Jonathan Roach

50 statements · 1 topic

Featured statements

Alpha one antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively.

quote · Biliary Atresia

We consider a direct bilirubin that is greater than 20% of the total or greater than 1.0 to prompt further workup for biliarytresia.

quote · Biliary Atresia

Nothing matches these filters — clear the search or widen the filters.

Jonathan's statements about Biliary Atresia 50 statements

Open the Biliary Atresia collection →

Error Traps and Culture of Safety in Biliary Atresia

Quotation The first potential error trap in biliary tresia is not considering biliary tresia in the differential diagnosis of any newborn greater than 2 weeks of life with hyperbilirubinemia. Open

Statement The first potential error trap in biliary atresia is not considering biliary atresia in the differential diagnosis of any newborn greater than 2 weeks of life with hyperbilirubinemia. Open

Quotation The first potential error trap in biliary tresia is not considering biliary tresia in the differential diagnosis of any newborn greater than 2 weeks of life with hyperbilirubinemia. Open

Statement The first potential error trap in biliary atresia is not considering biliary atresia in the differential diagnosis of any newborn greater than 2 weeks of life with hyperbilirubinemia. Open

Quotation We consider a direct bilirubin that is greater than 20% of the total or greater than 1.0 to prompt further workup for biliarytresia. Open

Statement A direct bilirubin greater than 20% of the total or greater than 1.0 prompts further workup for biliary atresia. Open

Quotation We consider a direct bilirubin that is greater than 20% of the total or greater than 1.0 to prompt further workup for biliarytresia. Open

Statement A direct bilirubin greater than 20% of the total or greater than 1.0 prompts further workup for biliary atresia. Open

Statement Alpha-1 antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively. Open

Quotation Alpha one antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively. Open

Statement Alpha-1 antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively. Open

Quotation Alpha one antitrypsin deficiency needs to be ruled out prior to proceeding to the operating room, as this can be a confusing picture intraoperatively. Open

Statement Ultrasounds are obtained on all biliary atresia patients to look for abnormalities in the gallbladder as well as the triangular cord sign. Open

Statement Findings on liver biopsy pathology such as bridging fibrosis, bile duct plugging, and proliferation of bile ducts are all suggestive of biliary atresia. Open

Statement If workup is suggestive of biliary atresia, there is no need to wait for the result of every esoteric test prior to proceeding to the operating room. Open

Quotation This is because age at the time of Kasai is the primary determinant of outcome in these patients. Open

Statement Age at the time of Kasai is the primary determinant of outcome in biliary atresia patients. Open

Quotation This is because age at the time of Kasai is the primary determinant of outcome in these patients. Open

Statement Some gallbladders in biliary atresia do not have lumen, and in these patients further exploration and likely Kasai will proceed. Open

Statement To avoid contrast extravasation during cholangiogram, the technique involves mobilizing the gallbladder off the gallbladder fossa, amputating the dome of the gallbladder, inserting the cholangiography catheter directly into the lumen, and tying it off with a silk ligature. Open

Statement Vascular variants in biliary atresia may include a preduodenal portal vein, which is rare. Open

Statement More commonly but still rare are confusing branching patterns of the hepatic artery and the portal vein in biliary atresia. Open

Statement It is recommended to carry out dissection to the secondary branching of the right and left hepatic arteries, but sometimes this branching can be quite early and dissection needs to occur up to the substance of the liver. Open

Statement The most reliable determinant of where the hilar plate exists is between the bifurcation of the right and left portal vein. Open

Quotation The most reliable determinant of where the hilar plate exists is between the bifurcation of the right and left portal vein. Open

Statement It is important to dissect the fibrous cone of the biliary remnants down into the bifurcation of the portal vein where small portal branches must be tied off. Open

Statement The transection plane of the biliary remnants should be flush with the capsule of the liver so as not to dissect into the substance of the liver nor remain too shallow into the fibrous cone. Open

Statement Due to the results of the START trial, steroids are no longer routinely used in post-Kasai care. Open

Quotation Due to the results of the START trial, we no longer routinely use steroids in our post-operative care. Open

Statement The use of antibiotics prophylactically to prevent cholangitis after Kasai is a controversial topic. Open

Statement Prophylactic antibiotics are currently used on all patients after Kasai at the speaker's institution. Open

Statement Biliary atresia patients require long-term follow-up care either with the pediatric surgeon or with the pediatric hepatologist. Open