# Acute Pancreatitis — GCMD Library living collection Everything in the library about acute pancreatitis — built automatically from dossiers that name it. Updated: n/a · 11 episodes · 312 cited statements ## Episodes ### Fundamentals - [Welcome and Introductions: Pancreatic Disease](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969) — video · 6:04 · [machine version](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969.md) ### Acute Management - [Acute Pancreatitis](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871) — podcast · 45:24 · [machine version](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871.md) - [Misconceptions of Acute Pancreatitis: Pancreatic Disease](https://origin-library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974) — video · 2:28 · [machine version](https://origin-library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974.md) - [Acute Pancreatitis](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293) — podcast · 45:24 · [machine version](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293.md) ### Surgical Management - [Endoscopic & Surgical Interventions: Pancreatic Disease](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972) — video · 55:54 · [machine version](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972.md) - [Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849) — video · 1:06:03 · [machine version](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849.md) ### Case-Based Learning - [ERCP: Pancreatic Disease](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967) — video · 9:11 · [machine version](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967.md) - [Update Course Rewind: Management of Acute Pancreatitis 2023](https://origin-library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523) — video · 6:46 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523.md) ### In-Depth Reviews - [Acute and Acute Recurrent Pancreatitis: Pancreatic Disease](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970) — video · 56:45 · [machine version](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970.md) - [Pancreas Care Updates 2020 - FULL SHOW](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381) — video · 2:04:44 · [machine version](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381.md) - [Update Course 2023 - Updates in Pancreatitis](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269) — video · 32:50 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269.md) ## Chapters - [0:00](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=0) Introduction and Series Context (Ep 8) - [1:23](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=83) Case Presentation and Diagnostic Criteria (Ep 8) - [4:25](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=265) Pain Management in Acute Pancreatitis (Ep 8) - [7:02](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=422) Nutrition Management: NPO vs. Early Feeding (Ep 8) - [14:29](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=869) Enteral vs. Parenteral Nutrition and Fat Intake (Ep 8) - [17:29](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1049) IV Fluid Resuscitation Strategy (Ep 8) - [21:58](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1318) Standardized Order Sets and Case Outcome (Ep 8) - [24:50](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1490) Case Recurrence and Imaging for Complications (Ep 8) - [28:15](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1695) CT Findings and Prognostic Markers (Ep 8) - [31:08](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1868) Management of Complicated Pancreatitis (Ep 8) - [36:15](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=2175) Workup for Acute Recurrent Pancreatitis (Ep 8) - [42:04](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=2524) Endoscopic Necrosectomy and Closing Remarks (Ep 8) - [0:00](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=0) Introduction and Series Context (Ep 1) - [1:23](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=83) Case Presentation and Diagnostic Criteria (Ep 1) - [4:24](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=264) Pain Management in Acute Pancreatitis (Ep 1) - [7:02](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=422) Nutrition Management: NPO Duration and Early Feeding (Ep 1) - [14:29](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=869) Enteral Versus Parenteral Nutrition and Fat Intake (Ep 1) - [17:29](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=1049) IV Fluid Resuscitation Strategy (Ep 1) - [22:51](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=1371) Standardized Order Set and Patient Outcome (Ep 1) - [24:50](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=1490) Case Recurrence and Imaging for Complications (Ep 1) - [28:15](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=1695) Necrotizing Pancreatitis: Diagnosis and Prognostication (Ep 1) - [31:52](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=1912) Management of Complicated Pancreatitis (Ep 1) - [35:27](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=2127) Acute Recurrent Pancreatitis: Definition and Workup (Ep 1) - [38:17](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=2297) Interventional Approaches and Necrosectomy (Ep 1) - [42:11](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=2531) Advanced Imaging and BMI as Risk Factor (Ep 1) - [44:40](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-871?t=2680) Closing Remarks (Ep 1) - [0:00](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=0) Introduction to ERCP in Acute Pancreatitis and Case Presentation (Ep 2) - [1:39](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=99) Initial CT Imaging Findings (Ep 2) - [2:37](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=157) Clinical Course and Follow-up Ultrasound (Ep 2) - [3:50](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=230) ERCP Findings and Therapeutic Intervention (Ep 2) - [5:54](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=354) Follow-up ERCP and Treatment Success (Ep 2) - [7:10](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=430) Poll Results Discussion and Session Conclusion (Ep 2) - [0:00](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=0) Welcome, Housekeeping, and Event Introduction (Ep 3) - [3:33](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=213) Course Director Introduction and Faculty Panel Presentation (Ep 3) - [0:00](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=0) Definitions and diagnostic criteria for acute pancreatitis (Ep 5) - [3:20](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=200) Initial imaging approach and case presentation (Ep 5) - [6:07](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=367) Pain management and imaging modalities (Ep 5) - [9:11](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=551) Nutritional management and evidence for early feeding (Ep 5) - [18:20](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1100) IV fluid resuscitation strategies (Ep 5) - [24:20](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1460) Standardized order sets and outcomes (Ep 5) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - 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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 3:00](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 2:40](https://origin-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 1 · 2:09](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 2:23](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 4:03](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 6:21](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 6:35](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 