Jaimie Nathan

110 statements · 6 topics

Featured statements

The number one prognostic factor for patients with pancreatoblastoma is complete surgical excision, whether that is at the initial presentation or following neoadjuvant chemotherapy.
quote · Pancreatic Tumors
We really have to consider degree of resection whenever we're considering removing a portion of the pancreas because we have to think about endocrine and exocrine needs long-term.
quote · Pancreatic Tumors
in the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.
quote · Acute Pancreatitis
we are loath, loathe to intervene.
quote · Acute Pancreatitis
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).
clinical · Acute Recurrent Pancreatitis
Sticking needles or drains into the pancreas risks introducing infection into sterile necrosis; intervention should be avoided unless there is true significant clinical deterioration.
opinion · Hirschsprung disease

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Jaimie's statements about Acute Pancreatitis 18 statements

Open the Acute Pancreatitis collection →

Acute Pancreatitis

Quotation we're not force feeding the kids. Exactly. We're not pushing feeds in the face of ongoing emesis. Open
Quotation you really, you can very much be opening a can of worms if you're starting to stick things into the pancreas. Open
Statement Sticking needles or drains into the pancreas risks introducing infection into sterile necrosis; intervention should be avoided unless there is true significant clinical deterioration. Open
Quotation we are loath, loathe to intervene. Open

Welcome and Introductions: Pancreatic Disease

Statement The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis Open
Quotation Anything you wanted to know about the pancreas, uh, and we'll spend the next 4 hours talking about surgical approaches. Open
Statement Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program Open
Statement 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 Open
Statement Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center Open
Statement 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 Open
Statement Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine Open
Statement Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event Open
Statement Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event Open
Quotation please we'd like to keep this, uh, uh, highly interactive, so, um, bring us your questions, bring us your comments, and, uh, we hope to be able to answer them. Open

Acute Pancreatitis

Quotation we're not force feeding the kids. We're not pushing feeds in the face of ongoing emesis. Open
Statement 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). Open
Quotation you really, you can very much be opening a can of worms if you're starting to stick things into the pancreas. Open
Quotation in the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains. Open
Jaimie's statements about Acute Recurrent Pancreatitis 14 statements

Open the Acute Recurrent Pancreatitis collection →

Welcome and Introductions: Pancreatic Disease

Quotation Anything you wanted to know about the pancreas, uh, and we'll spend the next 4 hours talking about surgical approaches. Open
Statement The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis Open
Statement Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program Open
Statement 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 Open
Statement Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center Open
Statement 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 Open
Statement Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine Open
Statement Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event Open
Statement Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event Open
Quotation please we'd like to keep this, uh, uh, highly interactive, so, um, bring us your questions, bring us your comments, and, uh, we hope to be able to answer them. Open

Acute Pancreatitis

Quotation we're not force feeding the kids. We're not pushing feeds in the face of ongoing emesis. Open
Statement 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). Open
Quotation you really, you can very much be opening a can of worms if you're starting to stick things into the pancreas. Open
Quotation in the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains. Open
Jaimie's statements about Hirschsprung disease 4 statements

Open the Hirschsprung disease collection →

Acute Pancreatitis

Quotation we're not force feeding the kids. Exactly. We're not pushing feeds in the face of ongoing emesis. Open
Quotation you really, you can very much be opening a can of worms if you're starting to stick things into the pancreas. Open
Statement Sticking needles or drains into the pancreas risks introducing infection into sterile necrosis; intervention should be avoided unless there is true significant clinical deterioration. Open
Quotation we are loath, loathe to intervene. Open
Jaimie's statements about Islet Cell / TPIAT 10 statements

Open the Islet Cell / TPIAT collection →

Welcome and Introductions: Pancreatic Disease

Statement The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis Open
Quotation Anything you wanted to know about the pancreas, uh, and we'll spend the next 4 hours talking about surgical approaches. Open
Statement Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program Open
Statement 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 Open
Statement Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center Open
Statement 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 Open
Statement Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine Open
Statement Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event Open
Statement Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event Open
Quotation please we'd like to keep this, uh, uh, highly interactive, so, um, bring us your questions, bring us your comments, and, uh, we hope to be able to answer them. Open
Jaimie's statements about Pancreatic Tumors 46 statements

