Understanding Cholestasis in Pediatrics: Insights from Dr. Jesse Reeves-Garcia’s Presentation

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Cholestasis, a condition where bile flow from the liver is reduced or blocked, is a significant concern in pediatric gastroenterology. During his recent presentation at Nicklaus Children’s Hospital’s Pediatric Grand Rounds, Dr. Jesse Reeves-Garcia, a leading expert in pediatric gastroenterology, shed light on the causes, diagnosis, and treatment of this complex condition.

What is Cholestasis?

Cholestasis occurs when bile, a fluid essential for digestion and nutrient absorption, fails to flow properly from the liver to the intestine. This can lead to a buildup of bile acids in the liver, causing damage and other health complications. 

Common symptoms include:

  • Jaundice (Yellowing of the skin and eyes)
  • Dark urine
  • Pale stools
  • Itchy skin (pruritus)
  • Poor growth and weight gain
Causes of Pediatric Cholestasis

Dr. Reeves-Garcia highlighted the primary causes of cholestasis in children, which include:

  • Biliary Atresia A blockage or absence of bile ducts, often requiring early surgical intervention.
  • Genetic and Metabolic Disorders: Conditions like Alagille Syndrome or Alpha-1 Antitrypsin Deficiency.
  • Infections: Viral or bacterial infections affecting the liver.
  • Parenteral Nutrition-Associated Liver Disease: Cholestasis related to long-term intravenous nutrition.

Understanding the root cause is crucial for effective treatment and preventing long-term liver damage.

Why Early Diagnosis Matters

Dr. Reeves-Garcia emphasized the importance of early recognition and diagnosis in preventing long-term complications, such as liver fibrosis or failure. Diagnostic tools used in assessing cholestasis include:

  • Blood Tests: To evaluate liver enzymes, bile acid levels, and overall liver function.
  • Imaging: Ultrasound or hepatobiliary scans to visualize bile ducts and liver structure.
  • Liver Biopsy: When needed, to confirm the cause of cholestasis and guide treatment.
Effective Management Strategies

Treatment for cholestasis is tailored to the underlying cause. Dr. Reeves-Garcia outlined the following approaches:

  • Medical Management: Medications to reduce bile acid levels, alleviate itching, and improve bile flow.
  • Nutritional Support: Specialized diets or supplements to address deficiencies caused by poor fat absorption.
  • Surgical Interventions: Procedures like the Kasai procedure for biliary atresia to restore bile flow.
  • Liver Transplantation: In severe cases where liver function is significantly impaired.
The Role of Multidisciplinary Care

Dr. Reeves-Garcia also stressed the importance of a team-based approach in managing pediatric cholestasis. Collaboration between pediatric gastroenterologists, hepatologists, nutritionists, and surgeons ensures comprehensive care for young patients.

43 thoughts on “Understanding Cholestasis in Pediatrics: Insights from Dr. Jesse Reeves-Garcia’s Presentation”

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  37. The Role of Testosterone in Muscle Hypertrophy

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  39. Steroid Legal Alternatives

    Intratesticular testosterone (ITT) levels are about 50 to a hundred times greater than in circulation (180) and exogenous administration severely suppresses this
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    In explicit, an affiliation between testosterone remedy and prostate most cancers was rapidly drawn primarily based on animal experiments and limited case studies (81).
    Notably, the ventral prostate of the rat grew to become the model organ for androgenic activity in the renowned
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    Both the medical literature and newspapers contain reports of beforehand mild-mannered
    people who committed homicide and lesser assaults whereas taking AASs (Thiblin et al.,
    1997). Though stories of severe violence generate each alarm and widespread attention, the total variety
    of such stories is small. Moreover, the results of AASs
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    Nonetheless, most however not all studies in humans
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    Anabolic steroids are classed as performance and image-enhancing medicine (PIEDs) .
    Anvarol is a clever reincarnation of Anavar that provides natural metabolism- and
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    There are numerous names for steroids, and every nation might
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    Erectile dysfunction is defined as the inability to attain or keep an erection sufficient for satisfactory sexual
    efficiency (189). Testosterone performs an necessary function in practically
    each aspect of erectile perform (190) and erectile
    dysfunction is taken into account a suggestive symptom of testosterone deficiency (191).

    Nonetheless, not all hypogonadal males develop erectile dysfunction, and TRT typically leads to only a small enchancment in erectile operate (192).

    Additionally, Anabolic steroids may fit by enhancing the athletic performance of athletes and bodybuilders.
    Therefore, generally it is also called[2] a performance-enhancing drug.
    Anabolic steroids may increase[1] the quantity of protein contained in the cells, particularly in the skeletal
    muscle. Athletes may take steroids for a certain period, stop, then start once more a number of
    times a 12 months. Athletes additionally typically use many steroids on the similar time (a follow referred to as stacking), they usually
    take them by different routes (by mouth, injection, or patch).
    They may also improve the dose through a cycle (called pyramiding).

    This generally implies that individuals are able to train more typically and for longer durations of time,
    with improved restoration. The apply of combining a number of Steroid Legal Alternatives varieties, corresponding to injectable and oral steroids, is recognized as stacking.
    The thought behind this method is that the numerous
    sorts mix to provide a stronger impression. Many people attempt to stack steroids to
    maximise their mixed effectiveness, although there isn’t a proof to assist this declare.

    This consists of each dietary dietary supplements, similar to niacin, red yeast
    rice extract and berberine, but also prescription medication similar to
    statins. Besides its side effects, its use may lead to underestimation of CVD risk
    when using danger algorithms which are guided by HDL-cholesterol levels.
    Purple yeast rice extract contains monacolin K (lovastatin), which
    explains its efficacy in decreasing LDL-cholesterol (144).

    Whereas its use is in all probability going protected (145),
    industrial purple yeast rice dietary supplements can differ significantly of their lovastatin content material (146).
    Berberine additionally reduces LDL-cholesterol, though this discovering is usually
    supported by trials of poor methodological quality (147). Orally ingested AAS are quickly absorbed
    within the gastrointestinal (GI) tract, with serum concentrations peaking
    1–2 hours after ingestion of methyltestosterone (8).

    Reply
  40. Anavar dosage for women and men

    As a end result, you’ll have a permanent
    redness that makes people think you’ve simply been running on your life.
    On the other hand, if you’re on a mass acquire or bulking cycle, your face may turn out to be rounder,
    giving rise to the not-so-flattering ‘moon face’ look.

    Sadly, the remedies that teens use to control their zits generally
    don’t work for adults as a end result of their pores
    and skin is rather more worn. In this section,
    we contemplate some typical results that steroids can have
    on the face of the user. This is as a end result of of nuclei
    in the muscle cells rising when on steroids, which is permanent, even as quickly as steroid administration comes to a halt.

    When comparing steroids earlier than and after 1
    cycle, the adjustments may be fairly noticeable, especially with a well-designed
    stack.
    If users are in search of the results of Anavar however don’t need to experience
    the same degree of unwanted side effects, we
    suggest shopping for a legal Anavar dosage for women and men
    different, such as Anvarol. Usually, Anavar can flush out extracellular water and shuttle
    fluid inside the muscle. When an individual stops taking Anavar, they’re unlikely to look as dry, with their muscle
    tissue being much less full.
    We see people with blessed genetics take androgenic steroids
    for years and nonetheless hold their hair. A well-known instance of that is Jay Cutler, a four-time
    Mr. Olympia winner. Research exhibits that taking 25–50
    mg of clomiphene per day, or every different day, is efficient
    at restoring pure testosterone manufacturing (21).
    Doses as excessive as a hundred mg may also be taken daily and have been proven to be helpful in recovering testosterone ranges in young males after 2–3 months.

    It is dependent upon the precise condition being treated, the type and dose of steroid,
    and the patient’s total well being. Generally, short-term use (a few days to a few weeks) is safer than long-term use.

    By taking a proactive and personalized method, it’s
    attainable to harness the benefits of steroid therapy while minimizing potential risks and enhancing general high quality of
    life for older adults.
    It has been theorized that these estrogenic
    unwanted effects are as a outcome of Anadrol performing as a progestin;
    nevertheless, research present Anadrol to have little impact on progesterone
    ranges. Nosebleeds and complications can occur while
    on Anadrol, which can be a signal of elevated blood strain. If this occurs, get a checkup, and in case your blood stress is high, cycle off
    instantly. Users with hypertension or a history of coronary heart illness of their household ought
    to chorus from using Anadrol.
    Anadrol can be one of the highly effective compounds for enhancing energy, making it extremely popular among strongmen and
    powerlifters, in our expertise. Moreover, anabolics can reduce the
    blood move to the penis, hence decreasing libido and causing impotence.

    The decreased blood move and the problem getting or maintaining an erection could
    cause a user’s penis to look smaller, although the length suffers no factual changes.

    Androgenic steroids facilitate nitric oxide production, which
    analysis reveals is crucial in supplying blood move to the
    penis. Thus, we often see Deca-Durabolin compromising circulation in this regard.
    Additionally, Deca-Durabolin raises prolactin ranges, a lactating hormone that may decrease arousal or sexual curiosity.
    The reality is steroids have triggered more
    extreme unwanted aspect effects on women than they do males.
    Until you’re competing professionally the best factor is
    to keep away from them. There other alternatives together with legal steroids for ladies that
    supply related benefits without the side effects. Some ladies progressively decrease
    the dose in the direction of the top of a cycle and taper off; however, this isn’t essential.

    Muscle mass seems to be influenced by AAS administration [30,92,93].
    In truth, testosterone, by binding to AR,
    produces an increased manufacturing of IGF-1, a decreased expression of myostatin and the differentiation of pluripotent mesenchymal cells into a myogenic lineage.
    Weightlifters uncovered to AASs had decrease cognitive functions,
    similar to motor and government efficiency, in comparability with nonexposed subjects [43].
    Moreover, one other imaging study confirmed markedly increased proper amygdala volumes;
    markedly decreased right amygdala and reduced dACCgln/glu and scyllo-inositol levels in comparability with nonusers [45].

    Latest evidence, by administrating neuropsychological tests to weightlifters
    both AAS customers and nonusers, demonstrated a cognitive
    disfunction because of long-term high AAS publicity [46].
    In this regard, oxidative stress and apoptosis as a outcome of AASs abuse might lead to neurodegeneration and dementia, particularly in long-term users, adolescents and
    young adults [47,48]. The presence of apoptosis
    in brain areas of rats handled with long-term administration of nandrolone was
    advised in a recent examine.
    Please note, this is solely a quote of advantages and/or authorization. We can not guarantee cost or verification eligibility as conveyed by your medical insurance provider might be correct and complete.
    Cost of advantages are topic to all phrases, circumstances, limitations, and exclusions of the member’s contract at time of service.
    People who use AAS have weaker hearts compared to those who by no
    means used the medicine. In the identical examine,
    it was also reported that utilizing anabolics frequently for
    2 years worsen coronary heart capabilities. Muscular
    strength may even drastically improve as a outcome of enhanced ATP (intracellular adenosine triphosphate) production and better ranges of exogenous testosterone, enhancing protein synthesis.

    Reply
  41. PedsElite

    If you’re lucky sufficient to have no family historical past of
    male pattern baldness, then you’re not prone to endure from this facet effect.
    The problem is many people have no idea if we have the “baldness gene” – till we use an anabolic steroid like Trenbolone or Primobolan,
    which have strong androgenic results. The premise of hormonal
    male contraception hinges on the adverse feedback exerted by sex hormones on LH and FSH secretion.
    However, many bodybuilders don’t use a regular steroid in Phase 1 as a result of they use growth hormone to reinforce the
    preliminary enhance in testosterone, uncooked steroid powder calculator.
    Some bodybuilders proceed to use anabolic steroids throughout
    Section 1, using progress hormone to enhance the preliminary
    improve in testosterone, anabolic steroids cycles. In the primary three weeks of the cycle,
    Part 2 is usually taken with testosterone and growth hormone.
    Phase 2 begins with the athletes getting extra muscular in the course of the first three weeks and
    the bodybuilding cycle progresses in a similar fashion to normal progress because the cycle progresses, anabolic steroid cycles and doses.

    Heightened prolactin will kill your intercourse drive, although this problem doesn’t have an result on everybody who
    makes use of Tren. By enhancing the effectivity of how your body makes use of vitamins from meals (mostly carbs,
    proteins, and fats), each calorie you absorb is used to its
    full potential. Collagen additionally acts as
    an antioxidant and supports the skin and connective tissues.
    In different words, enhanced collagen synthesis has wide-ranging health benefits.

    I built an improved version of the old steroid plotter, that now
    permits customers to Save, Monitor, and Graph
    their Cycles, Compounds, Ancillaries, Blood Work, and Journal Entries.
    Our Steroid Conversion Calculator is designed with ease of use in mind.

    It’s necessary to notice that, in distinction to a lot of other steroids, Testosterone Cypionate does not pose a risk for liver toxicity.
    Testosterone Cypionate is mostly extensively obtainable, and its well-known pharmaceutical model name, Depo-Testosterone, is
    used medically to treat low testosterone and another circumstances.
    Its recognition with bodybuilders stays robust right now,
    and whether it’s used alone or stacked with another steroid, Testosterone Cypionate customers can be
    confident of excellent results. In this case, our patient’s body temperature increases by approximately 1 diploma.
    We discover that fats loss ceases approximately
    4-6 weeks right into a cycle when the body inevitably reaches homeostasis and cools down. This is why bodybuilders sometimes cycle clenbuterol for short
    durations, with transient protocols of two weeks on and a couple of weeks
    off for max efficacy.
    Underground labs can basically vary from massive industrial setups to small
    garage-based labs. You won’t know where you’re buying from,
    even if suppliers advertise themselves as the very
    best high quality (it’s of their financial interest to do so).
    Different oils are often used in compounded variations of Testosterone Cypionate; typically,
    you choose between sesame and grapeseed. The kind of oil solution could make a big distinction to how comfortable
    your injections might be (and, in some circumstances, how painful they
    may be), so it’s essential to pay attention to the differences
    in oils. Testosterone Cypionate is understood to have some adverse results on cholesterol.

    However, clenbuterol’s most potent trait, in our experience,
    is its metabolic results. We have overseen ladies administering 50–75 mg/day with out experiencing masculinization.
    Winstrol’s effects are similar to Anavar’s,
    allowing users to minimize back fats mass while including moderate amounts of muscle tissue.
    Stacking Deca Durabolin with an androgenic steroid such as Anadrol, testosterone, or trenbolone can mitigate low NO ranges.
    Deca Durabolin’s weak androgenic nature, when mixed with high prolactin ranges, can contribute to circumstances of erectile dysfunction.
    Medically, it is used by males who’ve low testosterone
    and infertility. In addition, you should take correct relaxation time between two cycles
    to assist you recuperate rapidly and improve your health.
    Individuals who have any severe illnesses or current surgery,
    they should strictly keep away from this drug.
    The half-life of a steroid is a very totally different idea to
    detection time. While the half-life does affect detection time to an extent, you can not depend on a steroid’s half-life to estimate simply
    how lengthy that steroid might be able to be detected by way of drug testing.

    In the HAARLEM study, a transient small enhance in serum creatinine concentrations of unknown medical relevance was observed during AAS use (from 93.1 μmol/L (1.05
    mg/dL) to 97.eight μmol/L (1.eleven mg/dL)). Creatinine concentrations returned to baseline
    after cessation of use. Albuminuria, as measured by dipstick evaluation, emerged or increased
    in 16% of the themes (155). In those receiving 1-androsterone, serum creatinine ranges elevated considerably
    from 97.3 μmol/L (1.1 mg/dL) to a hundred and fifteen.0 μmol/L (1.three mg/dL).

    The total clinical effects, however, are crystal clear – initially the muscle-building impact pursued by AAS users.
    More recent well-designed trials continued to supply further assist for the potent muscle-building results of AAS that had already been recognized
    by athletes for decades (15, 22, 35–38).

    This puts you above commonplace testosterone substitute,
    however not an excessive dose that causes more prominent unwanted effects.
    The danger of virilizing side effects from testosterone is exceptionally excessive
    in females. It’s a guaranteed end result, and many women will discover that even extremely low doses can bring about the growth of masculine features.
    One Other aspect of your outcomes with this steroid will relate to recovery.
    You ought to discover less time to recover from intense exercises and less muscle pain post-workout.

    Not solely will heavier lifting capability contribute to your results with Testosterone Cypionate, but so will the elevated
    endurance and stamina you feel. As Quickly As Testosterone Cypionate kicks in, you’ll be able to work out longer than ordinary, with
    fatigue not coming on on the level it normally would.

