require intervention." — Juan Gurria (clinical) [Ep 10 · 21:36](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1296)
- "Patients with acute pancreatitis should be fed as soon as possible (orally or via NG/NJ tube) because bacterial translocation from NPO status will complicate the disease." — Juan Gurria (clinical) [Ep 10 · 23:29](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1409)
- "Lactated Ringer solution for initial resuscitation in acute pancreatitis is better than normal saline, per a paper from Cincinnati Children's by Dr. Farrell." — Juan Gurria (host_summary) [Ep 10 · 23:48](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1428)
- "In pediatric patients with hereditary pancreatitis or hereditary plus anatomic abnormalities, half will develop chronic pancreatitis." — Juan Gurria (epidemiological) [Ep 10 · 25:13](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1513)
- "Chronic pain in pancreatitis involves brain plasticity, hypertrophic nerve reactions, and peripheral nerve hypersensitization, not just organic retroperitoneal pain." — Juan Gurria (clinical) [Ep 10 · 26:50](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1610)
- "After total pancreatectomy, 95% of pain is resolved, but 5% may persist due to central sensitization and requires behavioral medicine and psychiatric support." — Juan Gurria (clinical) [Ep 10 · 27:43](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1663)
- "Pediatric chronic pancreatitis usually presents with minimal ductal changes, not the dilated ducts seen in adults, so drainage procedures are often not applicable." — Juan Gurria (clinical) [Ep 10 · 28:37](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1717)
- "In patients with genetic mutations, partial pancreatectomy (Whipple, distal pancreatectomy) discards islet mass and does not address the underlying defect, so the remaining pancreas continues to be affected." — Juan Gurria (clinical) [Ep 10 · 28:57](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1737)
- "Cincinnati Children's evaluates over 100 patients per year for chronic pancreatitis but only operates on 25–30, because medical and endoscopic options should be exhausted first." — Juan Gurria (clinical) [Ep 10 · 25:38](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=1538)
- "TPIAT is indicated when patients have chronic pancreatitis findings, at least 6 months of disease, exocrine or endocrine insufficiency, and impaired quality of life despite maximal medical and endoscopic therapy." — Juan Gurria (guideline) [Ep 10 · 37:54](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2274)
- "The goal of islet autotransplantation is to replace beta cell mass and insulin secretory capacity, not to cure diabetes—pain control is the primary indication." — Juan Gurria (clinical) [Ep 10 · 39:00](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2340)
- "TPIAT used to be a 20-hour operation but is now down to an average of 8–9 hours at Cincinnati Children's." — Juan Gurria (clinical) [Ep 10 · 40:28](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2428)
- "Spleen-sparing TPIAT is now performed in 80% of cases (over the last 5 years), compared to none in the first 8 years of the program." — Juan Gurria (clinical) [Ep 10 · 43:42](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2622)
- "Spleen-sparing TPIAT has equal glycemic outcomes to splenectomy TPIAT when islet equivalent per kilogram transplanted is matched." — Juan Gurria (clinical) [Ep 10 · 43:15](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2595)
- "Intraoperative pyloric Botox injection reduces gastroparesis, decreases length of stay, and improves time to full oral intake and glycemic control after TPIAT." — Juan Gurria (clinical) [Ep 10 · 45:16](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2716)
- "Islet isolation takes about 3–3.5 hours, sometimes 4 hours depending on the degree of pancreatic injury." — Juan Gurria (clinical) [Ep 10 · 46:27](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2787)
- "TPIAT is performed under anticoagulation (heparin) to prevent portal vein thrombosis during islet infusion." — Juan Gurria (clinical) [Ep 10 · 47:39](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2859)
- "Portal vein thrombosis rate at Cincinnati Children's is less than 1% for TPIAT." — Juan Gurria (clinical) [Ep 10 · 48:11](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2891)
- "Cincinnati Children's has performed close to 200 TPIAT cases with no anastomotic leaks." — Juan Gurria (clinical) [Ep 10 · 48:26](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=2906)
- "Patients are extubated in the operating room after TPIAT." — Juan Gurria (clinical) [Ep 10 · 50:07](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3007)
- "TPIAT results in over 80% reduction in opioid use at 1–2 months, with sustained effect for years." — Juan Gurria (host_summary) [Ep 10 · 50:58](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3058)
- "Younger children are more likely to achieve insulin independence and opioid independence after TPIAT." — Juan Gurria (clinical) [Ep 10 · 51:32](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3092)
- "Islet yield (IEQ/kg) is inversely related to pancreatic calcification, ductal dilation, fibrosis, duration of symptoms, and prior resections or drainage procedures." — Juan Gurria (clinical) [Ep 10 · 52:25](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3145)
- "Transplanting ≥5000 islet equivalents per kilogram into the portal vein predicts 92% insulin independence at 36 months (Minnesota data); Cincinnati Children's currently achieves 70% insulin independence." — Juan Gurria (host_summary) [Ep 10 · 53:03](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3183)
- "Predictors of insulin independence after TPIAT include younger age at surgery, smaller body surface area, no pre-existing insulin dependence, and higher IEQ/kg transplanted." — Juan Gurria (clinical) [Ep 10 · 54:59](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3299)
- "TPIAT dramatically improves quality of life in appropriately selected children, with families reporting they have 'never met this kid before'—new person, happy, playing, eating normally." — Juan Gurria (clinical) [Ep 10 · 56:09](https://qa.library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-children-with-dr-juan-gurria-11849?t=3369)

## Changelog
- Sep 7: 4 items added automatically
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