9:03](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 9:32](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 13:19](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 14:29](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 15:28](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 12:41](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 19:02](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 19:45](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 20:18](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 23:48](https://origin-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 1 · 28:19](https://origin-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 1 · 28:41](https://origin-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 1 · 29:51](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 30:31](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 31:20](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 32:32](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 33:08](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 5:15](https://origin-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. — Maisam Abu-El-Haija (guideline) [Ep 1 · 34:34](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 1 · 35:31](https://origin-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 1 · 41:01](https://origin-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. — Jaimie Nathan (opinion) [Ep 1 · 39:16](https://origin-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 1 · 25:33](https://origin-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 1 · 34:03](https://origin-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 1 · 42:34](https://origin-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. — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 43:35](https://origin-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). — Maisam Abu-El-Haija (epidemiological) [Ep 1 · 43:58](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 3:02](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 2:40](https://origin-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 8 · 2:09](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 4:03](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 6:21](https://origin-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. — Maisam Abu-El-Haija (opinion) [Ep 8 · 6:27](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 9:03](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=543) - 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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 14:29](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 15:28](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=928) - 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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 19:45](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1185) - 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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 24:10](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 5:00](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 5:28](https://origin-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 8 · 28:19](https://origin-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 8 · 29:51](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 30:31](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 31:20](https://origin-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). — Maisam Abu-El-Haija (clinical) [Ep 8 · 32:32](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 33:08](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1988) - 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). — Maisam Abu-El-Haija (clinical) [Ep 8 · 35:37](https://origin-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). — Jaimie Nathan (clinical) [Ep 8 · 38:49](https://origin-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 8 · 41:12](https://origin-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 8 · 42:34](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 43:25](https://origin-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. — Maisam Abu-El-Haija (clinical) [Ep 8 · 43:58](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=2638) - ERCP was introduced in the 1970s as a purely diagnostic modality (clinical) [Ep 2 · 0:10](https://origin-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 2 · 0:10](https://origin-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 2 · 0:10](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=10) - CT provides value in complex cases and complex patients for pancreatic imaging (clinical) [Ep 2 · 1:39](https://origin-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 2 · 1:49](https://origin-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 2 · 2:00](https://origin-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 2 · 3:05](https://origin-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 2 · 3:05](https://origin-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 2 · 3:27](https://origin-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 2 · 4:26](https://origin-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 2 · 5:30](https://origin-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 2 · 6:22](https://origin-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 2 · 6:42](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402) - ERCP is invasive and has the potential to exacerbate pancreatitis (clinical) [Ep 2 · 6:42](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=402) - The goal of ERCP in this setting is to be therapeutic (clinical) [Ep 2 · 6:42](https://origin-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 2 · 8:19](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499) - Continuing conservative management was not acceptable to the family (clinical) [Ep 2 · 8:19](https://origin-library.globalcastmd.com/watch/ercp-pancreatic-disease-967?t=499) - A patient with an enlarging collection is potentially failing watchful waiting (clinical) [Ep 2 · 8:40](https://origin-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 3 · 0:28](https://origin-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 3 · 1:22](https://origin-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 3 · 1:27](https://origin-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 3 · 2:00](https://origin-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 3 · 2:38](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=158) - The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis — Jaimie Nathan (clinical) [Ep 3 · 3:38](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 4:05](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 4:23](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 4:40](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 4:54](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 5:17](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 5:33](https://origin-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 — Jaimie Nathan (clinical) [Ep 3 · 5:47](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=347) - Data on opioids causing sphincter of Oddi spasm and worsening pancreatitis is conflicting. (clinical) [Ep 4 · 0:29](https://origin-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 4 · 0:40](https://origin-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 4 · 1:07](https://origin-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 4 · 1:10](https://origin-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 4 · 1:10](https://origin-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 4 · 1:23](https://origin-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 4 · 1:36](https://origin-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 