# Pancreatitis — GCMD Library living collection

Also covered as: chronic pancreatitis · acute recurrent pancreatitis · acute pancreatitis · gallstone pancreatitis · exocrine pancreatic insufficiency · necrotizing pancreatitis · pancreas divisum · portal vein thrombosis

Experts: Dr. Todd Ponsky, Dr. Andrew Trout, Dr. Juan Gurria, Dr. Jamie Nathan

Updated: n/a · 23 episodes · 439 cited statements

## Episodes
### Fundamentals
- [Welcome and Introductions: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969) — video · 6:04 · [machine version](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969.md)
- [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)

### Acute Management
- [Misconceptions of Acute Pancreatitis: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974) — video · 2:28 · [machine version](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974.md)
- [Update Course Rewind: Management of Acute Pancreatitis 2023](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523) — video · 6:46 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523.md)

### Medical Management
- [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)

### Nutritional Management
- [Enteral Nutritional Support For Pancreatitis: Practice Gap discussion at...](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351) — video · 16:15 · [machine version](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351.md)
- [Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451) — video · 1:00 · [machine version](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451.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)
- [Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706) — video · 7:31 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706.md)

### Complications
- [ERCP: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967) — video · 9:11 · [machine version](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967.md)
- [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735) — video · 3:53 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735.md)
- [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)
- [Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736) — podcast · 3:53 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736.md)

### Case-Based Learning
- [Acute Pancreatitis](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871) — podcast · 45:24 · [machine version](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871.md)
- [Acute Pancreatitis](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293) — podcast · 45:24 · [machine version](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293.md)
- [Case-Based Journal Review: Cholelithiasis 2024](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797) — podcast · 18:12 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797.md)

### In-Depth Reviews
- [Acute and Acute Recurrent Pancreatitis: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970) — video · 56:45 · [machine version](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970.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)

### Long-Term Care
- [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)
- [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)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=0) Post-resection pancreatitis risk in pediatric solid pseudopapillary neoplasms (Ep 21)
- [0:04](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=4) Practice Gap #9: Enteral Nutrition in Pancreatitis (Ep 10)
- [0:00](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=0) Introduction and Series Context (Ep 2)
- [1:23](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=83) Case Presentation and Diagnostic Criteria (Ep 2)
- [4:24](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=264) Pain Management in Acute Pancreatitis (Ep 2)
- [7:02](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=422) Nutrition Management: NPO Duration and Early Feeding (Ep 2)
- [14:29](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=869) Enteral Versus Parenteral Nutrition and Fat Intake (Ep 2)
- [17:29](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1049) IV Fluid Resuscitation Strategy (Ep 2)
- [22:51](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1371) Standardized Order Set and Patient Outcome (Ep 2)
- [24:50](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1490) Case Recurrence and Imaging for Complications (Ep 2)
- [28:15](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1695) Necrotizing Pancreatitis: Diagnosis and Prognostication (Ep 2)
- [31:52](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1912) Management of Complicated Pancreatitis (Ep 2)
- [35:27](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2127) Acute Recurrent Pancreatitis: Definition and Workup (Ep 2)
- [38:17](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2297) Interventional Approaches and Necrosectomy (Ep 2)
- [42:11](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2531) Advanced Imaging and BMI as Risk Factor (Ep 2)
- [44:40](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2680) Closing Remarks (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=0) Introduction and Series Context (Ep 11)
- [1:23](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=83) Case Presentation and Diagnostic Criteria (Ep 11)
- [4:25](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=265) Pain Management in Acute Pancreatitis (Ep 11)
- [7:02](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=422) Nutrition Management: NPO vs. Early Feeding (Ep 11)
- [14:29](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=869) Enteral vs. Parenteral Nutrition and Fat Intake (Ep 11)
- [17:29](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1049) IV Fluid Resuscitation Strategy (Ep 11)
- [21:58](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1318) Standardized Order Sets and Case Outcome (Ep 11)
- [24:50](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1490) Case Recurrence and Imaging for Complications (Ep 11)
- [28:15](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1695) CT Findings and Prognostic Markers (Ep 11)
- [31:08](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1868) Management of Complicated Pancreatitis (Ep 11)
- [36:15](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2175) Workup for Acute Recurrent Pancreatitis (Ep 11)
- [42:04](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2524) Endoscopic Necrosectomy and Closing Remarks (Ep 11)
- [0:00](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=0) Introduction and Transfusion Policy Discussion (Ep 1)
- [1:40](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=100) Case Presentation: Acute Pancreatitis Nutrition Question (Ep 1)
- [6:00](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=360) Evidence for Early Enteral Feeding in Pancreatitis (Ep 1)
- [8:35](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=515) Management of Gallstone Pancreatitis: ERCP vs Operative Approach (Ep 1)
- [14:41](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=881) Timing of Cholecystectomy and Summary (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=0) Introduction to ERCP in Acute Pancreatitis and Case Presentation (Ep 9)
- [1:39](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=99) Initial CT Imaging Findings (Ep 9)
- [2:37](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=157) Clinical Course and Follow-up Ultrasound (Ep 9)
- [3:50](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=230) ERCP Findings and Therapeutic Intervention (Ep 9)
- [5:54](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=354) Follow-up ERCP and Treatment Success (Ep 9)
- [7:10](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=430) Poll Results Discussion and Session Conclusion (Ep 9)
- [0:00](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=0) Welcome, Housekeeping, and Event Introduction (Ep 4)

## 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 0:48](https://qa.library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=48)
- "Early enteral feedings when not associated with vomiting decrease morbidity, infectious risk, and mortality in pancreatitis" — Ray (clinical) [Ep 10 · 0:17](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=17)
- "Nasogastric feeds are equally as tolerated as nasojejunal feeds in pancreatitis" — Ray (clinical) [Ep 10 · 0:26](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=26)
- "Earlier surgical intervention is recommended for gallstone pancreatitis" — Ray (guideline) [Ep 10 · 0:26](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=26)
- "Traditional teaching was to wait many days for amylase and lipase to normalize and for abdominal pain to resolve before starting feeds in pancreatitis" (opinion) [Ep 10 · 0:35](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=35)
