UTHSC PA Program Podcast

In this episode, we tackle toxic megacolon, a life-threatening complication of severe colonic inflammation most commonly associated with ulcerative colitis and Clostridioides difficile infection. We review the pathophysiology of nitric oxide–mediated colonic paralysis, hallmark clinical features of systemic toxicity, and the critical imaging findings of colonic dilation ≥6 cm. The discussion emphasizes early recognition, ICU-level management, appropriate antimicrobial and corticosteroid therapy, and clear surgical indications.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Sheth SG, LaMont JT. Toxic megacolon. The Lancet. 1998;351(9101):509-513. doi:https://doi.org/10.1016/s0140-6736(97)10475-5

3) Ausch C, Madoff RD, Gnant M, et al. Aetiology and surgical management of toxic megacolon. Colorectal Disease. 2006;8(3):195-201. doi:https://doi.org/10.1111/j.1463-1318.2005.00887.x

4) Tapani MJ, Olavi KH. Surgical Management of Toxic Megacolon. Hepatogastroenterology. 2014 May;61(131):638-41. PMID: 26176049

In this episode, we break down chronic cholecystitis using a practical, clinically focused framework. We review the pathophysiology of recurrent gallstone obstruction leading to chronic inflammation and fibrosis, along with hallmark history and exam findings such as postprandial right upper quadrant pain with typically normal labs. The discussion highlights first-line imaging, including ultrasound and HIDA scan interpretation, and clarifies how to distinguish chronic disease from acute cholecystitis and biliary colic. We conclude with evidence-based management, patient counseling, and clear indications for elective laparoscopic cholecystectomy.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Gallaher JR, Charles A. Acute Cholecystitis: A Review. JAMA. 2022;327(10):965-975. doi:https://doi.org/10.1001/jama.2022.2350

3) Strasberg SM. Acute Calculous Cholecystitis. New England Journal of Medicine. 2008;358(26):2804-2811. doi:https://doi.org/10.1056/nejmcp0800929

In this episode, we review pyloric stenosis, a classic pediatric surgical condition every clinician should recognize. We cover the underlying pathophysiology of gastric outlet obstruction, hallmark clinical features such as projectile non-bilious vomiting, and key physical exam findings. The discussion highlights diagnostic imaging, electrolyte abnormalities, and evidence-based management, including preoperative stabilization and definitive surgical treatment.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Vanderbilt University Medical Center Children's Quality & Safety. Pyloric Stenosis Clinical Practice Guideline. Vanderbilt University Medical Center; 2023. https://www.vumc.org/childrens-quality-safety/sites/default/files/public_files/Pyloric%20Stenosis%20CPG_06.20.23.pdf. Accessed January 22, 2026.

3) Garfield K, Sergent SR. Pyloric Stenosis. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555931/

In this episode, we review peptic ulcer disease (PUD) with a practical, clinically focused approach. We cover underlying pathophysiology, key risk factors—including H. pylori and NSAID use—classic symptoms, and important complications such as bleeding and perforation. The discussion highlights diagnostic strategies, evidence-based treatment, and prevention pearls to help clinicians confidently evaluate and manage patients with upper GI complaints.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) American College of Gastroenterology. Peptic ulcer disease (PUD). GI.org. https://gi.org/topics/peptic-ulcer-disease/. Accessed January 22, 2026.

3) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peptic ulcers (stomach ulcers) — definition & facts. NIDDK.nih.gov. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/definition-facts. Accessed January 22, 2026.

4) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peptic ulcers (stomach ulcers). NIDDK.nih.gov. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers. Accessed January 22, 2026.

In this episode, we break down gastroesophageal reflux disease (GERD) with a practical, clinical focus. We review underlying pathophysiology, common risk factors, and classic versus atypical presentations. The discussion highlights key diagnostic considerations, lifestyle and pharmacologic management strategies, and red flags that warrant further evaluation or referral to help clarify everyday decision-making in the management of reflux-related symptoms.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) American College of Gastroenterology. Acid reflux/GERD (gastroesophageal reflux disease). GI.org. https://gi.org/topics/acid-reflux/. Accessed January 22, 2026.

3) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Acid reflux (GER and GERD) in adults — definition & facts. NIDDK.nih.gov. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts. Accessed January 22, 2026.

4) Dong P, Lin L, Sun K, Tang F, Li Q, Zhou X, Liu F, Yang Z, Li J, Jiang L, Zhao P, Sun X, Wang Q. Accuracy of the diagnosis of gastroesophageal reflux disease by a trial of potassium-competitive acid blocker treatment. BMC Gastroenterol. 2025;25:406. doi:10.1186/s12876-025-03981-1.

In this episode, we review cholelithiasis, focusing on gallstone formation, risk factors, and classic clinical presentations. We break down biliary colic versus complications, key physical exam findings, and the most appropriate diagnostic imaging. The discussion also covers management strategies, including indications for surgical referral and how to distinguish uncomplicated gallstones from more serious biliary disease. A practical, high-yield review designed for PA students and clinicians managing common abdominal complaints.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Cholelithiasis. Merck Manual Professional Version. Merck & Co Inc. https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/cholelithiasis. Accessed January 22, 2026.

