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
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.
Disclaimer: NASPGHAN/gutsandgrowth assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. The discussion, views, and recommendations as to medical procedures, choice of drugs and drug dosages herein are the sole responsibility of the authors. Because of rapid advances in the medical sciences, the Society cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. Some of the slides reproduced in this syllabus contain animation in the power point version. This cannot be seen in the printed version.