- "Enteral feeding can be provided even in the presence of infected pancreatic phlegmon" (clinical) [Ep 10 · 0:49](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=49)
- "Lipase half-life is about 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, or salivary disease." — Maissam Abu Al Haija (clinical) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=180)
- "Amylase rises and normalizes much quicker than lipase, so in a patient presenting 2 days after symptom onset, amylase may not be the best indicator of pancreatitis." — Maissam Abu Al Haija (clinical) [Ep 2 · 2:40](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=160)
- "Ultrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas." — Andrew Trout (clinical) [Ep 2 · 2:09](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=129)
- "Ultrasound is limited in the setting of suspected complications of pancreatitis; CT is the image of choice for complicated cases to better visualize necrosis, fluid collections, hemorrhage, or masses." — Maissam Abu Al Haija (clinical) [Ep 2 · 2:23](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=143)
- "The most helpful use of ultrasound in acute pancreatitis is looking for a biliary component—CBD dilation suggesting need for early ERCP, or gallstones that change management—not documenting pancreatitis or looking for complications." — Maissam Abu Al Haija (clinical) [Ep 2 · 4:03](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=243)
- "There is no data identifying a superior pain medication for acute pancreatitis; even adult studies have not identified optimal management." — Maissam Abu Al Haija (clinical) [Ep 2 · 6:21](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=381)
- "Opioids should not be avoided in acute pancreatitis; when used appropriately, they can help advance feeds, improve outcomes, and facilitate earlier discharge." — Maissam Abu Al Haija (clinical) [Ep 2 · 6:35](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=395)
- "Early nutrition (within 24 to 72 hours) in acute pancreatitis is associated with more favorable outcomes: it maintains gut barrier function, inhibits bacterial translocation, and lowers the incidence of systemic inflammatory response." — Maissam Abu Al Haija (clinical) [Ep 2 · 9:03](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=543)
- "A 2012 meta-analysis comparing TPN versus enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, lower mortality, and fewer infections." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 9:32](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=572)
- "The Ekerwal 2007 study randomized 60 adult patients to eat on admission versus NPO and found that early feeding did not increase abdominal pain and decreased length of stay by 2 days." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 13:19](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=799)
- "In a Cincinnati Children's study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, and patients who received feeds had similar pain scores to those kept NPO." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 14:29](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=869)
- "Pilot analysis showed patients with the lowest pain scores were those who ate the most fat; fat intake did not increase length of stay." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 15:28](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=928)
- "Studies comparing NG feeds versus NJ feeds in acute pancreatitis show no difference in outcomes; duration of hospital stay and mortality were very similar, even in severe acute pancreatitis." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 12:41](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=761)
- "Aggressive IV fluid resuscitation (more than one-third of 72-hour fluid volume given in the first day) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 19:02](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1142)
- "In studies of aggressive resuscitation, the late resuscitation group received more total fluid than the early resuscitation group, suggesting a critical 24-hour window for intervention." — Maissam Abu Al Haija (clinical) [Ep 2 · 19:45](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1185)
- "A 2011 study of 40 patients using goal-directed management (resuscitating to urine output of 3 mL/kg/hour) showed early resuscitation with lactated Ringer's reduced inflammation markers (CRP) compared to normal saline." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 20:18](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1218)
- "In a Cincinnati Children's study of 201 patients, those kept NPO with low IV fluids had 35% rate of developing severe pancreatitis, versus 4.2% in those who ate early and received aggressive resuscitation." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 23:48](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1428)
- "For CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients as the goal is to identify complications (venous thrombosis, necrosis, fluid collections), not masses." — Andrew Trout (clinical) [Ep 2 · 28:19](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1699)
- "Oral contrast is helpful in CT of pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but a sick patient who cannot tolerate oral contrast can still have an informative CT without it." — Andrew Trout (clinical) [Ep 2 · 28:41](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1721)
- "On contrast-enhanced CT, absent enhancement in pancreatic tissue is highly concerning for necrosis." — Andrew Trout (clinical) [Ep 2 · 29:51](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1791)
- "Ranson's criteria have not proven sensitive and specific for predicting severity in pediatric pancreatitis when validated in further studies, despite initial promise in a 2002 Midwest study." — Maissam Abu Al Haija (clinical) [Ep 2 · 30:31](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1831)
- "A Cincinnati Children's prognostic tool using white blood cell count, albumin value, and lipase on admission can predict severity in almost 70% of pediatric pancreatitis patients." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 31:20](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1880)
- "Antibiotics should not be used routinely in mild acute pancreatitis or in severe pancreatitis unless there is infected necrosis." — Maissam Abu Al Haija (clinical) [Ep 2 · 32:32](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1952)
- "When antibiotics are indicated for infected pancreatic necrosis, imipenem or 3rd generation cephalosporins are good initial choices." — Maissam Abu Al Haija (clinical) [Ep 2 · 33:08](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1988)
- "MRCP is not the most helpful imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it is better reserved for workup of biliary and pancreatic ductal issues after resolution." — Maissam Abu Al Haija (clinical) [Ep 2 · 5:15](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=315)
- "The INSPPIRE consortium defines acute recurrent pancreatitis in children as at least two distinct episodes with complete resolution of pain and a one-month pain-free interval, or normalization of enzymes with complete pain resolution in less than one month." — Maissam Abu Al Haija (guideline) [Ep 2 · 34:34](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2074)
- "Workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC." — Maissam Abu Al Haija (clinical) [Ep 2 · 35:31](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2131)
- "In adult literature, there is growing evidence for endoscopic necrosectomy via EUS (transmural approach through stomach into necrotic cavity) showing good outcomes, but pediatric experience is extremely limited." — Tom Lynn (clinical) [Ep 2 · 41:01](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2461)
- "Sticking needles or drains into the pancreas risks introducing infection into sterile necrosis; intervention should be avoided unless there is true significant clinical deterioration." — Jamie Nathan (opinion) [Ep 2 · 39:16](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2356)
- "The pancreas can be difficult to visualize on ultrasound in larger patients, in patients who are not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration." — Andrew Trout (clinical) [Ep 2 · 25:33](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=1533)
- "In MRI of the pancreas after acute attacks have resolved, a prominent pancreatic duct (visible as a white stripe) and some atrophy/irregularity of contour may be seen, but these findings alone are not diagnostic of chronic pancreatitis." — Andrew Trout (clinical) [Ep 2 · 34:03](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2043)