Open the Pancreatic Tumors collection →

Pancreatic Masses

Statement Elevated lipase and elevated bilirubin suggest obstruction in the pancreatic head, which can be caused by neoplasms or more commonly in pediatrics by non-neoplastic findings such as autoimmune pancreatitis or complications of pancreatitis. Open
Statement Pancreatoblastoma is the most common malignant pancreatic tumor in children, typically presenting in patients less than 10 years of age. Open
Statement In pancreatoblastoma, alpha-fetoprotein is elevated in up to 80% of cases. Open
Statement Up to 45-50% of pancreatoblastoma cases present with metastases. Open
Statement Pancreatoblastomas respond well to chemotherapy with a cisplatin and doxorubicin-based regimen. Open
Quotation The number one prognostic factor for patients with pancreatoblastoma is complete surgical excision, whether that is at the initial presentation or following neoadjuvant chemotherapy. Open
Statement The number one prognostic factor for pancreatoblastoma is complete surgical excision, whether at initial presentation or following neoadjuvant chemotherapy. Open
Statement Solid pseudopapillary neoplasms are more common in young female patients, typically in their second or third decade of life. Open
Statement Solid pseudopapillary tumors are indolent and slow-growing, often presenting with very large masses in the body and tail of the pancreas. Open
Quotation You really actually want to avoid enucleation or simply biopsy of these lesions. There tends to be a high recurrence rate if you're simply trying to enucleate these lesions. Open
Statement Enucleation or simple biopsy of solid pseudopapillary neoplasms should be avoided due to high recurrence rates; complete surgical resection is required. Open
Statement Solid pseudopapillary neoplasms have a recurrence rate of up to 10% but excellent long-term survival with 95% 10-year survival. Open
Statement Neuroendocrine tumors make up about 1-2% of all pancreatic tumors and can be either benign adenomas or malignant carcinomas. Open
Statement Neuroendocrine tumors tend to present in children over 10 years of age, though they are more common in middle-aged patients. Open
Statement In 10% of patients, neuroendocrine tumors may present in the setting of multiple endocrine neoplasia type 1, von Hippel-Lindau, or tuberous sclerosis. Open
Statement Insulinoma is the most common neuroendocrine tumor, accounting for almost 50% of pancreatic neuroendocrine tumors, followed by gastrinomas at 30%. Open
Statement Insulinomas are typically benign; 6% can be malignant. 90% are solitary, 10% are associated with MEN1. Open
Statement Insulinomas present with Whipple's triad: symptoms of hypoglycemia, low fasting blood glucose, and symptom resolution with glucose administration. Open
Statement On imaging, a solid lesion in the pancreas is more worrisome than a cystic lesion when found incidentally. Open
Statement Ultrasound is low cost and easily accessible but the pancreas is often suboptimally visualized and characterization of pancreatic masses is poor. Open
Statement CT scan is rapidly acquired with good resolution but has downsides of radiation and need for contrast; it is often used for solid tumor staging. Open
Statement MRI provides better differentiation between solid and cystic or fluid components and can better characterize components of a pancreatic mass. Open
Quotation We can really never confidently differentiate a benign versus a malignant lesion of the pancreas simply with cross-sectional imaging, whether it be CT scan or MRI. Open
Statement Cross-sectional imaging (CT or MRI) cannot confidently differentiate a benign versus malignant pancreatic lesion. Open
Statement A completely cystic pancreatic lesion is less concerning for malignancy, but if the mass has solid components, it becomes more concerning for neoplasm. Open
Statement Pediatric EUS is not practical in many institutions because there are not many practitioners in the pediatric GI community comfortable with pediatric EUS. Open
Statement In the pediatric realm, autoimmune pancreatitis is more common than pancreatic neoplasm. Open
Statement With negative biliary cytology and after biliary and pancreatic duct stenting, a four-week steroid trial with taper can be initiated for presumed autoimmune pancreatitis, even if IgG4 findings are normal. Open
Statement Type 1 autoimmune pancreatitis is IgG4-mediated; type 2 autoimmune pancreatitis is IgG4-negative. Open
Statement Autoimmune pancreatitis with a pancreatic head mass is typically very steroid responsive, with rapid resolution of the mass in most cases. Open
Statement For malignant pancreatic head lesions, a radical resection (Whipple pancreaticoduodenectomy) is required; for benign or borderline benign lesions, duodenum-preserving pancreatic head resections (Beger or Berne procedures) may be considered. Open
