Podcasts about ercp

In this episode of The David Watson Podcast, I sit down with Dr Peter B. Cotton – world-renowned gastroenterologist and creator of the award-winning “Fred the Snake” children's book series – to talk about life after medicine, story-telling, and why his endoscope turned into a lovable snake called Fred. Peter has written 10 rhyming picture books for children about Fred the Snake and his friends, including the brand-new “When Fred the Snake and Friends Learn the Chinese Zodiac – and the Great Race”. We talk about how a career pioneering flexible endoscopy and ERCP became the unexpected inspiration for a gentle snake who teaches road safety, friendship, travel, and courage to kids and grandkids around the world. In this conversation we cover: • How a flexible endoscope became “Fred the Snake” and the start of a bedtime story • Turning that original road-safety rhyme into the first book, “When Fred the Snake Got Squished and Mended” • Why all the Fred books are written in rhyme and built around simple morals for children • The new Chinese Zodiac book and the story of the Great Race – explaining years, animals and culture to kids • Fred going to school, camping, the beach and traveling across the USA (East, Central and West) • The difference between writing scientific papers and imaginative children's books • What Peter has learned about confidence, voice and “writing what you're actually good at” • Grandparents, puppets and why reading to children still matters in a digital world • Growing up in Herefordshire, training at Cambridge and in London, and why he moved to the USA • Life on a small island in South Carolina, golf stories from around the world, and finally “hanging up” the clubs • Reflections on retirement, legacy, family and finding a second creative career later in life If you're a parent, grandparent, educator or aspiring children's author, this episode is full of ideas about how to combine fun, rhyme and gentle life lessons in stories for young readers. Find Peter Cotton and Fred the Snake: Website (signed copies, blog and resources): https://petercottontales.com Fred the Snake books on Amazon (search): “Peter B. Cotton Fred the Snake”

This week we are talking about Pancreatic cancer.  This is a type of cancer that begins as a growth of cells in the pancreas. The pancreas lies behind the lower part of the stomach. It makes enzymes that help digest food and hormones that help manage blood sugar. The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma. This type begins in the cells that line the ducts that carry digestive enzymes out of the pancreas. Pancreatic cancer rarely is found at its early stages when the chance of curing it is greatest. This is because it often doesn't cause symptoms until after it has spread to other organs. Your health care team considers the extent of your pancreatic cancer when creating your treatment plan. Treatment options may include surgery, chemotherapy, radiation therapy or a mix of these. Pancreatic cancer often doesn't cause symptoms until the disease is advanced. When they happen, signs and symptoms of pancreatic cancer may include: Belly pain that spreads to the sides or back. Loss of appetite. Weight loss. Yellowing of the skin and the whites of the eyes, called jaundice. Light-colored or floating stools. Dark-colored urine. Itching. New diagnosis of diabetes or diabetes that's getting harder to control. Pain and swelling in an arm or leg, which might be caused by a blood clot. Tiredness or weakness. It's not clear what causes pancreatic cancer. Doctors have found some factors that might raise the risk of this type of cancer. These include smoking and having a family history of pancreatic cancer. Understanding the pancreas The pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. It releases hormones, including insulin. These hormones help the body process the sugar in the foods you eat. The pancreas also makes digestive juices to help the body digest food and take in nutrients. How pancreatic cancer forms Pancreatic cancer happens when cells in the pancreas develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the instructions tell the cells to grow and multiply at a set rate. The cells die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes there to be too many cells. The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic ductal adenocarcinoma or pancreatic exocrine cancer. Less often, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called pancreatic neuroendocrine tumors or pancreatic endocrine cancer. Risk factors Factors that might raise the risk of pancreatic cancer include: Smoking. Type 2 diabetes. Chronic inflammation of the pancreas, called pancreatitis. Family history of DNA changes that can increase cancer risk. These include changes in the BRCA2 gene, Lynch syndrome and familial atypical multiple mole melanoma (FAMMM) syndrome. Family history of pancreatic cancer. Obesity. Older age. Most people with pancreatic cancer are over 65. Drinking a lot of alcohol. As pancreatic cancer progresses, it can cause complications such as: Weight loss. People with pancreatic cancer might lose weight as the cancer uses more of the body's energy. Nausea and vomiting caused by cancer treatments or a cancer pressing on the stomach might make it hard to eat. Sometimes the body has trouble getting nutrients from food because the pancreas isn't making enough digestive juices. Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellowing of the skin and the whites of the eyes. Jaundice can cause dark-colored urine and pale-colored stools. Jaundice often occurs without belly pain. If the bile duct is blocked, a plastic or metal tube called a stent can be put inside it. The stent helps hold the bile duct open. This is done using a procedure called endoscopic retrograde cholangiopancreatography, also called ERCP. During ERCP, a health care professional puts a long tube with a tiny camera, called an endoscope, down the throat. The tube goes through the stomach and into the upper part of the small intestine. The health professional puts a dye into the pancreatic ducts and bile ducts through a small tube that fits through the endoscope. The dye helps the ducts show up on imaging tests. The health professional uses those images to place a stent at the right spot in the duct to help hold it open. Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Treatments, such as radiation and chemotherapy, might help slow tumor growth and provide some pain relief. When medicines aren't helping, a health care professional might suggest a celiac plexus block. This procedure uses a needle to put alcohol into the nerves that control pain in the belly. The alcohol stops the nerves from sending pain signals to the brain. Bowel blockage. Pancreatic cancer can grow into or press on the first part of the small intestine, called the duodenum. This can block the flow of digested food from the stomach into the intestines. A health care professional might suggest putting a tube called a stent in the small intestine to hold it open. Sometimes, it might help to have surgery to place a feeding tube. Or surgery can attach the stomach to a lower part of the intestines where the cancer isn't causing a blockage. Prevention Screening for people with a high risk of pancreatic cancer Screening uses tests to look for signs of pancreatic cancer in people who don't have symptoms. It might be an option if you have a very high risk of pancreatic cancer. Your risk might be high if you have a strong family history of pancreatic cancer or if you have an inherited DNA change that increases the risk of cancer. Pancreatic cancer screening might involve imaging tests, such as MRI and ultrasound. These tests are generally repeated every year. The goal of screening is to find pancreatic cancer when it's small and most likely to be cured. Research is ongoing, so it's not yet clear whether screening can lower the risk of dying of pancreatic cancer. There are risks to screening. This includes the chance of finding something that requires surgery but later turns out to not be cancer. Talk about the benefits and risks of pancreatic cancer screening with your health care team. Together you can decide whether screening is right for you. Genetic testing for cancer risk If you have a family history of pancreatic cancer, discuss it with a health care professional. The health professional can review your family history and help you understand whether genetic testing might be right for you. Genetic testing can find DNA changes that run in families and increase the risk of cancer. If you're interested in genetic testing, you might be referred to a genetic counselor or other health care professional trained in genetics. Ways to lower risk You might reduce your risk of pancreatic cancer if you: Stop smoking. If you smoke, talk to a member of your health care team about ways to help you stop. These might include support groups, medicines and nicotine replacement therapy. Maintain a healthy weight. If you are at a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss of 1 to 2 pounds (0.5 to 1 kilogram) a week. To help you lose weight, exercise most days of the week. Slowly increase the amount of exercise you get. Choose a diet rich in vegetables, fruit and whole grains with smaller portions.  (CREDITS: MAYO CLINIC)