- "Evidence for secretin-enhanced MRCP in pediatric pancreatitis is limited; even adult literature shows iffy data on added value, though it may improve visualization of ductal anomalies in some cases." — Andrew Trout (clinical) [Ep 2 · 42:34](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2554)
- "In a prospective acute pancreatitis registry at Cincinnati Children's (nearly 3 years old), increased weight percentile-for-age (not BMI) during the first attack predicts recurrence." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 43:35](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2615)
- "Higher BMI may predict severe pancreatitis course in adults and children based on studies outside the US, though this has not yet been proven in the Cincinnati US population (sample size 85 patients)." — Maissam Abu Al Haija (epidemiological) [Ep 2 · 43:58](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-871?t=2638)
- "Lipase half-life is about 7 days and is more specific for pancreatic/intestinal pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, or salivary issues." — Maissam Abu Al Haija (clinical) [Ep 11 · 3:02](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=182)
- "Amylase rises and normalizes much quicker than lipase; in a patient presenting 2 days after symptom onset, amylase may not be the best indicator." — Maissam Abu Al Haija (clinical) [Ep 11 · 2:40](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=160)
- "Ultrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis; it is radiation-free and gives a reasonably good look at the pancreas, but is limited for evaluating complications." — Andrew Trout (clinical) [Ep 11 · 2:09](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=129)
- "The most helpful use of ultrasound in acute pancreatitis is looking for a biliary component (CBD dilation suggesting early ERCP need, or gallstones changing management), not documenting pancreatitis or looking for complications." — Maissam Abu Al Haija (clinical) [Ep 11 · 4:03](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=243)
- "There is no data on optimal pain medication in acute pancreatitis; even adult studies have not identified a superior medication." — Maissam Abu Al Haija (clinical) [Ep 11 · 6:21](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=381)
- "Opioids used in the right patient and setting in acute pancreatitis can allow earlier feeding, improve outcomes, and enable earlier discharge; providers should not be shy about using them." — Maissam Abu Al Haija (opinion) [Ep 11 · 6:27](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=387)
- "Early enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with more favorable outcomes: maintains gut barrier function, inhibits bacterial translocation, lowers incidence of systemic inflammatory response, and avoids severe complications." — Maissam Abu Al Haija (clinical) [Ep 11 · 9:03](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=543)
- "A 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, surgical intervention rate, mortality, and infections." — Maissam Abu Al Haija (host_summary) [Ep 11 · 9:32](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=572)
- "The 2007 Ekerwal study randomized 60 adult patients to eat on admission vs. NPO; early feeding did not increase abdominal pain and decreased length of stay by 2 days." — Maissam Abu Al Haija (host_summary) [Ep 11 · 13:19](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=799)
- "Cincinnati Children's replicated the early feeding approach in 38 pediatric admissions with mild pancreatitis (published late 2015); early nutrition was safe, feasible, and not associated with worse pain outcomes." — Maissam Abu Al Haija (clinical) [Ep 11 · 14:29](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=869)
- "Pilot analysis showed patients who ate the most fat had the lowest pain scores; fat intake did not increase length of stay. Patients likely self-regulate and eat more when ready." — Maissam Abu Al Haija (clinical) [Ep 11 · 15:28](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=928)
- "NG feeds vs. NJ feeds in acute pancreatitis show no difference in outcomes; duration of hospital stay and mortality are similar even in severe acute pancreatitis." — Maissam Abu Al Haija (host_summary) [Ep 11 · 12:41](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=761)
- "Aggressive IV fluid resuscitation in acute pancreatitis is associated with improved outcomes; early aggressive resuscitation (>1/3 of 72-hour fluid volume in first 24 hours) reduces mortality and incidence of SIRS and organ failure at 72 hours." — Maissam Abu Al Haija (host_summary) [Ep 11 · 18:58](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1138)
- "In the late resuscitation group, patients received more total fluid than the early resuscitation group, but outcomes were worse, indicating a critical 24-hour window for intervention." — Maissam Abu Al Haija (clinical) [Ep 11 · 19:45](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1185)
- "A small 2011 study (40 patients) and a 2023 abstract (40 patients, Spain) showed early resuscitation with lactated Ringer's (LR) vs. normal saline reduced inflammation (CRP markers) when using goal-directed management targeting urine output 3 mL/kg/hr." — Maissam Abu Al Haija (host_summary) [Ep 11 · 20:05](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1205)
- "Cincinnati Children's study of 201 patients showed 35% of NPO + low IV fluids group developed severe pancreatitis vs. 4.2% in early PO + aggressive resuscitation group." — Maissam Abu Al Haija (clinical) [Ep 11 · 24:10](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1450)
- "CT is the imaging test of choice when complicated pancreatitis is suspected; it best visualizes necrosis, fluid collections, hemorrhage, and masses." — Maissam Abu Al Haija (clinical) [Ep 11 · 5:00](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=300)
- "MRCP is useful for workup of biliary and pancreatic ductal issues but is not the first imaging modality in acute pancreatitis; edema during acute attack obscures ductal anatomy." — Maissam Abu Al Haija (clinical) [Ep 11 · 5:28](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=328)
- "For pediatric pancreatitis CT, a portal venous phase is sufficient (no multi-phase needed); oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not a deal-breaker if patient cannot tolerate it." — Andrew Trout (clinical) [Ep 11 · 28:19](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1699)
- "Absent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis." — Andrew Trout (clinical) [Ep 11 · 29:51](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1791)
- "Ranson's criteria applied to pediatric pancreatitis (studied since 2002, including Midwest/University of Cincinnati studies) initially showed promise but did not prove sufficiently sensitive and specific upon validation." — Maissam Abu Al Haija (clinical) [Ep 11 · 30:31](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1831)
- "Cincinnati Children's study proposes using white blood cell count, albumin, and lipase on admission to predict severity in ~70% of pediatric pancreatitis patients; this tool still needs optimization." — Maissam Abu Al Haija (clinical) [Ep 11 · 31:20](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1880)
- "Antibiotics should not be used in mild pancreatitis or in severe pancreatitis unless infected necrosis is suspected (e.g., fever present)." — Maissam Abu Al Haija (clinical) [Ep 11 · 32:32](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1952)
- "When antibiotics are indicated in pancreatitis, imipenem or 3rd-generation cephalosporins are good initial choices based on available evidence." — Maissam Abu Al Haija (clinical) [Ep 11 · 33:08](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=1988)
- "Acute recurrent pancreatitis (ARP) is defined by the INSPPIRE group as ≥2 distinct episodes with complete pain resolution and a 1-month pain-free interval, or enzyme normalization with complete pain resolution in <1 month." — Maissam Abu Al Haija (host_summary) [Ep 11 · 34:47](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2087)
- "ARP workup includes inflammatory causes (IBD, celiac), systemic/mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing (PRSS1, SPINK1, CFTR, CTRC)." — Maissam Abu Al Haija (clinical) [Ep 11 · 35:37](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2137)
- "Aspiration of pancreatic necrosis to rule out infection carries risk of introducing infection into a sterile collection; empiric antibiotics may be started if fever is present, but aspiration is rarely performed (Cincinnati has needed one necrosectomy in 10 years)." — Jamie Nathan (clinical) [Ep 11 · 38:49](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2329)
