UTHSC PA Program Podcast

In this episode, we review gastroparesis, a chronic disorder of delayed gastric emptying without mechanical obstruction. We break down normal gastric motility, the role of the vagus nerve and interstitial cells of Cajal, and how dysfunction leads to impaired antral contraction and pyloric relaxation. The discussion highlights key risk factors—including diabetes, postsurgical vagal injury, and medications—along with classic symptoms such as nausea, early satiety, and postprandial fullness. We cover diagnostic strategies with gastric emptying studies and evidence-based management, from dietary modification and prokinetic therapy to advanced interventions for refractory cases.

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) Dilmaghani S, Zheng T, Camilleri M. Epidemiology and healthcare utilization in patients with gastroparesis: a systematic review. Clin Gastroenterol Hepatol. 2023;21(9):2239-2251.e2. doi:10.1016/j.cgh.2022.07.011.

3) Reddivari AKR, Mehta P. Gastroparesis. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551528/

4) Schol J, Wauters L, Dickman R, et al; ESNM Gastroparesis Consensus Group. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J. 2021;9(3):287-306. doi:10.1002/ueg2.12060.

In this episode, we review ileus, a functional inhibition of gastrointestinal motility without mechanical obstruction, most commonly seen after surgery. We break down the neurogenic and inflammatory phases that suppress peristalsis, along with key risk factors such as opioid use, intra-abdominal infection, and electrolyte imbalances. The discussion highlights how to distinguish ileus from small bowel obstruction using imaging, clinical findings, and time course. We also cover supportive management, prevention strategies including ERAS protocols, and practical clinical pearls to reduce complications and hospital length of stay.

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) Beach EC, De Jesus O. Ileus. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558937/

3) Khawaja, Z. H., Gendia, A., Adnan, N., & Ahmed, J. (2022). Prevention and Management of Postoperative Ileus: A Review of Current Practice. Cureus, 14(2), e22652. https://doi.org/10.7759/cureus.22652

4) Weledji E. P. (2020). Perspectives on paralytic ileus. Acute medicine & surgery, 7(1), e573. https://doi.org/10.1002/ams2.573

In this episode, we review acute appendicitis, a common yet time-sensitive surgical emergency. We break down the pathophysiology of luminal obstruction—most often from a fecalith—leading to infection, ischemia, and potential perforation within 24–48 hours if untreated. The discussion covers classic symptom progression from periumbilical pain to right lower quadrant tenderness, key physical exam maneuvers, appropriate imaging strategies, and current treatment standards including antibiotics and laparoscopic appendectomy. High-yield clinical pearls emphasize early recognition, risk of recurrence with nonoperative management, and the role of the Alvarado score alongside imaging to guide diagnosis.

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) Krzyzak M, Mulrooney SM. Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment. Cureus. 2020 Jun 11;12(6):e8562. doi: 10.7759/cureus.8562. PMID: 32670699; PMCID: PMC7358958.

3) Moris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults JAMA. 2021; 326(22):2299-.

4) Salminen, P., Haijanen, J., Minneci, P.C. et al. Appendicitis. Nat Rev Dis Primers 11, 79 (2025). https://doi.org/10.1038/s41572-025-00659-6

In this episode, we review abdominal and groin hernias, including inguinal (direct and indirect), femoral, umbilical, and incisional types. We break down the pathophysiology of fascial defects leading to organ protrusion, key risk factors such as heavy lifting and prior surgery, and the clinical distinction between reducible, incarcerated, and strangulated hernias. The discussion highlights hallmark exam findings, when imaging is helpful, and clear indications for urgent surgical referral. A high-yield, clinically focused review designed to help clinicians recognize complications early and manage hernias appropriately in both outpatient and emergent settings.

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) Nadia A Henriksen, Heather Bougard, Mário R Gonçalves, William Hope, Ritu Khare, Jenny Shao, Andrea C Quiroga-Centeno, Eva B Deerenberg, Primary ventral and incisional hernias: comprehensive review, BJS Open, Volume 9, Issue 1, February 2025, zrae145, https://doi.org/10.1093/bjsopen/zrae145

3) Joppin V, Masson C, Bendahan D, Bege T. A review of ventral hernia biomechanics Journal of the Mechanical Behavior of Biomedical Materials. 2026; 173:107159-.

4) McBee, Patrick J.; Walters, Ryan W.1; Fitzgibbons, Robert J.. Current status of inguinal hernia management: A review. International Journal of Abdominal Wall and Hernia Surgery 5(4):p 159-164, Oct–Dec 2022. | DOI: 10.4103/ijawhs.ijawhs_36_22

In this episode, we review gastritis, an inflammatory condition of the gastric mucosa commonly triggered by H. pylori infection, NSAID use, alcohol, or physiologic stress. We break down the pathophysiology of mucosal inflammation, key differences between acute and chronic gastritis, and the clinical features of epigastric pain, nausea, and possible GI bleeding. The discussion highlights appropriate diagnostic strategies—including when to pursue endoscopy—and evidence-based treatment such as PPI therapy and eradication of H. pylori. A focused, high-yield review emphasizing careful history-taking and differentiation from more life-threatening causes of upper GI bleeding.

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) Azer SA, Awosika AO, Akhondi H. Gastritis. [Updated 2024 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544250/

3) Rugge M, Savarino E, Sbaraglia M, Bricca L, Malfertheiner P. Gastritis: The clinico-pathological spectrum Digestive and Liver Disease. 2021; 53(10):1237-1246.

4) Provenza, Delaney MMS, PA-C; Provenza, John Michael MD. Vonoprazan: A novel agent used in eradicating Helicobacter pylori infection. JAAPA 37(12):p 13-17, December 2024. | DOI: 10.1097/01.JAA.0000000000000154

In this episode, we review esophageal varices, a life-threatening complication of portal hypertension most commonly seen in patients with cirrhosis. We break down the pathophysiology of increased portal venous pressure leading to fragile, dilated submucosal veins at high risk of rupture. The discussion highlights the dramatic presentation of upper GI bleeding, the critical role of emergent endoscopy, and evidence-based management including fluid resuscitation, band ligation, octreotide, antibiotics, and TIPS for refractory cases. A focused, high-yield review emphasizing early stabilization, prevention of rebleeding, and risk reduction strategies in patients with chronic liver 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) Meseeha M, Attia M. Esophageal Varices. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448078/

3) Pallio S, Melita G, Shahini E, Vitello A, Sinagra E, Lattanzi B, Facciorusso A, Ramai D, Maida M. Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar 8;13(6):1031. doi: 10.3390/diagnostics13061031. PMID: 36980343; PMCID: PMC10047815.

In this episode, we review ischemic bowel disease, a life-threatening condition caused by insufficient blood flow to the intestines. We break down the spectrum of disease—including ischemic colitis, acute mesenteric ischemia, and chronic mesenteric ischemia—and discuss key risk factors such as vascular disease and atrial fibrillation. The episode highlights the classic presentation of severe abdominal pain out of proportion to exam, the critical role of CT angiography, and the need for emergent surgical consultation.

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) Amini A, Nagalli S. Bowel Ischemia. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554527/

3) Theodore S, Xia T, Saillant N. Intestinal Ischemia — Etiology and Foundational Concepts NEJM Evidence. 2024; 3(3).

4) Ahmed M. Ischemic bowel disease in 2021. World J Gastroenterol. 2021 Aug 7;27(29):4746-4762. doi: 10.3748/wjg.v27.i29.4746. PMID: 34447224; PMCID: PMC8371501.

In this episode, we review systemic sclerosis (scleroderma), a rare connective tissue disease characterized by autoimmune endothelial injury and progressive fibrosis of the skin and internal organs. We break down hallmark features such as Raynaud phenomenon, skin tightening, GERD, and dyspnea, along with key physical exam findings like sclerodactyly and telangiectasias. The discussion highlights important autoantibodies—including anti–Scl-70 and anticentromere antibodies—plus essential screening for pulmonary hypertension and interstitial lung 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) Volkmann ER, Andréasson K, Smith V. Systemic sclerosis. Lancet. 2023 Jan 28;401(10373):304-318. doi: 10.1016/S0140-6736(22)01692-0. Epub 2022 Nov 25. PMID: 36442487; PMCID: PMC9892343.

3) Jerjen R, Nikpour M, Krieg T, Denton CP, Saracino AM. Systemic sclerosis in adults. Part I: Clinical features and pathogenesis. J Am Acad Dermatol. 2022;87(5):S0190-9622(22)00190-6. doi:10.1016/j.jaad.2021.10.065.

4) Jerjen R, Nikpour M, Krieg T, Denton CP, Saracino AM. Systemic sclerosis in adults. Part II: management and therapeutics. J Am Acad Dermatol. 2022 Nov;87(5):957-978. doi: 10.1016/j.jaad.2021.10.066. Epub 2022 Feb 4. PMID: 35131401.

In this episode, we review polymyositis, a rare autoimmune inflammatory myopathy characterized by symmetric proximal muscle weakness. We break down the T-cell–mediated pathophysiology, key clinical features such as difficulty climbing stairs or lifting arms, and important distinctions from dermatomyositis. The discussion highlights diagnostic strategies—including elevated creatine kinase levels, autoantibodies, EMG findings, and the role of muscle biopsy—as well as evidence-based treatment with corticosteroids and immunosuppressive therapy.

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) Connolly CM, Gupta L, Fujimoto M, Machado PM, Paik JJ. Idiopathic inflammatory myopathies: current insights and future frontiers The Lancet Rheumatology. 2024; 6(2):e115-e127.

3) Baig S, Paik JJ. Inflammatory muscle disease – An update Best Practice & Research Clinical Rheumatology. 2020; 34(1):101484-.

4) Lundberg IE, Fujimoto M, Vencovsky J, Aggarwal R, Holmqvist M, Christopher-Stine L, Mammen AL, Miller FW. Idiopathic inflammatory myopathies. Nat Rev Dis Primers. 2021 Dec 2;7(1):86. doi: 10.1038/s41572-021-00321-x. PMID: 34857798.

In this episode, we review osteomyelitis, a serious infection of bone that can progress to necrosis and chronic sequestrum formation if not treated promptly. We break down the pathophysiology of bone infection, common risk factors such as diabetes and IV drug use, and key differences between acute and chronic disease. The discussion highlights diagnostic strategies—including why MRI is the most sensitive early imaging modality and why bone biopsy remains the gold standard—along with evidence-based antibiotic and surgical management.

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) Nimmana BK, Savaliya V. Osteomyelitis. [Updated 2023 May 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532250/

3) Bury DC, Rogers TS, Dickman MM. Osteomyelitis: Diagnosis and Treatment. Am Fam Physician. 2021 Oct 1;104(4):395-402. PMID: 34652112.

4) Éric Senneville, Zaina Albalawi, Suzanne A van Asten, Zulfiqarali G Abbas, Geneve Allison, Javier Aragón-Sánchez, John M Embil, Lawrence A Lavery, Majdi Alhasan, Orhan Oz, Ilker Uçkay, Vilma Urbančič-Rovan, Zhang-Rong Xu, Edgar J G Peters, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), Clinical Infectious Diseases, 2023;, ciad527, https://doi.org/10.1093/cid/ciad527