In this episode of Behind the Knife, the minimally invasive surgery (MIS) team dives deep into the evolving field of common bile duct exploration (CBDE). From the historical context of laparoscopic approaches to the latest advances including robotic-assisted techniques, Drs. Shaina Eckhouse, James Jung, Zachary Weitzner, and Joey Lew discuss key evidence shaping modern practice. Listeners will learn about indications and anatomy guiding trans-cystic versus trans-choledochal approaches, practical tips for safe stone clearance, and critical considerations around learning curves and team coordination for robotic procedures. The episode also highlights important studies comparing single-stage laparoscopic CBDE with staged ERCP and cholecystectomy, emphasizing outcomes such as stone clearance, pancreatitis rates, and hospital length of stay. This comprehensive overview is a must-listen for MIS and acute care surgeons interested in optimizing the management of choledocholithiasis and streamlining patient care with minimally invasive techniques. Hosts:  - Shaina Eckhouse, MD, Bariatric Surgery Medical Director and Vice Chair of Clinical Operations, Department of Surgery, Duke University - James Jung, MD, PhD, Assistant Professor of Surgery, Duke University - Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD - Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals:  By the end of this episode, listeners will be able to: -  Describe the historical approaches to managing choledocholithiasis, including staged interventions and the evolution toward single-stage laparoscopic common bile duct exploration (CBDE). -  Summarize key clinical evidence comparing CBDE and ERCP, including landmark studies and meta-analyses evaluating outcomes, complications, and trends over time.​ - Distinguish between transcystic and transcholedochal approaches to CBDE, explaining indications, contraindications, and technical nuances for each technique.​ -  Identify appropriate candidates for transcystic exploration based on cystic duct anatomy and stone characteristics.​ - Recognize the impact of newer surgical technologies—such as digital choledochoscopy, Spyglass, and robotic platforms—on CBDE practice, efficiency, and safety.​ - Discuss the importance of multidisciplinary teamwork, preparation, and perioperative planning for successful CBDE, particularly in complex or altered anatomy cases.​​ - Appraise the learning curve and quality of evidence for new CBDE procedures, outlining the need for mentorship, ongoing training, and knowing when to collaborate with GI or hepatopancreaticobiliary (HPB) surgery.​ - Outline approaches and bailout strategies for challenging cases, including patients with surgically altered anatomy and use of adjuncts such as intraoperative cholangiography (IOC), feeding tube placement, and Fanelli stents.​​ - Evaluate safety outcomes and limitations associated with robotic-assisted CBDE and single-stage management, incorporating recent data from population-based studies.​ -  Reflect on strategies for tailoring CBDE techniques to individual patient anatomy, surgeon experience, and available resources, advocating for evidence-based practice and continuous learning. References: -  Giurgiu DI, Margulies DR, Carroll BJ, et al. Laparoscopic Common Bile Duct Exploration: Long-term Outcome. Arch Surg. 1999;134(8):839-844. doi:10.1001/archsurg.134.8.839 https://pubmed.ncbi.nlm.nih.gov/10443806/ -  Lyu Y, Cheng Y, Li T, Cheng B, Jin X. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc. 2019;33(10):3275-3286. doi:10.1007/s00464-018-06613-w https://pubmed.ncbi.nlm.nih.gov/30511313/ - Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I. Meta‐analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open. 2019;3(3):242-251. doi:10.1002/bjs5.50132 https://pubmed.ncbi.nlm.nih.gov/31183439/ - Cironi K, Martin MJ. Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon. Trauma Surg Acute Care Open. 2025;10(Suppl 1). doi:10.1136/tsaco-2025-001821 https://pubmed.ncbi.nlm.nih.gov/40255986/ - Zhang C, Cheung DC, Johnson E, et al. Robotic Common Bile Duct Exploration for Choledocholithiasis. JSLS J Soc Laparosc Robot Surg. 2025;29(1):e2024.00075. doi:10.4293/JSLS.2024.00075 https://pubmed.ncbi.nlm.nih.gov/40144383/ - Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303-1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/ Ad Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. 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George Webster is one of the world's leading figures in ERCP and cholangioscopy — and a fantastic personality, combining wisdom, practicality, and humor