- "Adult evidence supports endoscopic necrosectomy via EUS-guided transmural approach with good outcomes; pediatric experience is extremely limited and Cincinnati has not performed this procedure." — Tom Lynn (clinical) [Ep 11 · 41:12](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2472)
- "Secretin-enhanced MRCP has unclear added value in pediatric pancreatitis; adult literature data is 'iffy.' In acute recurrent or chronic pancreatitis patients, ducts are often dilated enough to visualize without secretin." — Andrew Trout (opinion) [Ep 11 · 42:34](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2554)
- "Cincinnati Children's prospective acute pancreatitis registry (3 years, 85 patients) found increased weight percentile for age (not BMI) during first attack predicts recurrence; abstract submitted to World Congress." — Maissam Abu Al Haija (clinical) [Ep 11 · 43:25](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2605)
- "Higher BMI predicts severe pancreatitis course in adults and some pediatric studies outside the US, but did not predict severity in Cincinnati's 85-patient sample, possibly due to wide BMI variation in both recurrence and non-recurrence groups." — Maissam Abu Al Haija (clinical) [Ep 11 · 43:58](https://qa.library.globalcastmd.com/watch/acute-pancreatitis-293?t=2638)
- "A restrictive transfusion policy with hemoglobin threshold of 7 (rather than 9 or 10) will have no difference in mortality." (host_summary) [Ep 1 · 1:03](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=63)
- "RBC transfusions may confer increased risk of DVT in pediatric patients (not NICU scenario), per JAMA Surgery paper." — Chuck (host_summary) [Ep 1 · 1:20](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=80)
- "Glutamine and arginine have been tried as amino acid nutritional supplements to stabilize gut mucosa or promote nutrition, but there is not a lot of evidence that they actually work." (clinical) [Ep 1 · 3:30](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=210)
- "In adults, evidence strongly recommends early feeding (24 to 48 hours) with enteral feedings for acute pancreatitis." — Chuck (host_summary) [Ep 1 · 6:16](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=376)
- "The route of enteral feeding (nasogastric vs nasojejunal) does not seem to make any difference in pancreatitis management." — Chuck (host_summary) [Ep 1 · 6:28](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=388)
- "In adults, enteral feeding in pancreatitis reduces morbidity, infectious complications, and mortality, particularly with severe pancreatitis but even in mild to moderate cases, based on meta-analyses and multiple studies." — Chuck (host_summary) [Ep 1 · 6:44](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=404)
- "There is no benefit to supplemental administration of specific amino acids (glutamine, arginine) in pancreatitis cases." — Chuck (host_summary) [Ep 1 · 7:05](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=425)
- "Most studies in children regarding enteral feeding in pancreatitis are fairly small and retrospective, but there is good reason to assume the same beneficial effects would occur as in adults." — Chuck (clinical) [Ep 1 · 7:17](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=437)
- "The myth from surgical training was that feeding would stimulate hormones and the pancreas, but that is not the case." — Craig (clinical) [Ep 1 · 7:28](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=448)
- "Studies specifically tracked pain and lipase levels and found they did not particularly correlate with enteral feeding; feeding did not cause these parameters to increase." — Chuck (host_summary) [Ep 1 · 8:09](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=489)
- "For gallstone pancreatitis with persistent obstruction, if you have an ERCP endoscopist at your institution, do laparoscopic cholecystectomy first, and if you cannot get the stone out, then remove it by ERCP postoperatively (the adult approach)." — Ron (clinical) [Ep 1 · 9:38](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=578)
- "Transcystic stone extraction techniques include flushing the stone out, pushing it back with a Fogarty catheter, or using a basket." — Ron (clinical) [Ep 1 · 9:58](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=598)
- "One study showed that operative management of gallstone pancreatitis cut down length of stay by about 2 days compared to waiting for ERCP." — Ron (clinical) [Ep 1 · 10:30](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=630)
- "If the common bile duct is dilated, the cystic duct is usually dilated, allowing placement of a choledochoscope through the cystic duct to basket the stone." — Ron (clinical) [Ep 1 · 11:31](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=691)
- "Using a basket with fluoroscopy during intraoperative cholangiogram is successful about 90% of the time for stone extraction." — Mark (clinical) [Ep 1 · 11:58](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=718)
- "The traditional teaching was to let pancreatitis settle down with an interval before cholecystectomy, but experience shows you probably do not gain with that delay; in fact, if you delay to an intermediate timepoint, you may be in a worse spot." — Craig (clinical) [Ep 1 · 12:30](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=750)
- "SAGES is now recommending a paradigm change: even for a stuck stone in gallstone pancreatitis, try laparoscopic cholecystectomy with intraoperative cholangiogram first, then send for ERCP if needed; pre-operative ERCP is falling by the wayside." (host_summary) [Ep 1 · 12:54](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=774)
- "By the time ERCP is set up for gallstone pancreatitis, the stone has often already passed, which is why there are so many negative ERCPs." (clinical) [Ep 1 · 13:23](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=803)
- "For gallstone pancreatitis after stone passage, cholecystectomy should be performed early in the same hospitalization (within 24-48 hours if clinically improving), even if pancreatitis has not completely resolved." — Chuck (clinical) [Ep 1 · 13:42](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=822)
- "If cholecystectomy is delayed until a month after gallstone pancreatitis, the pancreatitis can recur." (host_summary) [Ep 1 · 14:41](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=881)
- "Literature shows that amylase and lipase are not good predictors of severity of pancreatitis." — Ron (host_summary) [Ep 1 · 15:18](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=918)
- "There is no advantage of nasojejunal versus nasogastric feeds in pancreatitis unless the patient is vomiting and cannot tolerate nasogastric feeds." — Chuck (clinical) [Ep 1 · 15:31](https://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=931)
- "ERCP was introduced in the 1970s as a purely diagnostic modality" (clinical) [Ep 9 · 0:10](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "ERCP has evolved from a diagnostic to a more therapeutic modality over time" (clinical) [Ep 9 · 0:10](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "Advances in radiology have enabled non-invasive identification of abnormalities, contributing to ERCP's shift toward therapeutic use" (clinical) [Ep 9 · 0:10](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10)
- "CT provides value in complex cases and complex patients for pancreatic imaging" (clinical) [Ep 9 · 1:39](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=99)
- "Severe scoliotic curvature and spinal hardware make it difficult to get a good ultrasound" (clinical) [Ep 9 · 1:49](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=109)
- "Fluid collection replacing a large chunk of pancreas with no preserved pancreatic tissue around it indicates an area of necrosis or walled off necrosis" (clinical) [Ep 9 · 2:00](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=120)
- "Once you have a lay of the land with CT, you can use ultrasound to target and look at areas of interest in complex cases" (clinical) [Ep 9 · 3:05](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=185)
- "If ultrasound findings change dramatically or you're not getting a good sense of things, you may need to go back to cross-sectional imaging (CT or MRI)" (clinical) [Ep 9 · 3:05](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=185)
- "Ultrasound is a good modality to follow patients serially over time because it's easier on patients and lacks ionizing radiation" (clinical) [Ep 9 · 3:27](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=207)
- "Spinal fusion rods make it challenging to identify and visualize normal ductal structures during ERCP" (clinical) [Ep 9 · 4:26](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=266)
