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Jaundice
Everything in the library about jaundice — built automatically from the recorded discussions that name it
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
Evidence & Research
1 item
Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
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New Article you should know by Dr. Cecilia Gigena from Journal of Pediatric Surgery.
"Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels"
Authors: Jingying Jiang, Yifan Yang, Xue
video0:55 · Jul 2024
Case-Based Learning
1 item
Biliary Atresia-Case Presentation and Panel Discussion: Update Course 2014
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During the 2ndAnnual Stay Current in Pediatric Surgery Update Course in 2014, Dr. Robert Parry, Director of Pediatric Surgery, Akron Children's Hospital, and Dr. Nick Bruns present a clinical case of biliary atresia diagnosis. Topics discus
video23:47 · Jan 2019
In-Depth Reviews
1 item
Hepatoblastoma: Update Course 2014
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During the 2nd Annual Stay Current in Pediatric Surgery Update Course in 2014,Dr. Matthew Clifton presents on hepatoblastoma.Topics discussed includepre-treatment extent of disease (pretext) and post-treatment extent of disease staging for
video · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
The study was a retrospective cohort study conducted in China
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:11 ↗
The study included 329 patients with biliary atresia
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:21 ↗
40 of the 329 patients had low MMP-7 levels
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:21 ↗
Patients with low MMP-7 had significantly lower 3-month jaundice clearance
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:27 ↗
Patients with low MMP-7 had significantly lower 6-month jaundice clearance
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:27 ↗
Patients with low MMP-7 had significantly lower 1-year native liver survival
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:27 ↗
Measuring MMP-7 can help with prognosis in biliary atresia patients
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:40 ↗
MMP-7 measurement may in the future help with treatment of biliary atresia patients
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position0:40 ↗
Hepatoblastoma: Update Course 2014
PRETEXT staging stands for pretreatment extent of disease and is based on segmental liver anatomy prior to chemotherapy
clinical1:41 ↗
PRETEXT staging has a tendency to overstage because it is based purely on imaging and bulky tumors make it hard to assess true vascular invasion versus mass effect
clinical1:41 ↗
POSTTEXT refers to extensive disease after neoadjuvant chemotherapy has been given
clinical1:41 ↗
Key staging annotations include involvement of the retrohepatic cava or hepatic veins and the portal vein bifurcation
clinical3:52 ↗
COG recommendations state that PRETEXT stage 2 tumors with no vascular involvement and achievable 1 cm margin can be resected upfront without neoadjuvant chemotherapy
guideline7:30 ↗
COG feels that PRETEXT stage 1 and 2 tumors do not necessarily need referral to centers with liver resection expertise if the local surgeon feels competent
guideline7:55 ↗
Most tumor shrinkage from chemotherapy occurs within the first two cycles
clinical10:26 ↗
Current recommendations are that after two cycles of chemotherapy, if the tumor has not shrunk to a resectable point, the patient should be evaluated for transplant
guideline10:26 ↗
As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from the vascular supply, so chemotherapy does not improve vascular margins
clinical10:26 ↗
The goal surgical margin for hepatoblastoma resection is 1 cm
clinical12:08 ↗
Survival in patients undergoing extended or heroic resections (tumor liver explants with back table resection and reimplant, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival
clinical12:33 ↗
There has been a move away from heroic resections for hepatoblastoma
opinion12:33 ↗
Patients who undergo failed resection followed by rescue transplant have worse survival than patients who undergo planned transplant upfront
clinical14:52 ↗
Patients should be referred to a transplant center early even if they may not ultimately need transplant, to have pre-transplant evaluation completed and be plugged into the system
guideline15:48 ↗
Primary transplant patients with hepatoblastoma do surprisingly well despite immunosuppression against rejection in the setting of cancer
clinical16:38 ↗
For non-transplant center surgeons, criteria for proceeding with resection include feeling 95% confident of success and ability to perform an anatomic resection with good margin
opinion18:56 ↗
Disease close to hepatic veins, disease extending across the liver, or involvement of the portal vein should prompt referral to a transplant center
opinion19:54 ↗
The truth about resectability is determined at the time of operation despite all available imaging
opinion21:52 ↗
In Europe, all liver tumors receive chemotherapy upfront before surgery because it results in smaller, easier-to-resect tumors
clinical22:13 ↗
Core needle biopsy for hepatoblastoma typically requires about 10 passes through an area that includes normal parenchyma and tumor
clinical23:53 ↗
There are two camps regarding pulmonary metastasis treatment: one advocates resecting metastases upfront before hepatectomy, the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites
clinical24:49 ↗
There is no good data on either side of the pulmonary metastasis timing debate, with both approaches limited to a handful of patients
opinion24:49 ↗
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