Send us a textDr. Douglas G. Adler, MD, F.A.C.G., A.G.A.F., F.A.S.G.E. ( https://douglasgadler.com/ ) is Director of the Center for Advanced Therapeutic Endoscopy, AdventHealth Porter in Denver, Colorado ( https://www.adventhealth.com/find-doctor/doctor/douglas-adler-md-1891748687 ). Dr. Adler is also the Editor-in-Chief of Gastrointestinal Endoscopy ( https://www.giejournal.org/ ). Prior to moving to Colorado, Dr. Adler was a tenured Professor of Medicine at the University of Utah School of Medicine in Salt Lake City, UT. Dr. Adler was also the GI Fellowship Program Director at the University of Utah School of Medicine for seven years. Dr. Adler focuses his clinical, educational, and research efforts on the diagnosis and management of patients with gastrointestinal cancers and complex gastrointestinal disease, with an emphasis on therapeutic endoscopy. Dr. Adler is an internationally recognized expert on all facets of Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS), gastrointestinal stenting, Gastric Peroral Endoscopic Myotomy (GPOEM), and other topics. He is the author of more than 600 scientific publications, articles, and book chapters and he has published 9 gastroenterology textbooks, including the first textbook on Interventional Endoscopic Ultrasound. Dr. Adler has also published more than 70 articles on history, aviation, aerospace, and astronomy.Dr. Adler received his medical degree from Cornell University Medical College in New York, NY. He completed his residency in Internal Medicine at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston, MA. Dr. Adler completed both a general gastrointestinal fellowship and a therapeutic endoscopy/ERCP fellowship at Mayo Clinic in Rochester, MN. He then returned to the Beth Israel Deaconess Medical Center for a fellowship in endoscopic ultrasound.#DouglasAdler #TherapeuticEndoscopy #AdventHealthPorter #GastrointestinalEndoscopy #EndoscopicRetrogradeCholangiopancreatography #EndoscopicUltrasound #GastrointestinalStenting #GastricPeroralEndoscopicMyotomy #Transluminal #Lumen #Choledochoduodenostomy #MinimallyInvasive #GlucagonLikePeptide1Agonists #FecalMicrobiotaTransplantation #Colonoscopy #AdvancedPancreaticobiliaryEndoscopy #NeilArmstrong #BuzzAldrin #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #ViralPodcast #STEM #Innovation #Technology #Science #ResearchSupport the show

One patient died and 25 others were found to have been harmed when a nurse was permitted to perform complex medical procedures in the UK.Gastroenterologist Dr. Kaveh Hoda joins me to discuss the necessary training to perform an endoscopic retrograde cholangiopancreatography (ERCP), a procedure most commonly used to remove gallstones. From the BBC article: 68 patients underwent ERCPs with a 'single consultant nurse', and a review found that 58 received "substandard" care from the service between 2016-21, including 25 who "suffered some degree of harm". https://www.bbc.com/news/articles/clym224qgdyoAs nurses and PAs continue to advocate for more privileges, could this happen in the US?PhysiciansForPatientProtection.org

Dr Philip Smith, Digital and Education Editor of Gut and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK interviews Professor Yanglin Pan from the State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China, on the paper "Rectal diclofenac versus indomethacin for prevention of post-ERCP pancreatitis (DIPPP): a multicentre, double-blind, randomised, controlled trial" published in paper copy in Gut in July 2025. Please subscribe to the Gut podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3UOTwqS) or Spotify (https://spoti.fi/3Ifxq9p).

ERCP in liver transplantation can be challenging — from indication to execution. Jeanin van Hooft explains it all!

In this episode of The Interventional Endoscopist, I sit down with Dr. Jessica Widmer—Division Chief of Gastroenterology at NYU Langone Hospital–Long Island—for an honest, insightful, and inspiring conversation. Dr. Widmer shares her journey from a small town in Pennsylvania to becoming a leader in interventional endoscopy. We discuss her training path, early exposure to ERCP and cholangioscopy, and her decision to pursue advanced training at Cornell. She reflects on mentors who shaped her career, including Dr. Stavros Stavropoulos and Dr. Michel Kahaleh, and offers practical tips on teaching and performing cholangioscopy and pancreatoscopy. The episode also touches on the evolution and future of GI, training Challenges women face in interventional endoscopy, and balancing demanding careers with family life. We discuss the value of mentorship and society involvement Whether you're an advanced fellow, practicing endoscopist, or simply curious about the human side of medicine, this conversation delivers wisdom, humor, and heart. Subscribe, rate, and share—and stay tuned for more episodes exploring the minds shaping the future of GI.   Link to the GOLD program: https://www.asge.org/home/education/advanced-education-training/leadership-development/gi-organizational-leadership-development-program

Na žlučové cesty, třeba při jejich ucpání či zúžení, je tu zajímavá metoda ERCP. Do jícnu a žaludku, například kvůli refluxní chorobě, se endoskopista zase podívá metodou gastroskopie. Plejáda endoskopických metod i technik a postupů se ovšem průběžně velmi podstatně rozrůstá.

Wie beeinflussen die neuen Abrechnungssysteme den Klinikalltag? Im Nachgang unseres DGVS DRG Forums vor einer Woche diskutieren Jörg Albert, Thomas Rösch und Petra Lynen am Beispiel von ERCP und Resektionen, welche Herausforderungen und Unsicherheiten die Umstellung mit sich bringt. Während die Ambulantisierung im Rahmen der aktuellen Abrechnungsvorgaben hauptsächlich durch wirtschaftliche Zwänge bestimmt wird, bleiben Entbürokratisierung und Qualitätssicherung auf der Strecke. Ein kritischer Blick auf die Realität hinter den Reformen.

In this episode, hosts Drs. Temara Hajjat and Jenn Lee talk to Dr. David Vitale about EUS and ERCP indications in patients with acute pancreatitis and pancreatitis complications. Dr. Vitale is a pediatric gastroenterologist, the director of the interventional endoscopy center at Cincinnati Children's Hospital and Medical Center, and an Assistant Professor at the University of Cincinnati School of Medicine.  Learning Objectives:Understanding the indications of ERCP and EUS in acute pancreatitis Understand the indications of ERCP and EUS in pancreatitis complications Recognize the possible risks of EUS and ECRP in childrenSupport the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Welcome back to Scrubbing In! this episode, hosts Alan, and Mo are joined by Hemel Modi, currently an HPB Fellow at Cambridge, to dive deep into the complexities of pancreatic cancer. We explore everything from clinical scenarios to surgical techniques, exam strategies, and multidisciplinary approaches. This episode is packed with actionable insights, including the key steps for managing pancreatic cancer cases in the FRCS General Surgery exam, complications to watch for post-operatively, and the latest advancements in surgical oncology. We're also proud to announce that this episode is sponsored by Johnson & Johnson, who continue to support surgical education and training through innovative resources and fellowships. Key Takeaways: • Comprehensive FRCS exam preparation tips for pancreatic cancer. • Discussion on Whipple's procedure and its nuances, including pylorus-preserving techniques. • Diagnostic and imaging strategies: CT, EUS, ERCP, and more. • Multidisciplinary care in HPB surgery. • Common exam pitfalls and how to avoid them.

In this episode, Martin talks to Cansu Cimen, a researcher at University Hospitals Groningen in the Netherlands, about a recent paper that documents an outbreak and in particular the critical role of next-generation sequencing (NGS) in tracking and controlling the transmission of MDROs via contaminated duodenoscopes. Focusing on an outbreak linked to ESBL-producing Citrobacter freundii and Klebsiella pneumoniae after endoscopic retrograde cholangiopancreatography (ERCP), standard culture methods failed to detect contamination. After many negative cultures using established methods, destructive dismantling of the implicated scope revealed contamination on hard-to-clean components, highlighting NGS as an effective tool for identifying pathogen transmission pathways. Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, et al. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum beta-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024;13(1):31. https://doi.org/10.1186/s13756-024-01386-5. Download the paper here

In this episode, Martin talks to Cansu Cimen, a researcher at University Hospitals Groningen in the Netherlands, about a recent paper that documents an outbreak and in particular the critical role of next-generation sequencing (NGS) in tracking and controlling the transmission of MDROs via contaminated duodenoscopes. Focusing on an outbreak linked to ESBL-producing Citrobacter freundii and Klebsiella pneumoniae after endoscopic retrograde cholangiopancreatography (ERCP), standard culture methods failed to detect contamination. After many negative cultures using established methods, destructive dismantling of the implicated scope revealed contamination on hard-to-clean components, highlighting NGS as an effective tool for identifying pathogen transmission pathways. Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, et al. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum beta-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024;13(1):31. https://doi.org/10.1186/s13756-024-01386-5. Download the paper here

Broadcast from KSQD, Santa Cruz on 10-10-2024: Dr. Dawn announces Medicare's new list of over 200 drugs available for $2 per 30-day supply, covering a wide range of medications. She discusses a new urine test called ExoDx for prostate cancer screening, which can help avoid unnecessary biopsies in the "gray zone" of elevated PSA levels. The doctor addresses a listener's question about Klebsiella pneumoniae found in a nasal swab, explaining colonization versus infection and the risks of unnecessary antibiotic use. Dr. Dawn explores the reliability of QuantiFERON TB tests, suggesting potential false positives and the importance of retesting with different antigen tubes. She discusses orthostatic hypotension in older adults, offering practical tips like squeezing a firm ball before standing up and proper standing techniques to prevent falls. The doctor explains the importance of vitamin A for vegans, highlighting potential BCMO1 genetic variations that may affect beta-carotene conversion and recommending blood tests. Dr. Dawn addresses a question about elevated bilirubin levels post-gallbladder removal, discussing possible causes and diagnostic procedures like MRI and ERCP.

Broadcast from KSQD, Santa Cruz on 10-10-2024: Dr. Dawn announces Medicare's new list of over 200 drugs available for $2 per 30-day supply, covering a wide range of medications. She discusses a new urine test called ExoDx for prostate cancer screening, which can help avoid unnecessary biopsies in the "gray zone" of elevated PSA levels. The doctor addresses a listener's question about Klebsiella pneumoniae found in a nasal swab, explaining colonization versus infection and the risks of unnecessary antibiotic use. Dr. Dawn explores the reliability of QuantiFERON TB tests, suggesting potential false positives and the importance of retesting with different antigen tubes. She discusses orthostatic hypotension in older adults, offering practical tips like squeezing a firm ball before standing up and proper standing techniques to prevent falls. The doctor explains the importance of vitamin A for vegans, highlighting potential BCMO1 genetic variations that may affect beta-carotene conversion and recommending blood tests. Dr. Dawn addresses a question about elevated bilirubin levels post-gallbladder removal, discussing possible causes and diagnostic procedures like MRI and ERCP.

Das Thema Krankenhausreform beschäftigt uns seit geraumer Zeit. In NRW wurden die Leistungsgruppen eingeführt, vor allem mit dem Ziel komplexe Eingriffe mehr und mehr zu zentralisieren und so die Qualität der Versorgung zu verbessern. Die Gastroenterologie ist davon bisher nicht betroffen, man könnte jetzt sagen, das ist gut so. Andererseits bedeutet es, dass unsere komplexen Leistungen, wie zum Beispiel die ERCP, um die es heute gehen wird, unter dem Radar laufen und vielleicht sogar drohen, in die allgemeine Innere Medizin abzudriften. Was aber würde dies für die Versorgungsqualität bedeuten? Petra Lynen plaudert heute mit Ludger Leifeld, Chefarzt am St. Bernward Krankenhaus in Hildesheim und Leiter DGVS Kommission Qualität über die Publikation „Einfluss der Spezialisierung auf die Erfolgs- und Komplikationsrate bei der ERCP“ und darüber, wie wichtig eine Zuordnung dieser komplexen Leistung zu unserem Fachgebiet ist.

In this EE epsiode we discuss with Amrita Sethi from New York again - we discuss recent randomized studies how to drain the bile duct in distal malignant obstruction: Via ERCP or via EUS access to place a metal stent

Last time with Nageshwar Reddy we saw exciting tips and tricks if ERCP cannulation becomes difficult. Now we can relax with his brilliant course of normal sphincterotomy

Master Nageshwar Reddy continues with his basic ERCP series and the hot topic of difficult cannulation

This is the start of an ERCP series with Master Nageshwar Reddy - the first episode is about how to position the papilla and how to cannulate

Dr. Komanduri shares how he performs a successful ERCP, explains how patient anatomy dictates planning and explores why the double-wire technique – using Autotome™ Pro RX Cannulating Sphincterotome – is his preferred approach to biliary access. 

Citrón a Fentanyl so šťastím nezabil. Keď si voláte sanitku, nechajte vchodové dvere otvorené. Zlé výsledky zvyknú byť vyznačené hrubým písmom. Podvedome pacientom prajeme lepšiu diagnózu. Keď aj doktori (Jožko+Lukáš) rozmýšľajú, čo je vlastne ERCP. Krv ako kola. NEXT? HIŠA FRANKO, GRIČ A CRNO ZRNO/slovinský bedeker  https://open.spotify.com/episode/1nij2IxxC0qoz5t1n1XSFm?si=BSfLyToQTuScOk9KFkGDIQ  Tento týždeň vám podcasty ZAPO prináša SPP, s elektrinou a plynom jednoducho a výhodne pod jednou strechou  https://moje.spp.sk/  Penta zlepšuje zdravotníctvo: Nová nemocnica Bory  https://nemocnica-bory.sk/   S VÚB účtom, appkou a kartou od Visa si deti poradia aj s peniazmi  https://www.vub.sk/ludia/ucty/juniorbanking.html  Vražedné Psyché LIVE po prvýkrát v ČESKEJ REPUBLIKE! 14. apríla o 18:30 / KD Rubín, Brno. A hneď o 2 dni, 16. apríla Trenčín, Piano Club. V Trenčíne sa vám predstaví aj podcast Zveromachri, hrať bude kapela Silky Džon a pán doktor Droba otvorí večer hrou na klavíri. Vstupenky na  www.zapotour.sk  Podcasty by ZAPO môžeš počúvať už aj na Youtube a nezabudni nám dať odber  https://www.youtube.com/@ZAPOTV  Produkcia @doktormafilipaofficial by ZAPO @zapoofficial   

Im Nachgang zu den letzten DGVS-Rundmails fasst Jörg Albert für uns die neuesten Entwicklungen zusammen, ERCP and endosonographische Punktionen werden zu Hybrid-DRGs; zudem diskutieren wir endoluminale Eingriffe wie größere Endoresektionen.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Prabhleen Chahal, MD Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most dreaded complication of this procedure. So what are the patient-related, procedure-related, and operator-related risk factors for developing post-ERCP pancreatitis, and how can we work to prevent it? Join Dr. Peter Buch as he speaks with Dr. Prabhleen Chahal, Program Director of the Advanced Endoscopy Fellowship at the Cleveland Clinic.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Prabhleen Chahal, MD Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most dreaded complication of this procedure. So what are the patient-related, procedure-related, and operator-related risk factors for developing post-ERCP pancreatitis, and how can we work to prevent it? Join Dr. Peter Buch as he speaks with Dr. Prabhleen Chahal, Program Director of the Advanced Endoscopy Fellowship at the Cleveland Clinic.

Dr. Maranki explores advances in ERCP technology and technique, approaches to cannulation and access, treatments for stones and strictures – and the impact of mentors and allies on her career. ENDO-1715504-AA

* 라디오주치의 : 순천향의대 가정의학과 유병욱 교수 - 청취자 Q&A : 하지불안정증 (2062) / 만성췌장염 ERCP 시술 (8458) / 담낭용종 수술 후 관리 (현수연) * 이주의 의학정보 : 염민주 리포터 - "잠드는 데 30분 넘게 걸린다면 사망위험 2배 증가" 外_ * 하루한알 의약상식 : 대한약사회 정재훈 약사 - "구충제, 비염에 효과 있을까?"

Approach to workup of cholangitis, chronic cholecystitis, Gallstone Ileus, Cholangiocarcinoma including Klatskin tumor, Carcinoma of GB and Pancreas At the end some house-cleaning on iatrogenic complications of gallstone disease after ERCP and other procedures are discussed (including bile duct injury and bile leak); For SOD refer to previous episode on cholecystitis management and complications of cholecystectomy.

In this episode, Dr. Temara Hajjat and Dr. Jenn Lee discuss with Dr. Roberto Gugig from Stanford's Lucile Packard Children's Hospital the indications, techniques, and potential complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in pediatric patients. Dr. Gugig is a pediatric gastroenterologist and Professor of Pediatrics who specializes in advanced endoscopy including ERCP and EUS. Objectives:1. Diving into the science of pediatric ERCP and EUS imaging. 2. Unpacking the intricacies of diagnosing pancreaticobiliary disorders in children using EUS or ERCP. 3. Shedding light on higher complication rates in patients under two years old and how to mitigate them. Support the showAs always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Follow us on Twitter, Facebook and Instagram for all the latest news and upcoming episodes!

The title says it all

Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients.   Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality) ·      Bilirubin, albumin, INR, ascites, encephalopathy ·      Used to predict operative mortality based on cirrhosis severity ·      Mortality in EGS: - Child-Pugh A: 10% electively and 22% emergently - Child-Pugh B: 30% electively and 38% emergently - Child-Pugh C: 80% electively and up to 100% emergently Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older) ·      creatinine, bilirubin, INR, and sodium ·      MELD < 20 – 1% increase in mortality with each point increase ·      MELD > 20 – 2% increase in mortality with each point increase Pre-operative Planning ·      Identification of cirrhosis with physical examination, bloodwork and imaging ·      Involvement of other medical services (internal medicine, hepatology, ICU) as needed ·      Cirrhosis optimization, if possible ·      Abdominal wall mapping Unexpected Intraoperative Finding Communicate unexpected findings to the operative team and think of additional adjuncts you may need such as additional ports, topical hemostatic agents or energy devices. Think about why you are in the OR. If its an elective situation and can wait, consider bailing. If its emergent, you may have to do something more definitive. Exposure may be a challenge, you may have to alter your typical approach including where the assistant grabs and retracts. Extra hands are helpful. Bleeding can be a big deal. If possible, map out the abdominal wall ahead of time with cross-sectional imaging. Stay away from varices around the umbilicus or porta Ventral Hernia + Cirrhosis ·      Ideally, control ascites pre-operatively, if you can't consider leaving drains ·      Small (< 2cm) hernias close primarily ·      Larger (>2cm) hernias repair with mesh unless infected filed (controversial) ·      Minimally invasive repairs can be performed Benign Biliary Disease + Cirrhosis ·      Incidence of gallstones is 4-5 times higher in cirrhotic patients ·      Prophylactic laparoscopic cholecystectomy (LC) generally not done ·      LC generally considered acceptable in CP A or B but not C (exceptions: HD instability, gangrenous cholecystitis, hemorrhagic cholecystitis) ·      Cholecystostomy and ERCP are safe References:  Bleszynski, M. et. Al. Acute care and emergency general surgery in patients with chronic liver disease: how can be optimize perioperative care? A review of the literature. 2018. World Journal of Emergency Surgery; 13:32 Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5. Yeom SK, Lee CH, Cha SH, Park CM. Prediction of liver cirrhosis, using diagnostic imaging tools. World J Hepatol. 2015 Aug 18;7(17):2069-79. doi: 10.4254/wjh.v7.i17.2069. PMID: 26301049; PMCID: PMC4539400. Jain D, Mahmood E, V-Bandres M, Feyssa E. Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery. Ann Gastroenterol. 2018 May-Jun;31(3):330-337. doi: 10.20524/aog.2018.0249. Epub 2018 Mar 15. PMID: 29720858; PMCID: PMC5924855. **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Emergency General Surgery episode here: https://behindtheknife.org/podcast-category/emergency-general-surgery/

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Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.What is your anesthetic plan for ERCP procedures? Tune in today for the conclusion of our special Pro-Con debate series. We are reviewing the final arguments in favor of general endotracheal anesthesia. Spoiler alert: Both sides can agree that keeping patients safe requires a qualified anesthesia professional.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/137-the-debate-continues-general-endotracheal-anesthesia-for-ercp/

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.What is your anesthetic plan for ERCP procedures? The debate between monitored anesthesia care and general endotracheal anesthesia continues today. We are focusing on the Con-side of the debate in favor of GEA for ERCP with special guest, Luke Janik, who contributed audio clips to the show today.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/136-the-debate-continues-general-endotracheal-anesthesia-for-ercp/

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety. What is your anesthetic plan for ERCP procedures? Tune in today for a special Pro-Con debate show. We are focusing on the Pro-side of the debate in favor of monitored anesthesia care for ERCP and reviewing clinical monitoring, options to provide supplemental oxygen, and development of a safe and effective anesthetic plan.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/135-pros-for-providing-monitored-anesthesia-care-for-ercp/

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.What is your anesthetic plan for ERCP procedures? Tune in today for a special Pro-Con debate show. We are focusing on the Pro-side of the debate in favor of monitored anesthesia care for ERCP with special guest, Samantha Stamper, who contributed audio clips to the show today.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/134-keeping-patients-safe-during-monitored-anesthesia-care-for-ercp/

Dr Kim Kucharski discusses her article, "Comparison of technical failures and patient-related adverse events associated with 3 widely used mechanical lithotripters for ERCP: insights from the FDA Manufacturer and User Facility Device Experience (MAUDE) database" from the November issue.

Dr. Navin Kumar, an attending Gastroenterologist at Brigham and Women's Hospital, medical educator at Harvard Medical School, and co-founder of the Run the List podcast and host Blake Smith discuss how to approach a patient presenting with acute right-upper quadrant (RUQ) pain. Together, they discuss the various causes of RUQ pain, in addition to how to approach a set of liver function tests (LFTs), differentiating hepatocellular injury from a cholestatic pattern. They then discuss how various forms of imaging (RUQUS, CT) can guide diagnosis and management, leading to a discussion about the use of ERCP and cholecystectomy in such cases. Lastly, the episode closes with a diagnosis and three clinical pearls about RUQ pain and abnormal LFTs.

Host: Jonathan Buscaglia, MD, FASGEGuest Expert: B. Joseph Elmunzer, MD, MSc 

In this podcast episode, Peter B. Cotton, MD, FRCP, FRCS, professor of medicine at the Medical University of South Carolina, discusses the development and invention of the ERCP procedure, the innovation of digestive disease centers and more. Intro :02 Welcome to this episode of Gut Talk :23 About Cotton :23 The interview :37 Where did you grow up? :37 How did you get interested in gastroenterology? 1:38 That [trainees wanting to come to the endoscopy lab and not go to the basic science lab] must have put you in a difficult situation at times. How did you navigate that? 6:12 Could you tell us a little more about what that was like, from an operational perspective, of overseeing the endoscopy center, and perhaps how that role of operating in an endoscopy center as a trainee impacted you innovation in ER cepheid advanced endoscopy? 7:03 How flexible is the shaft of those initial endoscopes, and did you use sedation? 8:49 Is it a correct characterization that the building and innovation and inventions at this early stage in your career was really just to get the job done as opposed to you seeking out a role that was focused on inventing? 9:56 You were the only gastroenterologist at Middlesex for many years, correct? 10:52 How did that transition to Duke occur? … Did that [clinical load] drive a lot of your decision-making or was it more than that? 11:50 Where did the ERCP start? 15:11 How were you able to collaborate with other gastroenterologists and radiologists and surgeons? …What was that collaboration between these investigators that were really trying to drive this procedure forward like back in the Sixties and Seventies? 20:23 Were you able to pass endoscopic videos back and forth, or was that not really the way cases were shared? 21:36 About the Digestive Disorder Center at NUSC and Digestive Diseases Centers 24:43 Has it worked out the way you had envisioned? … What are the potential downfalls as people think about that type of Digestive Health Center model? 27:43 Summary of Cotton's memoir, The Tunnel at the End of the Light: My Endoscopic Journey in Six Decades 31:34 You also have written books for young children as well. What prompted you to writing and teaching one of the most complicated procedures to your book about “Fred the Snake”? 32:10 What are you most excited about with regards to opportunities facing younger gastroenterologists moving forward, and what advice would you give them to seize those opportunities? 34:54 Thank you Peter 36:42 Thanks for listening 36:58 Peter B. Cotton, MD, FRCP, FRCS, is professor of medicine at the Medical University of South Carolina. We'd love to hear from you! Send your comments/questions to guttalkpodcast@healio.com. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc Disclosures: Berry and Chey report no relevant financial disclosures. Cotton reports no relevant financial disclosures.

Episode 94: Elevated Alk Phos. Akhil explains what to do when the alkaline phosphatase is elevated, including labs, imaging and other studies. This is Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice.Elevated Alk Phos. By Akhil Patel, MS4, American University of the Caribbean. Comments by Hector Arreaza, MD. Serum alkaline phosphatase: When you find elevated serum alkaline phosphatase, you must consider the two most common sources: the liver and bones. Other sources to consider include the third-trimester placenta, intestine, and kidneys. To determine if the abnormal elevation of alkaline phosphatase has clinical significance, you need to consider if it is a physiological or pathological elevation first. Ruling out physiological concerns: Typically, you should rule out physiological causes first as they are fewer and easier to determine via patient history. This can be even quicker to determine but also sometimes bypassed if a patient's history and labs present with more concerning etiologies of pathological elevation.Common causes of physiological elevations in alkaline phosphatase include pregnancy, patients with blood type O and B after eating a fatty meal, and younger children. Pregnancy: During pregnancy women in their third trimester will have elevated serum alk phos from the placenta. Blood type: During digestion, alk phos is released from the intestines in patients of blood type O and B. A postprandial increase can be 1.5 to 2 times the upper limit of normal in these patients, however, there is no clinical significance. Children: Younger children tend to have higher alk phos due to increased bone turnover. You can find a reference range chart online for different age groups. It is possible for alk phos to be up to three times higher in infancy and adolescence reflecting the ages with the highest bone growth velocity. Fun fact: Alkaline Phosphatase (also known as ALP) is a natural enzyme present in raw milk. Complete pasteurization will inactivate the enzyme in milk, therefore, presence of alkaline phosphatase in milk is an indicator of failed pasteurization. This is because the most heat-stable bacteria found in milk, Mycobacterium paratuberculosis, is destroyed by temperatures lower than those required to denature ALP.Evaluation of pathological alkaline phosphatase: Degree of elevation: Another consideration is the level of alk phos elevation. If alk phos is at least four times the upper limit of normal, then cholestasis is the likely cause with many specific etiologies to consider. If alk phos is not markedly elevated (four times the upper limit) then the cause is likely not as specific and many different etiologies should be considered whether hepatic or non-hepatic.  Liver source: Common symptoms: Jaundice, abdominal pain, ascites, easy bruising, nausea and/or vomiting, choluria, acholia or hypocholia, unexplained weight loss, fatigue, or anasarca.If alk phos is elevated along with liver function testing and bilirubin, it is easier to determine the liver etiology (hepatitis, cirrhosis). However, if it is an isolated elevation in alkaline phosphatase, then other sources must be considered more carefully. A helpful test at this point is to look at is GGT or serum 5'-Nucleotidase for elevation. Typically, these will be elevated with alk phos if it is of liver origin. If they are not increased, you should consider bone-related etiologies.-If a hepatic cause is determined, a right upper quadrant ultrasound is the best initial test to determine intrahepatic or extrahepatic causes. This imaging will look at the hepatic parenchyma and bile ducts. Biliary dilation on ultrasound suggests an extrahepatic cause while no dilation suggests an intrahepatic cause. Liver source with biliary dilation: CBD is considered dilated when >6mm. If biliary dilation is present suggesting an extrahepatic cause, ERCP or MRCP is the next best step in visualizing the cause with choledocholithiasis being the most common cause. Other causes to consider: malignant obstruction, primary sclerosing cholangitis strictures, chronic pancreatitis causing strictures, and AIDS cholangiopathy. Malignant obstructions can be from the pancreas, gallbladder, ampulla of vater, bile duct, or distant metastasis. If the results of these tests are inconclusive the next best step is to consider a liver biopsy. Liver source without biliary dilation: Without biliary dilation on ultrasound, there is a larger pool of etiologies to consider for intrahepatic causes: drug toxicity, primary biliary cirrhosis, primary sclerosing cholangitis, viral hepatitis, cholestasis of pregnancy, and total parenteral nutrition (TPN). Tests: Antimitochondrial antibody (AMA) testing is a good place to start at this point which would suggest primary biliary cirrhosis (PBC) and indicate confirmation with a liver biopsy. Other tests to order at this point include hepatitis panel, EBV and CMV, and possibly pregnancy testing. If patient history and these tests are all negative, the next best step to consider is a liver biopsy if alk phos is significantly elevated more than two times the upper limit of normal. Summary: GGT, Liver US, Dilated? -> MRCP, ERCP, CT scan of abdomen and pelvis. Non dilated? AMA, Hepatitis panel, EBV, CMV, pregnancy test.Fun fact: When Alkaline phosphatase is elevated you can order the test called Alkaline Phosphatase isoenzymes. You will get a result with percentages for each isoenzyme: ALPI – intestinal, ALPL – nonspecific, but mainly expressed in liver, bone, and kidney; ALPP – placental, and ALPG – germ cells.  Nonhepatic evaluation:With an isolated alkaline phosphatase elevation and normal GGT or serum 5'-Nucleotidase, the first thing to consider is bone-related pathologies involving high bone turnover: Healing fractures, osteomalacia, Paget's disease of bone, osteogenic sarcoma, bone metastasis, hyperparathyroidism, and hyperthyroidism. Patient history, ordering thyroid and parathyroid function testing, imaging with bone scintigraphy are all important in sorting through the differential of bone-related pathologies. Other extrahepatic diseases to consider that have shown elevated alkaline phosphatase include myeloid metaplasia, peritonitis, diabetes mellitus, subacute thyroiditis, uncomplicated gastric ulcer, and sepsis. Each of these has its own work up and an elevated alk phos level has little significance clinically.Paget's disease of bone: Paget disease of bone is a benign disorder that presents with focal areas of increased bone turnover in one or more skeletal sites. Mostly affects male older adults, but female patients can also be affected. Commonly affects the bones of the pelvis, spine, skull, and long bones. Pain is the most common symptom, and the presentation of the disease may depend on which bones are affected, the extent of involvement, and the presence of complications. Paget's disease of bone may be asymptomatic, incidental elevated serum alkaline phosphatase levels on routine labs or abnormal imaging tests performed for other reasons can point to Paget's disease of bone. Other common symptoms include deafness, and tight hats. Diagnosis is normally done by plain radiography and serum alkaline phosphatase. Radionuclide scans is used to determine the extent of disease. Treatment with nitrogen-containing bisphosphonates (zoledronic acid, risedronate, and alendronate).Complications of the disease include arthritis, gait changes, hearing loss, nerve compression syndromes, and osteosarcoma. Use serum alkaline phosphatase for assessing treatment response. Early diagnosis of Paget disease of bone is key in the management and patients have a better prognosis when treatment is initiated before complications. Consult with a specialist to confirm the diagnosis and start treatment.__________________________Conclusion: Now we conclude our episode number 94 “Elevated Alk Phos”. Elevated Alk Phos can be normal in some circumstances, mainly in pregnancy and childhood. You can start a workup when the alk phos is persistently elevated 4 times above the upper limit of normal. The most common causes can be grouped as hepatic and non-hepatic, and the bones is the most common non-hepatic source. Even without trying, every night you go to bed being a little wiser.This week we thank Hector Arreaza, and Akhil Patel. Audio edition: Suraj Amrutia. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Williams, J., & Nieuwsma, J. (2016). Screening for depression in adults. In J. A. Melin (Ed.), UpToDate. Retrieved February 1, 2017, from https://www.uptodate.com/contents/screening-for-depression-in-adults. Lawrence S Friedman, MD (2020). Approach to the patient with abnormal liver biochemical and function tests. Shilpa Grover (Ed.), UpToDate. Retrieved Maye 12, 2022 from https://www.uptodate.com/contents/approach-to-the-patient-with-abnormal-liver-biochemical-and-function-tests.  Lawrence S Friedman, MD (2020). Enzymatic measures of cholestasis (eg, alkaline phosphatase, 5'-nucleotidase, gamma-glutamyl transpeptidase). Shilpa Grover (Ed.), UpToDate. Retrieved Maye 12, 2022 from https://www.uptodate.com/contents/enzymatic-measures-of-cholestasis-eg-alkaline-phosphatase-5-nucleotidase-gamma-glutamyl-transpeptidase.

What started as pancreatitis, turned into massive transfusion protocol and a visit to interventional radiology. In this episode, Sarah, Katleen, and Marissa discuss a case that took an unexpected turn for the worse. They break down the pathophysiology of pancreatitis, it's treatment, and the nurse's role in the patient's recovery.

A study in Surgical Endoscopy finds some benefits to delaying gallbladder surgery, at the expense of increased readmissions. Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes | Hospital Medicine Virtual Journal Club