- "Pancreatic sphincterotomy and pancreatic duct stent placement allow flow of pancreatic juices to the path of least resistance with hopes of resolving duct defects" (clinical) [Ep 9 · 5:30](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=330)
- "The decision to proceed with ERCP is based on clinical suspicion for pancreatic duct leak and the type of expertise available at the institution" (clinical) [Ep 9 · 6:22](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=382)
- "There is a growing number of pediatric gastroenterologists becoming skilled in performing ERCP" (clinical) [Ep 9 · 6:42](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "ERCP is invasive and has the potential to exacerbate pancreatitis" (clinical) [Ep 9 · 6:42](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "The goal of ERCP in this setting is to be therapeutic" (clinical) [Ep 9 · 6:42](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402)
- "Watchful waiting was an extension of the conservative approach already attempted in this case" (clinical) [Ep 9 · 8:19](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499)
- "Continuing conservative management was not acceptable to the family" (clinical) [Ep 9 · 8:19](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499)
- "A patient with an enlarging collection is potentially failing watchful waiting" (clinical) [Ep 9 · 8:40](https://qa.library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=520)
- "Cincinnati Children's has been leading the world in pediatric surgical education" — Todd Ponsky (opinion) [Ep 4 · 0:28](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=28)
- "The event will be recorded and available after 48 hours" — Todd Ponsky (clinical) [Ep 4 · 1:22](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=82)
- "A new video portal will allow users to search by keyword and watch specific segments rather than entire events" — Todd Ponsky (clinical) [Ep 4 · 1:27](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=87)
- "The Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world" — Todd Ponsky (clinical) [Ep 4 · 2:00](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=120)
- "Cincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists" — Todd Ponsky (clinical) [Ep 4 · 2:38](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=158)
- "Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's" — Todd Ponsky (host_summary) [Ep 4 · 3:06](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=186)
- "The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis" — Jamie Nathan (clinical) [Ep 4 · 3:38](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=218)
- "Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program" — Jamie Nathan (clinical) [Ep 4 · 4:05](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=245)
- "Ken Goldschneider is director of pain management at Cincinnati Children's, professor of clinical pediatrics and anesthesia, and plays a central role in pain management for patients with pancreatic diseases" — Jamie Nathan (clinical) [Ep 4 · 4:23](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=263)
- "Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center" — Jamie Nathan (clinical) [Ep 4 · 4:40](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=280)
- "Tom Lynn is a gastroenterologist who manages the vast majority or all endoscopic needs for children with pancreatic disorders, director of endoscopy for the Pancreas Care Center, and co-director of endoscopy for the division of gastroenterology" — Jamie Nathan (clinical) [Ep 4 · 4:54](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=294)
- "Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine" — Jamie Nathan (clinical) [Ep 4 · 5:17](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=317)
- "Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event" — Jamie Nathan (clinical) [Ep 4 · 5:33](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=333)
- "Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event" — Jamie Nathan (clinical) [Ep 4 · 5:47](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=347)
- "Direct pancreatic function testing means obtaining function directly from the pancreas, not relying on stool testing for fecal elastase." (clinical) [Ep 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 24:04](https://qa.library.globalcastmd.com/watch/function-tests-pain-management-pancreatic-disease-968?t=1444)
- "There is no good data supporting the avoidance of opioids in acute pancreatitis due to concerns about sphincter of Oddi spasm worsening the condition." (host_summary) [Ep 7 · 0:27](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=27)
- "Data on opioids causing sphincter of Oddi spasm and worsening pancreatitis is conflicting." (clinical) [Ep 7 · 0:29](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=29)
- "The majority of providers tend to keep pancreatitis patients NPO until pain is improved or lipase and amylase normalize." (clinical) [Ep 7 · 0:40](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=40)
- "Every mild pancreatitis case receives standardized management at the speaker's institution." (clinical) [Ep 7 · 1:07](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=67)
- "The speaker's institution is 659 beds or almost 700 beds with expansion." (clinical) [Ep 7 · 1:10](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=70)
- "Standardizing pancreatitis management was important because patients are distributed across multiple floors including HMO floors, trauma, cardiac, GI, and general pediatrics." (clinical) [Ep 7 · 1:10](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=70)
- "In trauma cases where the pancreatic duct is not in continuity, patients probably cannot be fed." (clinical) [Ep 7 · 1:23](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=83)
- "The standardized protocol allows children with mild pancreatitis to eat and they will self-regulate their intake." (clinical) [Ep 7 · 1:36](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=96)
- "Patients with severe pancreatitis are probably not going to be able to eat." (clinical) [Ep 7 · 1:49](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=109)
- "In severe pancreatitis, enteral nutrition can be used to expedite healing without tipping things over." (clinical) [Ep 7 · 1:54](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=114)
- "The standardized management approach has been shared with other institutions and found to be helpful." (opinion) [Ep 7 · 2:17](https://qa.library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=137)
- "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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 41:34](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2494)
- "Acute pancreatitis diagnosis requires two of three Atlanta criteria: clinical symptoms consistent with pancreatitis, serum amylase or lipase ≥3× upper limit of normal, and imaging findings consistent with pancreatitis." — Abu Haija (host_summary) [Ep 5 · 0:55](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=55)
- "Lipase has a half-life of approximately 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, and salivary gland disease." — Abu Haija (clinical) [Ep 5 · 4:31](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=271)
- "Amylase rises and normalizes much more quickly than lipase, so in patients presenting 2 days after symptom onset, amylase may not be elevated while lipase remains diagnostic." — Abu Haija (clinical) [Ep 5 · 4:31](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=271)
- "Ultrasound should be the initial imaging modality for suspected uncomplicated acute pancreatitis because it is radiation-free and provides a reasonably good look at the pancreas." — Andrew Trout (clinical) [Ep 5 · 3:43](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=223)
- "The primary value of ultrasound in acute pancreatitis is screening for biliary causes (CBD dilation, gallstones) rather than documenting pancreatitis or looking for complications." — Abu Haija (clinical) [Ep 5 · 5:54](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=354)
- "CT is the imaging modality of choice for suspected complicated pancreatitis, providing superior visualization of necrosis, fluid collections, hemorrhage, and masses compared to ultrasound." — Abu Haija (clinical) [Ep 5 · 6:51](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=411)
- "MRCP is not the optimal imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it should be reserved for workup of biliary and pancreatic ductal issues after inflammation resolves." — Abu Haija (clinical) [Ep 5 · 7:19](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=439)