4 · 1:49](https://origin-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 4 · 1:54](https://origin-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 4 · 2:17](https://origin-library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=137) - 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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=616) - 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://origin-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://origin-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://origin-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://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=883) - 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://origin-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://origin-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://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2131) - 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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-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://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2701) - 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://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=3185) - 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 9 · 0:35](https://origin-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 9 · 3:55](https://origin-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 9 · 4:19](https://origin-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 9 · 4:39](https://origin-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 9 · 4:42](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=282) - 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 9 · 6:21](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=381) - 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 9 · 9:24](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=564) - 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 9 · 10:19](https://origin-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 9 · 11:02](https://origin-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 9 · 12:13](https://origin-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 9 · 14:59](https://origin-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 9 · 15:23](https://origin-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 9 · 15:32](https://origin-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 9 · 15:48](https://origin-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 9 · 16:06](https://origin-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 9 · 16:33](https://origin-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 9 · 14:38](https://origin-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 9 · 14:44](https://origin-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 9 · 14:59](https://origin-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 9 · 20:59](https://origin-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 9 · 21:07](https://origin-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 9 · 21:12](https://origin-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 9 · 21:36](https://origin-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 9 · 21:48](https://origin-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 9 · 22:08](https://origin-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 9 · 24:08](https://origin-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 9 · 19:08](https://origin-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 9 · 19:22](https://origin-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 9 · 24:40](https://origin-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 9 · 25:07](https://origin-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 9 · 27:05](https://origin-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 9 · 27:32](https://origin-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 9 · 29:33](https://origin-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 9 · 29:59](https://origin-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 9 · 30:20](https://origin-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 9 · 26:32](https://origin-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 9 · 27:00](https://origin-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 9 · 31:10](https://origin-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 9 · 31:58](https://origin-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 9 · 32:23](https://origin-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 9 · 28:47](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=1727) - Acute pancreatitis could be fatal — Juan Gurria (clinical) [Ep 10 · 1:56](https://origin-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 10 · 1:58](https://origin-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 10 · 2:06](https://origin-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 10 · 2:22](https://origin-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 10 · 2:26](https://origin-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 10 · 2:29](https://origin-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 10 · 2:57](https://origin-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 10 · 3:07](https://origin-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 10 · 3:11](https://origin-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 10 · 3:25](https://origin-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 10 · 3:45](https://origin-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 10 · 3:54](https://origin-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 10 · 3:58](https://origin-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 10 · 4:18](https://origin-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 10 · 4:27](https://origin-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 10 · 4:47](https://origin-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 10 · 4:51](https://origin-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 10 · 4:57](https://origin-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 10 · 5:19](https://origin-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 10 · 5:26](https://origin-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 10 · 5:34](https://origin-library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=334) - 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 11 · 5:44](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=344) - In the Cincinnati Children's cohort of 1000 pediatric pancreatitis patients, 85% have genetic mutations. — Juan Gurria (epidemiological) [Ep 11 · 7:23](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 8:01](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=481) - Medications including L-asparaginase, steroids, valproic acid, and diuretics (Lasix) can cause pancreatitis in children. — Juan Gurria (clinical) [Ep 11 · 8:37](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 9:32](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 10:15](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=615) - Early necrosectomies (before 4 weeks) usually increase mortality. — Juan Gurria (clinical) [Ep 11 · 18:40](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 19:49](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=1189) - Asymptomatic pseudocysts, regardless of size, do not require intervention. — Juan Gurria (clinical) [Ep 11 · 21:36](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 23:29](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=1409) - In pediatric patients with hereditary pancreatitis or hereditary plus anatomic abnormalities, half will develop chronic pancreatitis. — Juan