Commercial Audio Only (1080p)
The speaker is Rod Gerardo from Cincinnati Children's
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position0:00
The new content format differs from existing YouTube videos and podcasts that go deep in the weeds with pediatric surgery
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position0:10
Dr. Jeff Ponsky will co-conduct interviews with Rod Gerardo
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position0:20
Interview subjects will include residents, fellows, and attendings from around the globe
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position0:24
Topics will cover resident wellness, general surgery concepts, and new technologies
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position0:28
Episodes will be available on the Stay Current Pediatric Surgery app and social media channels
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position0:32
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
The patient is a 16-year-old currently undergoing treatment for acute lymphoblastic leukemia (ALL) who presents with right upper quadrant pain, neutropenia, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position0:56
In this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position1:20
The patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy.
Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position1:49
From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away in gallstone pancreatitis.
When symptoms are improving in gallstone pancreatitis (biochemical normalization is not required), the approach is to proceed to cholecystectomy with intraoperative cholangiogram and coordinate with ERCP availability in case it might be needed.
Studies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.
Most stones can be cleared, some stones pass spontaneously, and good clinical judgment with local resources must be factored into management decisions.
Expert opinionLuke Neff2:59
In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:11
For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:22
The timing of cholecystectomy in gallstone pancreatitis should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:33
The 12th annual update course in pediatric surgery introduced a new classification system with three categories: Green Circle for established practice, Blue Square for promising newer practice, and Black Diamond for early adopter practice only.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position0:08
A 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.
Over 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.
Expert opinionDavid Vitale1:18
Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.
Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.
Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week.
Expert opinionLuke Neff2:07
From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis.
When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.
Studies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy.
If amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted.
Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.
Local resources and what is available must be factored into management decisions for biliary stones.
Expert opinionDavid Vitale3:07
In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:11