- "There is no data identifying a superior pain medication for acute pancreatitis in adults, and opioids can be used appropriately in the right setting without delaying recovery." — Abu Haija (clinical) [Ep 5 · 8:12](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=492)
- "Early enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with favorable outcomes including maintained gut barrier function, inhibited bacterial translocation, and lower incidence of systemic inflammatory response." — Abu Haija (clinical) [Ep 5 · 10:16](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=616)
- "A 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, and lower mortality." — Abu Haija (host_summary) [Ep 5 · 10:53](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=653)
- "In a 2007 randomized trial by Ekerwal and colleagues, adult patients with acute pancreatitis allowed to eat on admission had the same pain scores as NPO patients but were discharged 2 days earlier with no harmful events." — Abu Haija (host_summary) [Ep 5 · 15:21](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=921)
- "In a pediatric study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, with patients receiving feeds having similar pain scores to NPO patients." — Abu Haija (clinical) [Ep 5 · 16:31](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=991)
- "Pilot data showed patients who consumed the most fat during acute pancreatitis hospitalization had the lowest pain scores, suggesting patients self-regulate intake appropriately." — Abu Haija (clinical) [Ep 5 · 17:30](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1050)
- "There is no good evidence supporting low-fat diet restrictions in acute pancreatitis, though fat stimulates lipase secretion." — Abu Haija (opinion) [Ep 5 · 17:17](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1037)
- "Nasogastric (NG) feeds have similar outcomes to nasojejunal (NJ) feeds in acute pancreatitis, including in severe cases, with no added benefit from bypassing the ampulla of Vater." — Abu Haija (clinical) [Ep 5 · 14:43](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=883)
- "Adult retrospective studies show aggressive early fluid resuscitation (>one-third of 72-hour fluid volume given in first 24 hours) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours." — Abu Haija (host_summary) [Ep 5 · 20:10](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1210)
- "A 2011 study of 40 patients using goal-directed fluid resuscitation targeting urine output of 3 mL/kg/hr showed lactated Ringer's led to reduced inflammatory markers (CRP) compared to normal saline." — Abu Haija (host_summary) [Ep 5 · 21:22](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1282)
- "In a study of 201 pediatric pancreatitis patients, those receiving early PO intake plus aggressive IV fluids (≥1.5× maintenance) had a 4.2% rate of severe pancreatitis vs. 35% in the NPO/low-fluid group." — Abu Haija (clinical) [Ep 5 · 26:09](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1569)
- "Prophylactic antibiotics are not indicated for mild acute pancreatitis or for sterile pancreatic necrosis; they should be reserved for suspected or confirmed infected necrosis." — Abu Haija (clinical) [Ep 5 · 35:22](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2122)
- "When antibiotics are indicated for pancreatic necrosis, imipenem or third-generation cephalosporins are appropriate initial choices based on available evidence." — Abu Haija (clinical) [Ep 5 · 35:31](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2131)
- "Acute recurrent pancreatitis is defined as at least two distinct episodes with complete resolution of pain and either a one-month pain-free interval or enzyme normalization with complete pain resolution in less than one month." — Abu Haija (host_summary) [Ep 5 · 37:19](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2239)
- "Comprehensive workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (hypertriglyceridemia, hypercalcemia, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC." — Abu Haija (clinical) [Ep 5 · 38:00](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2280)
- "In pediatric acute pancreatitis, increased weight percentile for age at first attack predicts recurrence, based on a 3-year prospective registry of 85 patients." — Abu Haija (clinical) [Ep 5 · 46:01](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2761)
- "Ranson's criteria have not been validated as sensitive or specific for predicting mortality in pediatric pancreatitis, despite initial promising studies starting in 2002." — Abu Haija (clinical) [Ep 5 · 31:03](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1863)
- "A prognostic tool using white blood cell count, albumin, and lipase on admission can predict severe pancreatitis in approximately 70% of pediatric patients, though it requires further optimization." — Abu Haija (clinical) [Ep 5 · 31:54](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1914)
- "For CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients unless evaluating for masses." — Andrew Trout (clinical) [Ep 5 · 33:31](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2011)
- "Oral contrast is helpful in CT for pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but the exam can provide substantial information without it if the patient cannot tolerate oral contrast." — Andrew Trout (clinical) [Ep 5 · 33:50](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2030)
- "Aspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis." — Todd Ponsky (clinical) [Ep 5 · 41:39](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2499)
- "In adults, there is growing evidence for endoscopic necrosectomy via EUS-guided transmural approach showing positive outcomes, but pediatric evidence is extremely limited." — Tom Lin (clinical) [Ep 5 · 43:34](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2614)
- "The added value of secretin-enhanced MRCP in pediatric pancreatitis is not well established; even adult literature shows limited evidence, though it may improve visualization of ductal anomalies in select cases." — Andrew Trout (opinion) [Ep 5 · 45:01](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2701)
- "ERCP has evolved from a purely diagnostic modality in the 1970s to a primarily therapeutic modality, with non-invasive imaging (MRCP, CT) now preferred for diagnostic purposes." — Tom Lin (host_summary) [Ep 5 · 47:34](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2854)
- "For pancreatic duct leak demonstrated on ERCP, therapeutic options include pancreatic sphincterotomy and pancreatic duct stent placement to direct flow along the path of least resistance and allow duct healing." — Tom Lin (clinical) [Ep 5 · 53:05](https://qa.library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=3185)
- "Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes." — Joe Palermo (host_summary) [Ep 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 28:47](https://qa.library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1727)
- "Acute pancreatitis could be fatal" — Juan Gurria (clinical) [Ep 13 · 1:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=116)
- "Bolus times 2 is adequate fluid resuscitation, with 1.5 times maintenance once past the early phase of acute resuscitation" — Juan Gurria (clinical) [Ep 13 · 1:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=118)
- "Pancreatitis is a state of hypoxia requiring re-establishment of intravascular flow to the pancreas to prevent hypoxia, necrosis, and atrophic pancreas insufficiency" — Juan Gurria (clinical) [Ep 13 · 2:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=126)
- "Early fluid resuscitation is key in pancreatitis management" — Juan Gurria (clinical) [Ep 13 · 2:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=142)
- "Excessive fluid administration worsens outcomes in pancreatitis" — Juan Gurria (clinical) [Ep 13 · 2:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=146)
- "There is no reason to give antibiotics for pancreatitis, even in the face of necrosis or necrotizing pancreatitis, unless there are signs of sepsis or infected pancreatitis" — Juan Gurria (guideline) [Ep 13 · 2:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=149)
- "The North American Society of Pancreatitis, GI Pathology, and Nutrition published a position paper with guideline recommendations for pancreatitis management" — Juan Gurria (guideline) [Ep 13 · 2:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=177)
- "Early fluids lead to better outcomes in pancreatitis" — Juan Gurria (clinical) [Ep 13 · 3:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=187)
- "Recommended fluid bolus is 10 to 20 mL per kg, up to 3L in the first 24 hours, with reassessment at the 12-hour mark using urine output and vital signs" — Juan Gurria (guideline) [Ep 13 · 3:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=191)
