Although I was unable to attend this year’s liver symposium at NASPGHAN19, I reviewed the lecture notes. There is some terrific content. Here are some of the slides (borrowed with permission from NASPGHAN).
Link to complete NASPGHAN Chronic Liver Disease Symposium 2019
Session I
How do I best evaluate a cholestatic infant? Sanjiv Harpavat MD Texas Children’s Hospital
Related blog post: What is the evidence that biliary atresia starts in utero?
As for this algorithm, in my opinion, the 1st step needs to be to exclude emergencies associated with infantile cholestasis: coagulopathy, hypoglycemia, sepsis, and checking urine for reducing substances (cow’s milk formula can worsen liver disease if galactosemia is present). Subsequently, evaluation needs to proceed quickly to determine the etiology.
How do I interpret genetic results? Saul J. Karpen MD, PhD, Emory University School of Medicine/Children’s Healthcare of Atlanta
What do abnormal liver enzyme levels mean in a tween? William F. Balistreri MD, Cincinnati Children’s Hospital Medical Center
What do I do with this abnormal radiology finding? Jean Molleston MD, Riley Children’s Hospital
I have not selected slides from Dr. Molleston’s handout –the images are terrific. For most of the problems that are presented, the lecture notes do not provide specific recommendations for management.
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