Quotation We really have to consider degree of resection whenever we're considering removing a portion of the pancreas because we have to think about endocrine and exocrine needs long-term. Open
Statement Studies report up to about a 10% risk of diabetes (endocrine impairment) after just a distal pancreatectomy in the setting of otherwise normal pancreas. Open
Statement Enucleation may be appropriate for pancreatic neuroendocrine tumors but should be used sparingly; it is not recommended for solid pseudopapillary neoplasms due to higher recurrence risk. Open
Quotation The literature is actually replete with cases of these masquerades and mimicking. Open
Statement Type 1 autoimmune pancreatitis is IgG4-related systemic disease involving multiple organs (sialoadenitis, sclerosing cholangitis, retroperitoneal fibrosis) and responds quickly to steroids; IgG4 levels are elevated in 90% of patients. Open
Statement Type 2 autoimmune pancreatitis is pancreas-specific with normal IgG4 levels; 30% of patients also have IBD. Histology shows idiopathic duct-centric pancreatitis. Open
Statement Over 90% of children with autoimmune pancreatitis present with abdominal pain; about 40% present with obstructive jaundice. Open
Statement Positive serologies for IgG4 are described in only 22% of children with autoimmune pancreatitis in one study. Open
Statement In pediatric autoimmune pancreatitis, focal enlargement in the pancreatic head occurs in about 50% of patients; global pancreatic enlargement in 30%; main pancreatic duct irregularity in two-thirds; common bile duct strictures in 55%; and the capsule-like rim sign in only 16%. Open
Statement 93% of pediatric patients with autoimmune pancreatitis respond to steroids, indicating very steroid-responsive disease. Open
Statement Autoimmune pancreatitis in children more commonly follows a type 2 presentation rather than type 1 or IgG4-related presentation, based on data from the INSPIRE consortium and European pancreatic consortium. Open
Statement Ideally, a tissue diagnosis should be obtained before initiating therapy for autoimmune pancreatitis, but barriers in pediatrics (limited EUS-skilled endoscopists and pathologists, inadequate biopsies) often cannot be overcome. Open
Statement The diagnosis of autoimmune pancreatitis in children can be made with a combination of clinical and imaging findings because the risk of pediatric neoplasm is lower than autoimmune pancreatitis. Open
Statement Clinical response to corticosteroid therapy for autoimmune pancreatitis should be seen within a few weeks; imaging response should be anticipated after about three months. Open
Quotation You don't want to keep treating something that ends up being a pancreatic neoplasm with steroids. Open
Jaimie's statements about Pancreatitis 18 statements

Open the Pancreatitis collection →

Acute Pancreatitis

Quotation we're not force feeding the kids. Exactly. We're not pushing feeds in the face of ongoing emesis. Open
Quotation you really, you can very much be opening a can of worms if you're starting to stick things into the pancreas. Open
Statement Sticking needles or drains into the pancreas risks introducing infection into sterile necrosis; intervention should be avoided unless there is true significant clinical deterioration. Open
Quotation we are loath, loathe to intervene. Open

Welcome and Introductions: Pancreatic Disease

Statement The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis Open
Quotation Anything you wanted to know about the pancreas, uh, and we'll spend the next 4 hours talking about surgical approaches. Open
Statement Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program Open
Statement 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 Open
Statement Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center Open
Statement 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 Open
Statement Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine Open
Statement Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event Open
Statement Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event Open
Quotation please we'd like to keep this, uh, uh, highly interactive, so, um, bring us your questions, bring us your comments, and, uh, we hope to be able to answer them. Open

Acute Pancreatitis

Quotation we're not force feeding the kids. We're not pushing feeds in the face of ongoing emesis. Open
Statement 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). Open
Quotation you really, you can very much be opening a can of worms if you're starting to stick things into the pancreas. Open
Quotation in the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains. Open