- "Excessive fluid administration can flood the lungs and worsen outcomes" — Juan Gurria (clinical) [Ep 13 · 3:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=205)
- "Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline in pancreatitis" — Juan Gurria (clinical) [Ep 13 · 3:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=225)
- "If albumin is low in pancreatitis patients, albumin should be given" — Juan Gurria (clinical) [Ep 13 · 3:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=234)
- "Enrique de Madaria conducted a multi-center worldwide RCT called the Waterfall trial comparing moderate versus aggressive fluid resuscitation in pancreatitis" — Juan Gurria (clinical) [Ep 13 · 3:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=238)
- "The Waterfall trial was stopped early because patients receiving too much fluid were developing organ failure" — Juan Gurria (clinical) [Ep 13 · 4:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=258)
- "A follow-up Waterland trial is underway to determine whether lactated Ringer's is better than normal saline, expected to be published in one to two years" — Juan Gurria (clinical) [Ep 13 · 4:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=267)
- "Patients with pancreatitis should be fed as soon as they are able to tolerate oral intake" — Juan Gurria (clinical) [Ep 13 · 4:47](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=287)
- "Enteral nutrition is significantly better compared to TPN or NPO in pancreatitis" — Juan Gurria (clinical) [Ep 13 · 4:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=291)
- "Gastric feeding is preferred over post-pyloric feeding in pancreatitis if the patient can tolerate it" — Juan Gurria (clinical) [Ep 13 · 4:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=297)
- "Some vomiting is tolerable during refeeding in pancreatitis, similar to gastroschisis management" — Juan Gurria (opinion) [Ep 13 · 5:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=319)
- "If nutrition is lost and the patient loses ground, outcomes will be worse, with dropping albumin and worse inflammatory reaction" — Juan Gurria (clinical) [Ep 13 · 5:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=326)
- "Outcomes are dramatically better when the gut is fed in pancreatitis patients" — Juan Gurria (clinical) [Ep 13 · 5:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=334)
- "Vitals are the main consideration for deciding whether a pancreatitis patient should go to the floor or ICU" (host_summary) [Ep 13 · 5:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=348)
- "Fluid resuscitation is key in pancreatitis management" — Cecilia Gigena (host_summary) [Ep 13 · 5:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=355)
- "Patients should be reassessed at the 12 and 24 hour mark to avoid fluid overload" — Cecilia Gigena (host_summary) [Ep 13 · 5:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=357)
- "Current publications suggest lactated Ringer's is better in reducing inflammatory response in pancreatitis" (host_summary) [Ep 13 · 6:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=367)
- "It is important to feed pancreatitis patients as soon as possible, specifically aiming to feed in the stomach" (host_summary) [Ep 13 · 6:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=377)
- "Every ERCP carries a risk of post-ERCP pancreatitis, and with every pancreatitis attack, islet cells are lost." — Juan Gurria (clinical) [Ep 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 15 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 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 14 · 7:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-chronic-pancreatitis-2023-8546?t=430)
- "Chile has the highest rate of cholelithiasis globally" — Jose Campos (epidemiological) [Ep 16 · 1:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=67)
- "In a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery" — Cecilia Gigena (host_summary) [Ep 16 · 3:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=191)
- "When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%" — Cecilia Gigena (host_summary) [Ep 16 · 3:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=216)
- "Even in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult" — Todd Ponsky (clinical) [Ep 16 · 3:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=224)
- "Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients" — Cecilia Gigena (host_summary) [Ep 16 · 4:27](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=267)
- "When patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes" — Todd Ponsky (clinical) [Ep 16 · 5:01](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=301)
- "If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones" — Todd Ponsky (clinical) [Ep 16 · 5:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=336)
- "A Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones" — Em Gootee (host_summary) [Ep 16 · 6:26](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=386)
- "The machine learning algorithm for predicting CBD stones has a negative predictive value of 98%, meaning only 2% chance of missing stones when algorithm predicts low risk" — Jose Campos (host_summary) [Ep 16 · 7:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=431)
- "The previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm" — Em Gootee (host_summary) [Ep 16 · 7:33](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=453)
- "For patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower" — Todd Ponsky (opinion) [Ep 16 · 8:58](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=538)
- "In a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach" — Cecilia Gigena (host_summary) [Ep 16 · 11:27](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=687)
- "Patients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP" — Cecilia Gigena (host_summary) [Ep 16 · 11:41](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=701)
- "The laparoscopic common bile duct exploration study included 4 centers with a broad range of surgeons, demonstrating feasibility beyond single expert centers" — Jose Campos (host_summary) [Ep 16 · 11:56](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=716)
- "Of patients who had ERCP after failed laparoscopic CBD exploration (14% of OR-first group), outcomes were good without increased bile duct leak or complications" — Jose Campos (host_summary) [Ep 16 · 12:15](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=735)
- "In the stepwise laparoscopic CBD exploration approach, 84% of patients had stones cleared with saline flush through a ureteral catheter alone" — Jose Campos (host_summary) [Ep 16 · 12:30](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=750)
- "In a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence" — Em Gootee (host_summary) [Ep 16 · 13:34](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=814)
- "The ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group" — Em Gootee (host_summary) [Ep 16 · 13:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=834)
- "The ICG study compared different time periods rather than contemporaneous groups, confounding the comparison with improvements in surgical skill and instruments over time" — Jose Campos (opinion) [Ep 16 · 14:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=865)
- "The ICG study combined all complications without separately reporting common bile duct injuries, and bleeding complications are unlikely attributable to presence or absence of ICG" — Jose Campos (opinion) [Ep 16 · 14:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=883)
- "A complication rate of zero in any surgical series raises methodological concerns" — Jose Campos (opinion) [Ep 16 · 14:57](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=897)
- "ICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram" — Todd Ponsky (clinical) [Ep 16 · 15:21](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=921)
- "The ICG study compared ICG to simple visualization without any imaging technique, not to intraoperative cholangiogram, making improved visualization an expected rather than surprising finding" — Jose Campos (opinion) [Ep 16 · 15:38](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=938)
- "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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 17 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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 18 · 8:47](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=527)
- "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." — Em Gootee (host_summary) [Ep 20 · 0:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=56)