3) Gutt C, Schläfer S, Lammert F. The Treatment of Gallstone Disease. Dtsch Arztebl Int. 2020 Feb 28;117(9):148-158. doi: 10.3238/arztebl.2020.0148. PMID: 32234195

4) Reshetnyak VI. Concept of the pathogenesis and treatment of cholelithiasis. World J Hepatol. 2012 Feb 27;4(2):18-34. doi: 10.4254/wjh.v4.i2.18. PMID: 22400083

In this episode, we deliver a focused clinical review of acute cholecystitis, emphasizing the pathophysiology of gallbladder inflammation, classic presenting symptoms, and key physical exam findings. We walk through diagnostic strategies, including laboratory trends and imaging choices, and outline evidence-based management—from initial stabilization and antibiotics to indications for surgical intervention to help you confidently recognize and manage this common surgical condition.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Gomes M, Queiroz de Figueiredo B, Menezes A, Júnior Á, Carvalho B, Roehrs D, Loureiro L, Nunes N, Borges C, Machado K. Acute cholecystitis: diagnosis, complications and therapy: an integrative literature review. Res Soc Dev. 2022;11:e322111537469. doi:10.33448/rsd-v11i15.37469.

3) Mencarini L, Vestito A, Zagari RM, Montagnani M. The diagnosis and treatment of acute cholecystitis: a comprehensive narrative review for a practical approach. J Clin Med. 2024;13(9):2695. doi:10.3390/jcm13092695. PMID:38731224

4) Radiopaedia Article Contributors (including Henry Knipe). Acute cholecystitis. Radiopaedia.org. Published online. Updated July 31, 2025. https://radiopaedia.org/articles/acute-cholecystitis?lang=gb. Accessed January 22, 2026.

In this episode, we break down the major mitral valve disorders—mitral valve prolapse (MVP), mitral regurgitation (MR), and mitral stenosis (MS)—using a clear, high-yield, clinically focused approach. We explore core pathophysiology, classic presentations, and hallmark exam findings such as the midsystolic click of MVP, the blowing holosystolic murmur of MR, and the diastolic rumble with opening snap of MS. Listeners will also learn key risk factors, diagnostic strategies, and evidence-based management, including when to consider surgical repair or replacement. A concise and practical review perfect for PA students, educators, and clinicians aiming to sharpen their skills in evaluating and managing mitral valve disease.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP III, Gentile F, Jneid H, Krieger RV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM III, Thompson A, Toly C; on behalf of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):E72-E227. doi:10.1161/CIR.0000000000000923.

3) Harb SC, Griffin BP. Mitral valve disease: a comprehensive review. Curr Cardiol Rep. 2017 Aug;19(8):73. doi:10.1007/s11886-017-0883-5. PMID:28688022.

In this high-yield cardiology episode, we unpack aortic stenosis—the most common adult valvular disease associated with sudden cardiac death. Listeners will learn the core pathophysiology of LV outflow obstruction, key risk factors, and how this progressive disease often remains silent until symptoms appear. We break down the classic triad of syncope, angina, and dyspnea; hallmark physical exam findings like the crescendo-decrescendo systolic murmur radiating to the carotids; and essential diagnostic criteria on echocardiography. The episode closes with evidence-based treatment strategies, including when to move toward surgical or transcatheter valve replacement. A concise, clinically focused review ideal for PA learners and practitioners.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Willner N, Prosperi-Porta G, Lau L, et al. Aortic stenosis progression: a systematic review and meta-analysis. J Am Coll Cardiol Cardiovasc Imaging. 2023 Mar;16(3):314-328. doi:10.1016/j.jcmg.2022.10.009.

3) McNamara RL, Welch PJ, Bartlett JT, et al; for the STREAM-2 Steering Committee and Investigators. Management of ST-Segment Elevation Myocardial Infarction in Low-and Middle-Income Countries. JAMA. 2023;329(9):764-779. doi:10.1001/jama.2023.2826117.

In this episode, we break down aortic regurgitation—from the core pathophysiology of a "leaky" aortic valve to the classic physical exam findings every clinician should recognize. We walk through risk factors, epidemiology, diagnostic strategies, and when to consider surgical valve replacement. You'll hear high-yield teaching on hallmark signs such as wide pulse pressure, water-hammer pulses, and the blowing early diastolic murmur, along with practical insights on complications and modern TAVR considerations. A concise, clinically focused review for PA students and providers looking to strengthen their cardiology foundation.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Gill R, Farmer AD. Aortic regret? An updated review of aortic regurgitation: etiologies, imaging, surveillance, and intervention. Open Heart. 2025;12:e002249. PMID and PMCID: PMC12230845. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12230845/

3) Pawar S, Allen C, Mori M, et al. Contemporary diagnosis and treatment of aortic regurgitation: a state-of-the-art review. J Am Coll Cardiol. Published online Oct 28 2025. doi:10.1016/j.jacc.2025.10.026.