Gurria (epidemiological) [Ep 11 · 25:13](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 26:50](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 27:43](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 28:37](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 28:57](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 25:38](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 37:54](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 39:00](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 40:28](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 43:42](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 43:15](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 45:16](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 46:27](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=2787) - TPIAT is performed under anticoagulation (heparin) to prevent portal vein thrombosis during islet infusion. — Juan Gurria (clinical) [Ep 11 · 47:39](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=2859) - Portal vein thrombosis rate at Cincinnati Children's is less than 1% for TPIAT. — Juan Gurria (clinical) [Ep 11 · 48:11](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=2891) - Cincinnati Children's has performed close to 200 TPIAT cases with no anastomotic leaks. — Juan Gurria (clinical) [Ep 11 · 48:26](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=2906) - Patients are extubated in the operating room after TPIAT. — Juan Gurria (clinical) [Ep 11 · 50:07](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=3007) - Younger children are more likely to achieve insulin independence and opioid independence after TPIAT. — Juan Gurria (clinical) [Ep 11 · 51:32](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 52:25](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=3145) - 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 11 · 54:59](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-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 11 · 56:09](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=3369) - The Atlanta criteria classification scheme was described for adult patients and specifically did not consider pediatric patients, though it appears to hold true when extrapolated to the pediatric population. (guideline) [Ep 6 · 27:16](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1636) - When draining pseudocysts through the GI tract endoscopically, it is important to evaluate the pancreatic duct status before removing catheters to check for communication, ductal disruption, or stricture. — Milton Smith (clinical) [Ep 6 · 10:59](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=659) - Endoscopic drainage catheters are generally left in place for about 1 month to 6 weeks with repeat imaging before removal. — Milton Smith (clinical) [Ep 6 · 10:59](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=659) - After cystgastrostomy catheter removal, the fistula typically closes within a few days, even if there is ongoing pancreatic duct leak, because the flow is usually not brisk enough to keep it open. — Milton Smith (clinical) [Ep 6 · 15:43](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=943) - Puestow is typically considered for isolated large duct disease or chain-of-lakes appearance without an inflammatory mass in the head of the pancreas, and typically not in hereditary pancreatitis. — Todd Ponsky (clinical) [Ep 6 · 46:40](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2800) - Whipple is uncommonly considered in children with head-predominant pancreatic disease and is reserved primarily for cases with suspected malignancy. — Todd Ponsky (clinical) [Ep 6 · 52:58](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=3178) - Patients who undergo Puestow followed by total pancreatectomy have compromised islet yield compared to those who undergo total pancreatectomy without prior Puestow. — Todd Ponsky (clinical) [Ep 6 · 40:44](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2444) - In children with genetic etiology of pancreatitis, we are less likely to consider resectional and drainage procedures because the genetic makeup of the remaining pancreas will not change. — Todd Ponsky (opinion) [Ep 6 · 52:34](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=3154) - Genetics is involved in about 70% of chronic pancreatitis patients in the pediatric population. (epidemiological) [Ep 6 · 52:34](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=3154) - When considering whether a patient may need total pancreatectomy in the future, this significantly influences the decision to pursue conventional surgical options versus proceeding directly to TPIAT. — Todd Ponsky (opinion) [Ep 6 · 42:36](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2556) - Percutaneous drainage was chosen over repeat EUS cystgastrostomy for the mediastinal pseudocyst in Case 2 because introducing a stomach-to-pseudocyst connection might create more retroperitoneal scarring and make the planned TPIAT more challenging. — Todd Ponsky (clinical) [Ep 6 · 14:36](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=876) - Taking out the tail of the pancreas for a distal duct leak in a child with genetic pancreatitis would compromise islet yield if the patient needs total pancreatectomy in the future. — Todd Ponsky (clinical) [Ep 6 · 14:36](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=876) - Intraoperative ultrasound can be used during Beger procedure to locate the bile duct, and sometimes the duct can be found by sticking a needle into it under ultrasound guidance. — Todd Ponsky (clinical) [Ep 6 · 51:39](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=3099) - Acute pancreatitis is diagnosed when the patient has 2 out of 3 criteria: classic epigastric pain, lipase or amylase 3 times the upper limit of normal, and imaging findings. — Maisam Abu El Haija (guideline) [Ep 7 · 5:15](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=315) - Acute recurrent pancreatitis is defined as having more than 1 attack, typically separated by a 1 month free interval, but could be less than 1 month if there is normalization of enzymes and a pain-free period. — Maisam Abu El Haija (guideline) [Ep 7 · 5:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=330) - Chronic pancreatitis requires imaging findings plus one of three: abdominal pain consistent with pancreatic origin, evidence of exocrine insufficiency, or endocrine insufficiency. — Maisam Abu El Haija (guideline) [Ep 7 · 6:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=360) - New cases of acute pancreatitis have an incidence in the United States of 1 in 10,000 cases, with up to a third developing recurrent attacks. — Maisam Abu El Haija (epidemiological) [Ep 7 · 6:35](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=395) - Chronic pancreatitis in the young population has an incidence of up to 2 per 100,000. — Maisam Abu El Haija (epidemiological) [Ep 7 · 6:45](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=405) - For CT of the pancreas in both chronic and acute pancreatitis, intravenous contrast should always be used because it provides the detail needed for imaging pancreatic parenchyma and vessels. — Andrew Trout (clinical) [Ep 7 · 8:05](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=485) - A single phase portal venous phase CT is almost always sufficient for pancreatic imaging; non-contrast phase is not needed as calcific pancreatitis is uncommon in pediatrics. — Andrew Trout (clinical) [Ep 7 · 8:25](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=505) - MRI provides the best combination of parenchymal and duct detail for pancreas imaging and is the cross-sectional test of choice. — Andrew Trout (clinical) [Ep 7 · 10:55](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=655) - Secretin administration during MRI improves conspicuity of pancreas divisum and is most helpful in patients with non-dilated ducts for characterizing ductal abnormalities. — Andrew Trout (clinical) [Ep 7 · 11:25](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=685) - Ultrasound is the first line test of choice in acute pancreatitis, but is only moderately sensitive; CT or MRI should be used when complications are suspected or diagnosis cannot be confirmed. — Andrew Trout (clinical) [Ep 7 · 12:46](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=766) - Cross-sectional imaging for suspected complications in acute pancreatitis is typically obtained several days to at least a week after initial presentation when a patient is not improving as expected. — Andrew Trout (clinical) [Ep 7 · 13:05](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=785) - In the International Study Group cohort of 300 pediatric pancreatitis patients, genetic causes were positive in 48% of acute recurrent pancreatitis patients and 33% of chronic pancreatitis patients when searching for one of 4 genes. — Maisam Abu El Haija (epidemiological) [Ep 7 · 14:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=860) - The Cincinnati Children's 10-gene pancreatic genetic testing panel uses next generation sequencing with more than 50x coverage at every targeted base, with all pathogenic and novel variants confirmed by Sanger sequencing. — Maisam Abu El Haija (clinical) [Ep 7 · 15:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=950) - Variants of unknown clinical significance are reported because what is a variant of unknown significance today might be reclassified as pathogenic or likely pathogenic later as more studies are done. — Maisam Abu El Haija (opinion) [Ep 7 · 16:15](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=975) - Genetic testing should ideally be ordered as directed by a genetic counselor after discussing implications for the patient's future, medical insurance, offspring, and family members. — Maisam Abu El Haija (clinical) [Ep 7 · 22:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1320) - Exocrine pancreatic insufficiency is characterized by reduction or deficiency of exocrine pancreatic enzyme activity and bicarbonate in the intestinal lumen below what is required to digest food, leading to maldigestion and malabsorption. — David Vitale (clinical) [Ep 7 · 22:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1360) - For fecal elastase, values less than 100 are consistent with severe pancreatic insufficiency, 100 to 200 are indeterminate, and greater than 200 are normal. — David Vitale (clinical) [Ep 7 · 23:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1430) - Fecal elastase values fluctuate through the first year of life, so an initial value in a younger patient can be very different from a value at 1 or 2 years of age. — David Vitale (clinical) [Ep 7 · 24:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1450) - At Cincinnati Children's, endoscopic pancreatic function testing involves IV bolus of secretin or CCK at time zero, then collecting 3 duodenal aspirates at 5-minute intervals, with point-of-care pH testing to ensure no gastric contamination. — David Vitale (clinical) [Ep 7 · 25:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1550) - Pancreatic enzyme concentrations peak at 5 minutes after secretin/CCK stimulation and then down-trend at 10 and 15 minute samples in both healthy patients and those with chronic pancreatitis. — David Vitale (clinical) [Ep 7 · 27:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1640) - Pancreatic function testing can be temporarily abnormal during acute pancreatitis, so results within 6 to 8 weeks of an episode should not be heavily relied upon; testing should be repeated later. — David Vitale (clinical) [Ep 7 · 28:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1680) - MRI with secretin can provide non-invasive measurement of exocrine function by quantifying duodenal and jejunal fluid secretion in response to secretin, compared to normative ranges established in 50 healthy children. — Andrew Trout (clinical) [Ep 7 · 30:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1850) - In a cross-sectional analysis of 52 chronic pancreatitis patients at Cincinnati Children's, 25% were diagnosed with either pre-diabetes or diabetes; 15% were diagnosed after the first attack of pancreatitis. — Maisam Abu El Haija (epidemiological) [Ep 7 · 32:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=1950) - Mixed meal tolerance testing is the ideal diabetes screening method for pancreatic disease patients, similar to CF-related diabetes, involving fasting glucose followed by Boost stimulant and measuring insulin, glucose, and C-peptide every 30 minutes for 2 hours. — Maisam Abu El Haija (clinical) [Ep 7 · 33:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2000) - Despite multiple trials, there is no single medical or dietary intervention that can prevent recurrent episodes or treat pain effectively in chronic pancreatitis. — Maisam Abu El Haija (clinical) [Ep 7 · 34:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2090) - Low fat diet, pancreatic enzymes (if no exocrine insufficiency), antioxidant cocktail, steroids, leukotriene antagonists, and somatostatins have not been shown to be helpful in chronic pancreatitis pain management. — Maisam Abu El Haija (clinical) [Ep 7 · 35:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2110) - Cognitive behavioral therapy and physical therapy are effective in treating chronic pancreatitis pain when approached like other chronic pain conditions. — Maisam Abu El Haija (clinical) [Ep 7 · 35:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2130) - ERCP continues to be the gold standard for pancreatic duct imaging in children and is reserved for therapeutic interventions, with some exceptions for diagnostic purposes such as pancreatic trauma. — Tom Lin (clinical) [Ep 7 · 41:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2500) - There is no age limitation for performing ERCP at Cincinnati Children's; even neonates can undergo successful and safe ERCP with appropriate equipment and accessories. — Tom Lin (clinical) [Ep 7 · 42:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2540) - Altered surgical anatomy including Roux-en-Y is no longer a significant limitation for ERCP due to balloon enteroscopy techniques. — Tom Lin (clinical) [Ep 7 · 42:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2560) - MRCP has false negative rates for pancreatic duct stones, chronic pancreatitis findings, and anomalous pancreaticobiliary junction (APBJ), which may be overlooked depending on stone size or patient size. — Tom Lin (clinical) [Ep 7 · 43:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2590) - ERCP in children for chronic pancreatitis and pancreatic indications is more technically difficult and complex compared to performing similar procedures on adults, based on Cincinnati Children's experience with referrals from across the country. — Tom Lin (opinion) [Ep 7 · 44:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2640) - Post-ERCP pancreatitis is the greatest risk factor from ERCP, with rates of 3 to 11% in larger pediatric cohort studies, equivalent to adult rates. — Tom Lin (epidemiological) [Ep 7 · 45:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2700) - Other ERCP complications including perforation, bleeding, and infection occur at 1% or less in pediatric studies. — Tom Lin (epidemiological) [Ep 7 · 45:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2720) - Pancreatic duct stents are temporary; there is no consideration for permanent stents in the pancreatic duct at the current time. — Tom Lin (clinical) [Ep 7 · 46:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2780) - Serial stenting for pancreatic duct strictures should be performed for a maximum of one year; if strictures remain recalcitrant beyond one year, other interventions including surgical options should be considered. — Tom Lin (clinical) [Ep 7 · 47:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2850) - In pediatric patients with chronic pancreatitis, the vast majority of pancreatic duct stones are soft and non-calcified, making them readily and easily removed with standard endoscopic therapies using baskets or retrieval balloons. — Tom Lin (clinical) [Ep 7 · 49:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=2980) - Lithotripsy options for calcified pancreatic duct stones include mechanical lithotripsy using a basket, electrohydraulic lithotripsy, laser therapy under direct visualization, and extracorporeal shock wave lithotripsy (ESWL). — Tom Lin (clinical) [Ep 7 · 50:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=3020) - Pancreas divisum is the most common congenital anomaly of the pancreas and is a known risk factor for acute recurrent pancreatitis and chronic pancreatitis. — Tom Lin (clinical) [Ep 7 · 57:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=3450) - Pancreas divisum has a prevalence of 7% in the general healthy population and 15% in the International Study Group cohort of children with acute recurrent and chronic pancreatitis. — Tom Lin (epidemiological) [Ep 7 · 57:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=3470) - At Cincinnati Children's, nearly two-thirds of pancreas divisum patients who underwent therapeutic ERCP with minor papilla sphincterotomy had either symptom improvement or complete symptom resolution. — Tom Lin (clinical) [Ep 7 · 58:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=3530) - For endoscopic ultrasound, the standard GI echo endoscopes have a weight limit of 15 kg; below that weight there is risk of upper esophageal perforation when inserting the scope. — David Vitale (clinical) [Ep 7 · 62:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=3730) - An endobronchial echo endoscope at 6.5 millimeters can be used in smaller patients under 15 kg for diagnostic purposes and can perform fine needle aspiration up to 19 gauge. — David Vitale (clinical) [Ep 7 · 62:35](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=3755) - Diagnostic endoscopic ultrasound is quite safe with perforation rates very similar to standard upper endoscopy and similar bacteremia rates. — David Vitale (clinical) [Ep 7 · 67:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4050) - Risk of pancreatitis increases when biopsying the pancreas during EUS, and there is also risk of bleeding after biopsy. — David Vitale (clinical) [Ep 7 · 67:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4070) - Therapeutic EUS procedures such as cyst gastrostomy, cyst duodenostomy, or rendezvous procedures have higher risks of bleeding, infection, and perforation compared to diagnostic EUS. — David Vitale (clinical) [Ep 7 · 68:05](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4085) - Endoscopic ultrasound is more sensitive than transabdominal ultrasound and even MRI for detecting microlithiasis in the gallbladder and choledocholithiasis. — David Vitale (clinical) [Ep 7 · 72:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4350) - Pancreatic fluid collections are defined by time course: acute fluid collections or acute necrotic collections occur in less than 4 weeks, while pseudocysts or walled-off necrosis that may require intervention occur after greater than 4 weeks and have an encapsulated wall. — David Vitale (clinical) [Ep 7 · 73:04](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4384) - The mainstay of therapy for pancreatic fluid collections is observation; even large pseudocysts and walled-off necrosis can often resolve with time if the patient is minimally symptomatic. — David Vitale (clinical) [Ep 7 · 73:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4420) - Endoscopic transgastric or transduodenal drainage of walled-off necrosis has been shown in multiple studies to have lower complication rates and decreased length of stay compared to surgical or percutaneous intervention. — David Vitale (clinical) [Ep 7 · 76:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4600) - Lumen-apposing metal stents for pancreatic fluid collection drainage are generally left in place for about 3 to 4 weeks at a time. — David Vitale (clinical) [Ep 7 · 82:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4950) - Endoscopic drainage of walled-off necrosis is 90% technically successful with 10 to 15% morbidity, 70 to 80% of patients have resolution of their collections, and about 10 to 15% have recurrence. — David Vitale (epidemiological) [Ep 7 · 85:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5100) - In pediatric patients with necrotizing pancreatitis, step-up therapy is required less frequently than in adults; pediatric patients tend to do really well once drained internally. — David Vitale (opinion) [Ep 7 · 85:41](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5141) - Well over 50% of patients with chronic pancreatitis eventually require some type of operation. — Jaimie Nathan (epidemiological) [Ep 7 · 87:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5250) - The most common indication for surgery in chronic pancreatitis is debilitating pain that fails to respond to medical and endoscopic treatment options. — Jaimie Nathan (clinical) [Ep 7 · 88:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5280) - Conventional operations for chronic pancreatitis result in initial pain relief in a number of patients, but pain recurs in approximately 50% of patients over the long term. — Jaimie Nathan (clinical) [Ep 7 · 90:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5450) - Large dilated duct and inflammatory head masses are fairly uncommon in pediatric chronic pancreatitis patients, as opposed to the adult population where these anatomic findings are more common. — Jaimie Nathan (clinical) [Ep 7 · 91:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5500) - The primary goal of total pancreatectomy with islet autotransplantation is to relieve pain and debilitation and impaired quality of life, not to preserve or save islets. — Jaimie Nathan (clinical) [Ep 7 · 93:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5580) - The goal of the islet autotransplant component is to preserve beta cell mass and alpha cell mass to make glycemic control more straightforward than without the islet autotransplant. — Jaimie Nathan (clinical) [Ep 7 · 93:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5600) - Children with genetic risk factors tend to fail conventional surgeries more often than those without genetic risk factors. — Jaimie Nathan (clinical) [Ep 7 · 95:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5720) - Criteria for consideration of TPIAT include objective diagnostic criteria for chronic pancreatitis or acute recurrent pancreatitis with pain and debilitation lasting at least 6 months, defined as chronic opioid dependence or impaired quality of life from frequent hospitalizations and school absences. — Jaimie Nathan (clinical) [Ep 7 · 97:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5850) - For TPIAT, there is a minimum liver volume requirement of 400 cc in small children to accept the islet autotransplant; 3D reconstructions are used to assess liver volume in the smallest children. — Jaimie Nathan (clinical) [Ep 7 · 99:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=5980) - The islet isolation process takes about 3 to 4.5 hours and uses a combination of mechanical and enzymatic digestion (Ricordi method) to release a relatively pure islet solution in as small a tissue volume as possible. — Jaimie Nathan (clinical) [Ep 7 · 100:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6050) - During islet infusion, portal pressures are measured every 5 minutes; a pressure change greater than 25 centimeters of water is associated with a 10-fold increased risk of portal vein thrombosis. — Jaimie Nathan (clinical) [Ep 7 · 102:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6120) - If portal vein pressures rise substantially during islet infusion, the infusion is paused to allow autoregulation; if pressures remain elevated, islets are placed in a secondary site such as the peritoneal cavity. — Jaimie Nathan (clinical) [Ep 7 · 102:30](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6150) - Postoperatively, blood glucoses are kept very tight in the ICU and early postoperative period over several weeks to months as islets engraft, because hyperglycemia is very detrimental to the islets. — Jaimie Nathan (clinical) [Ep 7 · 103:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6220) - By the end of one week in the ICU after TPIAT, patients are at full feeds and transition out of the ICU to the endocrine floor where they are transitioned to an insulin pump. — Jaimie Nathan (clinical) [Ep 7 · 104:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6280) - In an early Cincinnati Children's study of the first 20 TPIAT patients, there was a dramatic and significant decrease in opioid use even within the first 90 days after surgery. — Jaimie Nathan (clinical) [Ep 7 · 112:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6720) - By 90 days post-TPIAT, there was dramatic improvement in getting patients off TPN who required it preoperatively, and a decrease in insulin requirements measured in units per kilogram per day. — Jaimie Nathan (clinical) [Ep 7 · 113:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6780) - Quality of life outcomes showed improvements in physical health scores and total SF-36 scores by 90 days after TPIAT in children. — Jaimie Nathan (clinical) [Ep 7 · 113:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6830) - Reduction in opioid use after TPIAT occurs pretty quickly over the first 6 months and is sustained over time, though a percentage of patients continue on opioids. — Jaimie Nathan (clinical) [Ep 7 · 114:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6880) - Pancreatitis pain shows dramatic improvement within the first 6 to 12 months after TPIAT and is sustained over time. — Jaimie Nathan (clinical) [Ep 7 · 115:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6920) - Younger children under 12 are more likely to achieve insulin independence after TPIAT, with rates approaching 50 to 60% at one year compared to 30 to 35% in children ages 13 to 19. — Jaimie Nathan (clinical) [Ep 7 · 116:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=6980) - Insulin independence after TPIAT is largely predicted by the number of islet equivalents per kilogram body weight isolated from the pancreas; insulin independence rates at 3 years increase with greater islet equivalent yield. — Jaimie Nathan (clinical) [Ep 7 · 117:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7030) - In children under 8 years old with high islet equivalent yield (median over 6000/kg), all patients had pain relief by 1 year and were free of opioids by a median of 68 days, with over 80% achieving at least a period of insulin independence. — Jaimie Nathan (clinical) [Ep 7 · 118:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7090) - At most recent follow-up, 64% of children under 8 were insulin independent compared to 41% of children over 9 years old. — Jaimie Nathan (clinical) [Ep 7 · 118:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7130) - Younger children may do better with insulin independence because they have a better metabolic milieu for engraftment, lower insulin demands, and beta cells from young children may have higher capacity to replicate. — Jaimie Nathan (opinion) [Ep 7 · 119:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7180) - More substantial pancreatic atrophy, ductal dilation, and fibrosis on histopathology correlate with lower islet yield after TPIAT. — Jaimie Nathan (clinical) [Ep 7 · 120:40](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7240) - Longer duration of symptoms correlates with lower islet yield after TPIAT. — Jaimie Nathan (clinical) [Ep 7 · 121:00](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7260) - Ductal drainage procedures such as Puestow and distal pancreatectomy reduce islet yield and decrease the probability of insulin independence if a patient subsequently needs TPIAT or completion pancreatectomy. — Jaimie Nathan (clinical) [Ep 7 · 121:20](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7280) - In adult TPIAT data at 10 years, insulin independence rates dropped from about low 30s percent early on to about low 20s percent, showing there is attrition over time. — Jaimie Nathan (clinical) [Ep 7 · 122:10](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=7330) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - 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. — Maisam Abu-El-Haija summarizing the discussion [Ep 8 · 9:32](https://origin-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. — Maisam Abu-El-Haija summarizing the discussion [Ep 8 · 13:19](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=799) - 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. — Maisam Abu-El-Haija summarizing the discussion [Ep 8 · 12:41](https://origin-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. — Maisam Abu-El-Haija summarizing the discussion [Ep 8 · 18:58](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1138) - 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. — Maisam Abu-El-Haija summarizing the discussion [Ep 8 · 20:05](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=1205) - 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. — Maisam Abu-El-Haija summarizing the discussion [Ep 8 · 34:47](https://origin-library.globalcastmd.com/watch/acute-pancreatitis-293?t=2087) - 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 summarizes what Dr. Jaimie Nathan said [Ep 3 · 3:06](https://origin-library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=186) - There is no good data supporting the avoidance of opioids in acute pancreatitis due to concerns about sphincter of Oddi spasm worsening the condition. — The host summarizing the discussion [Ep 4 · 0:27](https://origin-library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=27) - 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 summarizing the discussion [Ep 5 · 0:55](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=55) - 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 summarizing the discussion [Ep 5 · 10:53](https://origin-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 summarizing the discussion [Ep 5 · 15:21](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=921) - 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 summarizing the discussion [Ep 5 · 20:10](https://origin-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 summarizing the discussion [Ep 5 · 21:22](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=1282) - 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 summarizing the discussion [Ep 5 · 37:19](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2239) - 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 summarizing the discussion [Ep 5 · 47:34](https://origin-library.globalcastmd.com/watch/acute-and-acute-recurrent-pancreatitis-pancreatic-disease-970?t=2854) - 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 summarizing a resource [Ep 9 · 5:45](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=345) - Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline in pancreatitis. — Juan Gurria summarizing a resource [Ep 9 · 6:32](https://origin-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 summarizing a resource [Ep 9 · 8:33](https://origin-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 summarizing a resource [Ep 9 · 9:07](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=547) - Gastric feeding is preferred over jejunal feeding in pancreatitis when the patient can tolerate it. — Juan Gurria summarizing a resource [Ep 9 · 9:47](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pancreatitis-7269?t=587) - Vitals are the main consideration for deciding whether a pancreatitis patient should go to the floor or ICU — The host summarizes what Dr. Juan Gurria said [Ep 10 · 5:48](https://origin-library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=348) - Fluid resuscitation is key in pancreatitis management — Cecilia Gigena summarizes what Dr. Juan Gurria said [Ep 10 · 5:55](https://origin-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 summarizes what Dr. Juan Gurria said [Ep 10 · 5:57](https://origin-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 — The host summarizes what Dr. Juan Gurria said [Ep 10 · 6:07](https://origin-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 — The host summarizes what Dr. Juan Gurria said [Ep 10 · 6:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-management-of-acute-pancreatitis-2023-8523?t=377) - 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 summarizing a resource [Ep 11 · 18:17](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=1097) - The step-up approach for necrotizing pancreatitis—starting with transgastric endoscopic necrosectomy—reduces major complications compared to open surgery. — Juan Gurria summarizing a resource [Ep 11 · 20:06](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=1206) - 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 summarizing a resource [Ep 11 · 23:48](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=1428) - TPIAT results in over 80% reduction in opioid use at 1–2 months, with sustained effect for years. — Juan Gurria summarizing a resource [Ep 11 · 50:58](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=3058) - 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 summarizing a resource [Ep 11 · 53:03](https://origin-library.globalcastmd.com/watch/overview-of-the-surgical-management-of-acute-and-chronic-pancreatitis-in-childre-11849?t=3183) - Approximately 40% of acute pancreatitis patients will develop some form of fluid collection, but the majority resolve spontaneously, with less than 5% evolving into pseudocysts. — Tom Lynn summarizing the discussion [Ep 6 · 19:32](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1172) - Pancreatic pseudocysts are formally defined when they reach a time threshold of 4 weeks or greater, contain high amylase-rich fluid with little to no internal debris, and have a well-defined non-epithelialized wall. — Tom Lynn summarizing the discussion [Ep 6 · 20:00](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1200) - The revised Atlanta Classification (2012) categorizes inflammatory pancreatic fluid collections into four types: acute peripancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. — Tom Lynn summarizing the discussion [Ep 6 · 19:32](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1172) - Endoscopic ultrasound has limited use in pediatrics due to limited pediatric indications, insufficient awareness of its capabilities, and a very limited number of pediatric gastroenterologists with appropriate EUS training. — Tom Lynn summarizing the discussion [Ep 6 · 23:20](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1400) - Pancreatic duct leaks can manifest internally as peripancreatic fluid collections, pseudocysts, pancreatic ascites, pleural effusions, or pancreaticoenteric/biliary/bronchial fistulas, and externally as pancreaticocutaneous fistulas. — Tom Lynn summarizing the discussion [Ep 6 · 17:30](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1050) - Transpapillary pancreatic stent placement has greater likelihood of success when the defect can be bridged, but certain leaks can still resolve despite inability to bridge the defect. — Tom Lynn summarizing the discussion [Ep 6 · 18:20](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1100) - Risks of endoscopic intervention (EUS or ERCP) for pancreatic disease include developing or exacerbating pancreatitis, introducing infection into a sterile fluid collection, and developing pancreatic duct strictures from temporary stent placement. — Tom Lynn summarizing the discussion [Ep 6 · 18:50](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=1130) - Approximately 50% of chronic pancreatitis patients will eventually require surgery, with the most common indication being debilitating pain that fails to respond to medical and endoscopic treatment. — Todd Ponsky summarizing the discussion [Ep 6 · 42:36](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2556) - There is no clear consensus on optimal timing for surgical intervention in chronic pancreatitis; some advocate earlier surgery to avoid progressive inflammatory destruction, while others prefer a watch-and-wait approach due to variable surgical success rates. — Todd Ponsky summarizing the discussion [Ep 6 · 43:20](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2600) - Puestow procedure provides short-term pain relief in 75% of patients, but greater than 50% have recurrent pain, largely related to inability to fully decompress the duct or continued inflammation in the pancreatic head. — Todd Ponsky summarizing the discussion [Ep 6 · 45:50](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2750) - Whipple procedure for chronic pancreatitis provides good pain relief at 4-6 years but results in late endocrine and exocrine dysfunction in approximately 50% of patients. — Todd Ponsky summarizing the discussion [Ep 6 · 48:20](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2900) - Duodenum-preserving pancreatic head resections (Beger, Frey) achieve benefits of head resection and duct decompression while preserving bile duct and GI continuity. — Todd Ponsky summarizing the discussion [Ep 6 · 49:10](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2950) - The Beger procedure provides good pain relief in 80-85% of patients maintained at 5 years with minimal endocrine and exocrine insufficiency compared to Whipple, based on adult data. — Todd Ponsky summarizing the discussion [Ep 6 · 49:40](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=2980) - The Frey procedure shows equivalent pain relief (85-90%) and quality of life outcomes compared to Beger procedure in adults. — Todd Ponsky summarizing the discussion [Ep 6 · 50:50](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=3050) - For conventional surgical procedures in chronic pancreatitis, about 50% of patients have recurrence of pain over the long term based on adult data, with no long-term pediatric data available. — Todd Ponsky summarizing the discussion [Ep 6 · 51:20](https://origin-library.globalcastmd.com/watch/endoscopic-surgical-interventions-pancreatic-disease-972?t=3080) - Adult-based chronic pancreatitis criteria including Rosemont and conventional criteria can only be used as support and to guide interpretation in pediatric patients, not as definitive diagnostic tools. — David Vitale summarizing the discussion [Ep 7 · 68:50](https://origin-library.globalcastmd.com/watch/pancreas-care-updates-2020-full-show-3381?t=4130) ## Changelog - Sep 17: 1 item added automatically - Sep 16: 1 item added automatically - Sep 7: 5 items added automatically - Sep 7: 1 item no longer name acute pancreatitis - Sep 7: 5 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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