- "In this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests." — Em Gootee (host_summary) [Ep 20 · 1:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=80)
- "The patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy." — Luke Neff (clinical) [Ep 20 · 1:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=91)
- "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." — Em Gootee (host_summary) [Ep 20 · 1:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=109)
- "From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away in gallstone pancreatitis." — Jeff Ponsky (clinical) [Ep 20 · 2:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=133)
- "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." (clinical) [Ep 20 · 2:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=145)
- "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." — David Vitale (clinical) [Ep 20 · 2:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=158)
- "Most stones can be cleared, some stones pass spontaneously, and good clinical judgment with local resources must be factored into management decisions." — Luke Neff (opinion) [Ep 20 · 2:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=179)
- "In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs." — Em Gootee (host_summary) [Ep 20 · 3:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=191)
- "For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention." — Em Gootee (host_summary) [Ep 20 · 3:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=202)
- "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." — Em Gootee (host_summary) [Ep 20 · 3:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-10735?t=213)
- "Stone disease is increasing along with obesity in pediatric patients around the world, not just in the United States." — Em Gootee (host_summary) [Ep 19 · 0:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=52)
- "There are two main approaches for patients with stones in the common bile duct who need gallbladder removal: ERCP first to remove ductal stones followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery." — Em Gootee (host_summary) [Ep 19 · 1:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=85)
- "The choice between surgery-first and ERCP-first depends on the setting in which you reside and your own technical capabilities." (opinion) [Ep 19 · 1:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=110)
- "A surgery-first pathway reduces resource utilization, including MRCP, according to recently published work." — Em Gootee (host_summary) [Ep 19 · 2:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=131)
- "A paper from the Journal of American College of Surgeons defined a very specific and predictive score for cholelithiasis." — Em Gootee (host_summary) [Ep 19 · 2:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=145)
- "ERCP adds potential morbidity to a procedure, and even with good technique, pancreatitis occurs 10% of the time." — Em Gootee (host_summary) [Ep 19 · 3:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=182)
- "If the surgeon cannot do a cholangiogram, then ERCP is needed if someone can do it." — Em Gootee (host_summary) [Ep 19 · 3:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=196)
- "If you know how to put in a central line and understand the principles of Seldinger technique, then you can do intraoperative stone removal." — Em Gootee (host_summary) [Ep 19 · 3:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=224)
- "In a paper published in JPS, stone clearance rate reflected by a negative intraoperative cholangiogram was 86% with a surgery-first mindset." — Em Gootee (host_summary) [Ep 19 · 3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=230)
- "With minor additional techniques like advancing the catheter into the common bile duct or reaming the sphincter, the success rate was in the 90s." — Em Gootee (host_summary) [Ep 19 · 4:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=241)
- "At Cincinnati Children's, when surgeons cannot clear the duct, they call from the OR and an ERCP can be performed quickly in most cases." — Em Gootee (host_summary) [Ep 19 · 4:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=278)
- "At institutions without access to immediate ERCP, surgeons can place a clip or endo loop, close up, and perform ERCP within the next day or two." — Em Gootee (host_summary) [Ep 19 · 4:47](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=287)
- "According to Doctor Huntington, the biggest key to success is having all the necessary equipment in one place, because no one in the OR is going to know what to get on the fly." — Em Gootee (host_summary) [Ep 19 · 5:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=315)
- "A common bile duct with 3 or 4 impacted stones is typically not suitable for surgery-first approach." — Em Gootee (host_summary) [Ep 19 · 5:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=326)
- "Doctor Vitale cautions that when flushing, if a stone is impacted, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis." — Em Gootee (host_summary) [Ep 19 · 6:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=363)
- "When the pancreatic duct lights up during flushing, that is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present." — Em Gootee (host_summary) [Ep 19 · 6:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=375)
- "A study demonstrated an 86% success rate for surgery-first, but the ERCP group had a 10% complication rate, including cholangitis, bleeding, pancreatitis, and hemophilia." — Em Gootee (host_summary) [Ep 19 · 6:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=393)
- "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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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)
- "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." — Em Gaudi (host_summary) [Ep 23 · 0:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=8)
- "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." — David Vitale (clinical) [Ep 23 · 0:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=53)
- "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." — David Vitale (opinion) [Ep 23 · 1:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=78)
- "Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy." — David Vitale (clinical) [Ep 23 · 1:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=87)
- "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." — Luke Neff (clinical) [Ep 23 · 1:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=99)
- "Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week." — Luke Neff (opinion) [Ep 23 · 2:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=127)
- "From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis." — Luke Neff (clinical) [Ep 23 · 2:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=135)
- "When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed." — David Vitale (clinical) [Ep 23 · 2:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=144)
- "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." — Luke Neff (clinical) [Ep 23 · 2:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=158)
- "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." — Luke Neff (clinical) [Ep 23 · 2:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=158)
- "Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment." — David Vitale (clinical) [Ep 23 · 2:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=179)
- "Local resources and what is available must be factored into management decisions for biliary stones." — David Vitale (opinion) [Ep 23 · 3:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=187)
- "In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs." — Em Gaudi (host_summary) [Ep 23 · 3:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=191)
- "For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention." — Em Gaudi (host_summary) [Ep 23 · 3:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=205)
- "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." — Em Gaudi (host_summary) [Ep 23 · 3:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-preventing-gallstone-pancreatitis-2024-13736?t=215)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 4 items hidden — never mention Pancreatitis; unhide from the owner view
- Aug 31: 24 doctors auto-found from episode dossiers
- Aug 30: 23 doctors auto-found from episode dossiers
- Aug 30: 23 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 27 doctors auto-found from episode dossiers
- Aug 29: 29 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 34 items, 29 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 30 items, 29 dossiers, summaries for 3 audience(s)
- Aug 29: Collection generated from campaign corpus: 30 items, 29 dossiers, summaries for 1 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai