Andrew Trout

Andrew's statements about Acute Pancreatitis 22 statements

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Acute Pancreatitis

Statement 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. Open

Statement 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. Open

Quotation the pancreas can be a little bit difficult to see sometimes. Especially in larger patients Open

Statement 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. Open

Statement 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. Open

Statement On contrast-enhanced CT, absent enhancement in pancreatic tissue is highly concerning for necrosis. Open

Statement 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. Open

Statement 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. Open

Quotation when you have it's. Often in the chronic pancreatitic patients or the acute recurrence that we're doing these MR exams and they've had enough attacks that generally the ducts dilated and you can see it without secretin Open

Acute and Acute Recurrent Pancreatitis: Pancreatic Disease

Statement 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. Open

Quotation I mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible. Open

Statement 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. Open

Statement 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. Open

Statement 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. Open

Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease

Statement MR pancreatic function testing acquires identical imaging both prior to and following secretin administration, with about 15 minutes between pre and post imaging Open

Statement MR sequences can be thresholded to quantify the volume of fluid secreted in response to secretin by subtracting pre from post measurements Open

Statement In chronic pancreatitis patients with dilated and abnormal ducts at baseline, it is unclear whether secretin is needed to increase conspicuity of the duct Open

Acute Pancreatitis

Statement 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. Open

Statement 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. Open

Quotation when we see absent enhancement like that, that's highly concerning for necrosis within the. Pancreas. Open

Statement Absent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis. Open

Statement 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. Open

Andrew's statements about Acute Recurrent Pancreatitis 53 statements

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Acute and Acute Recurrent Pancreatitis: Pancreatic Disease

Statement 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. Open

Quotation I mean unfortunately the pancreas can be a little bit difficult to see sometimes. Especially in larger patients and as you say, in patients that are NPO, if you've got a stomach full of gas or if you have an ileus because there's a real inflammatory process going on, all that bowel gas can really affect the penetration of the ultrasound waves and make the pancreas non-visible. Open

Statement 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. Open

Statement 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. Open

Statement 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. Open

Function Tests & Pain Management: Pancreatic Disease

Quotation What we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing is to non-invasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing. Open

Statement MR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract. Open

Statement The delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation. Open

Statement MR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume. Open

Quotation We've proven that we can accurately quantitate fluid by measuring phantoms, so you can put phantoms in the MR scanner and you can prove that you can actually quantitate the fluid. Open

Statement Phantom studies have proven that MR can accurately quantitate fluid volume. Open

Statement Preliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing. Open

Statement Qualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency. Open

Quotation The qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt, and so it may be that there's a size dependency, a weight dependency. Open

Statement 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. Open

Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease

Quotation What we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing, is to noninvasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing. Open

Statement 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. Open

Quotation What we're trying to do here at Cincinnati Children's with the MRPFTs or MR pancreatic function testing, is to noninvasively accomplish or at least simulate what's going on with the endoscopic pancreatic function testing. Open

Statement 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. Open

Quotation We acquire identical imaging both prior to and following administration of secretin. So there's a question earlier about use of secretin and MRCP. This is our primary means of using Secretin or the main reason that we use Secretin for MRCP. Open

Statement In the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation. Open

Quotation The way our protocol is set up, it's about 15 minutes between pre and post. You give the amount, about 15 minutes for that fluid to accumulate. Open

Statement In the MRPFT protocol, there is about a 15-minute delay between pre- and post-secretin imaging to allow fluid accumulation. Open

Statement MRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid. Open

Quotation You take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin. Open

Statement MRPFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin fluid from post-secretin fluid. Open

Quotation You take your pre-image, you quantify your fluid on there, you take your post image, quantify your fluid there, subtract pre from post, and you have your secreted fluid volume in response to secretin. Open

Statement Correlation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients. Open

Quotation We are looking at that right now. That's, that's the big question. So we've done several steps to get ourselves on the way here. We've proven that we can accurately quantitate fluid. Open

Statement Correlation between MRPFT volumetric analysis and endoscopic pancreatic function testing is under study in about 35 patients. Open

Quotation We have some preliminary data in about 35 patients where we have been looking at the correlation between the secretin function, the endoscopic pancreatic function testing. Open

Quotation The qualitative assessment seems to be different between pediatric and adult patients, at least in my gestalt. And so it may be that there's a size dependency, a weight dependency, and so we're still figuring those sorts of things out. Open

Statement Qualitative assessment of exocrine function by MRPFT may differ between pediatric and adult patients, possibly due to size or weight dependency. Open

Statement 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. Open

Quotation In a patient with an abnormal duct, does that dilation add anything? I get it. I think there is a subset of patients where it probably does and there's a subset of patients where it probably doesn't, and that still needs to be teased and figured out. Open

Acute Pancreatitis

Statement 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. Open

Statement 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. Open

Statement Absent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis. Open

Quotation when we see absent enhancement like that, that's highly concerning for necrosis within the. Pancreas. Open

Statement 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. Open

Andrew's statements about Chronic Pancreatitis 30 statements

Open the Chronic Pancreatitis collection →