Collection
Pancreatic Surgery & Critical Care
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Pancreatic Inflammatory Disease
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Pancreatitis1 item
Update Course 2023 - Updates in Pancreatitis
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This session is on Updates in Pancreatitis with Dr. Juan Gurria.
The 11th Annual Pediatric Surgery Update Course was held on August 29, 2023 in Cleveland, Ohio and was livestreamed to a global audience. The full day symposium is desig
video32:50 · Oct 2023
Complex Pancreatic Procedures
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Total Pancreatectomy with Islet Autotransplantation1 item
Total Pancreatectomy with Islet Autotransplantation (TPIAT)
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In this video, we take you through a Total Pancreatectomy with Islet Autotransplantation (TPIAT)âone of the most complex abdominal surgeries performed in childr
podcast · Oct 2026
Multidisciplinary Pancreas Care
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Pancreas Care Center | Cincinnati Children's
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ttps://www.cincinnatichildrens.org/service/p/pancreas-care
At age 12, Bella Pedraja was a competitive swimmer, enjoying life with family and friends in her hometown in Florida. But one night everything took a turn when stomach pain landed
video · Oct 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course 2023 - Updates in Pancreatitis
Acute pancreatitis management has shifted from NPO and aggressive IV fluids causing pulmonary edema to early feeding and measured fluid resuscitation.
clinicalJuan Gurria0:35 ↗
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.
clinicalJuan Gurria3:55 ↗
Early fluid resuscitation is key to re-establish intravascular flow to the pancreas and prevent hypoxia, necrosis, and atrophic pancreatic insufficiency.
clinicalJuan Gurria4:19 ↗
Excessive fluid resuscitation in pancreatitis leads to worse outcomes including fluid overload and multi-system organ failure.
clinicalJuan Gurria4:39 ↗
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.
guidelineJuan Gurria4:42 ↗
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.
Host summaryJuan Gurria summarizing a resource — not the host's own clinical position5:45 ↗
Maintenance fluids should be 1.5 to 2 times normal maintenance, with reassessment at 12-24 hour mark to avoid fluid overload.
guidelineJuan Gurria6:21 ↗
Lactated Ringer's decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline in pancreatitis.
Host summaryJuan Gurria summarizing a resource — not the host's own clinical position6:32 ↗
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.
Host summaryJuan Gurria summarizing a resource — not the host's own clinical position8:33 ↗
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.
Host summaryJuan Gurria summarizing a resource — not the host's own clinical position9:07 ↗
Enteral nutrition as soon as the patient can tolerate PO is significantly better compared to TPN or NPO in acute pancreatitis.
clinicalJuan Gurria9:24 ↗
Gastric feeding is preferred over jejunal feeding in pancreatitis when the patient can tolerate it.
Host summaryJuan Gurria summarizing a resource — not the host's own clinical position9:47 ↗
Some vomiting can be tolerated when feeding pancreatitis patients, similar to gastroschisis management, because feeding the gut produces dramatically better outcomes.
clinicalJuan Gurria10:19 ↗
No patient needs TPN in the first 7 days of acute illness.
clinicalJuan Gurria11:02 ↗
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.
clinicalJuan Gurria12:13 ↗
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.
guidelineJuan Gurria14:59 ↗
The most common cause of pancreatitis in children is medication-induced, but the most common risk factor is genetic factors.
epidemiologicalJuan Gurria15:23 ↗
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.
clinicalJuan Gurria15:32 ↗
Cincinnati Children's genetic panel tests 10 different genetic markers for pancreatitis including PRSS1, CTRC, CFTR, and CPA1.
clinicalJuan Gurria15:48 ↗
Genetics have fundamentally changed the approach to pediatric chronic pancreatitis treatment.
opinionJuan Gurria16:06 ↗
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.
clinicalJuan Gurria16:33 ↗
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.
clinicalJuan Gurria14:38 ↗
ERCP does not change the islet yield available for transplantation, but pancreatitis attacks cause cell loss.
clinicalJuan Gurria14:44 ↗
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.
epidemiologicalJuan Gurria14:59 ↗
MRCP is the best non-invasive imaging study for the pancreas, superior to ultrasound and CT.
clinicalJuan Gurria20:59 ↗
ERCP is more therapeutic than diagnostic in chronic pancreatitis.
clinicalJuan Gurria21:07 ↗
Patients with chronic pancreatitis always have micronutrient and macronutrient deficiencies requiring nutritional support.
clinicalJuan Gurria21:12 ↗
Patients with chronic pancreatitis lose exocrine function first, then endocrine function, requiring screening and often pancreatic enzyme replacement therapy.
clinicalJuan Gurria21:36 ↗
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.
clinicalJuan Gurria21:48 ↗
Chronic pancreatitis increases the risk of pancreatic cancer up to thirteenfold.
epidemiologicalJuan Gurria22:08 ↗
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