    References:

    PedsElite

    Reply
  42. PedsElite

    When frontloading, you’ll twice or even triple your regular dose throughout the
    first week or so of utilizing the steroid. This
    permits you to take advantage of the pure fast spike in hormone release upon injection, which slows down afterward and becomes more gradual.
    Frontloading will amplify this initial impact early on and let you profit sooner from
    increased efficiency. Mostly, we are going to
    do frontloading when utilizing slower-acting steroids which have a longer half-life,
    like a few of the in style testosterone esters, including Testosterone Enanthate and Testosterone Cypionate.
    Frontloading is an ideal technique as a outcome of these steroids can take
    a couple of weeks to start out delivering effects. So, you’ll find a way to see the importance of familiarity with
    each compound’s half-life, even if you’re going with
    only a single compound cycle.
    It is perfect for contest prep, especially if you add Halotestin for the
    final three weeks of the cycle, which can harden up
    the physique whereas boosting strength fairly dramatically.
    A attainable reduction in urge for food from Anavar will
    assist along with your weight-reduction plan. You can count on excellent synergy between these two compounds to get you moving a
    few of the extra cussed fats. Start PCT 14 days after the cycle if you’ve
    used take a look at enanthate, then 20 days of Clomid at 50mg every day, and
    it helps to add half mg every day of Arimidex with it.
    Once More, observe the 1 Vial Testosterone
    Cycle above and exchange the Test with Deca. The cycle runs for under eight weeks, enough
    for Deca to work to its maximum impact.
    Buying from unknown web sites with no reviews or trusting someone at your fitness center,
    the place nobody can vouch for the product, increases the possibilities of being scammed.

    Pharmaceutical-grade Anadrol is created by scientists in a lab for medical
    functions. This could be bought on the black
    market if someone has been prescribed Anadrol for his or her anemia.
    So if they haven’t taken their treatment, they may resolve to sell it.

    Unlike anabolic steroids or artificial testosterone, Testo-Max is formulated from pure, clinically supported ingredients which might be
    protected for long-term use. There’s no hormonal suppression, no post-cycle therapy needed, and no danger of liver
    damage or mood instability. Although identified for
    power, D-Bal also triggers noticeable increases in muscle mass.
    Of weight acquire throughout a full cycle, depending on food regimen and coaching intensity.
    Winstrol can suppress testosterone levels, lowering sperm quantity
    and high quality. Customers who frequently administer poisonous anabolic steroids similar to Winstrol, with
    inadequate day off in between cycles, are at larger risk of testosterone deficiency or infertility.

    So, if you’re genetically vulnerable to losing your hair, Dianabol may trigger some thinning
    in vulnerable individuals. Gynecomastia occurs when a man’s hormones turn into imbalanced and
    estrogen ranges (the feminine intercourse hormone) rise excessively.
    This is relatively frequent in AAS (anabolic-androgenic steroids)
    use, notably Dianabol, as a end result of its estrogenic
    nature. In general, 37% of steroid customers will experience some form
    of gynecomastia (11).
    Anabolic steroids are like placing a rocket on a push bike – however should you don’t
    know what you’re doing, then you’re certain to fail or, worse, destroy
    not only your positive aspects however your health6.
    I discovered that again and again, and that’s what impressed me to study as
    a lot as I might about steroids. I put just as a lot importance on diet and
    workout as I do on steroids – in spite of everything, doing gear is a
    complete waste of money and time if your food regimen sucks or if you’re not prepared to
    kill it in the gym at each single workout. Discover a variety of SARMs designed to boost muscle progress, pace up recovery, and enhance overall athletic
    efficiency.
    But the extra fluid won’t be your good friend if you’d like
    a nice muscle definition and vascularity. However despite all its potency and genuine aspect effect risks, Anadrol CAN be tolerated nicely
    by many individuals, and side effects can be minimized with smart use.
    One study confirmed that whereas patients incessantly experienced unwanted side effects, they have been primarily mild and always reversible.

    For these under 25, caution is advised, as Dianabol can disrupt natural
    hormone production during formative years. Anabolic steroids are
    artificial variations of testosterone, the hormone
    liable for muscle development, energy, and performance. While both injectable
    and oral steroids serve related anabolic functions,
    how they’re administered can considerably influence their efficacy, unwanted aspect effects, and outcomes.

    Choosing between oral and injectable steroids isn’t just about preference—it’s
    about understanding your body, your targets, and your
    duty as a user. Oral steroids are quick and convenient but come
    with added liver stress and shorter cycles.

    References:

    PedsElite

    Reply

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