UTHSC PA Program Podcast

n this episode, we review lumbar disc herniation, a common cause of radicular back pain in adults ages 30–50. We break down the pathophysiology of nucleus pulposus herniation leading to nerve root compression, along with classic symptoms such as radiating leg pain, numbness, and weakness. The discussion highlights key exam findings like a positive straight leg raise, appropriate use of MRI, and evidence-based management—emphasizing that most cases improve with conservative treatment. We also review red flags and when to escalate care to prevent complications such as cauda equina syndrome.

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) Deyo RA, Mirza SK. CLINICAL PRACTICE. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016 May 5;374(18):1763-72. doi: 10.1056/NEJMcp1512658. PMID: 27144851.

3) Jin H, Lopez AM, Romero FG, Hoang R, Ramesh A, Bow HC. A Systematic Review of Treatment Guidelines for Lumbar Disc Herniation Neurospine. 2025; 22(2):389-402.

In this episode, we review cauda equina syndrome, a rare but time-sensitive neurologic emergency caused by compression of the lumbosacral nerve roots. We break down the underlying pathophysiology, high-risk causes such as herniated disc or spinal tumor, and the classic red flag symptoms including saddle anesthesia, urinary retention, and bilateral leg weakness. The discussion emphasizes urgent MRI evaluation and the need for emergent surgical decompression to prevent permanent neurologic deficits.

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) Casey K. Cauda equina syndrome. Cauda equina syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice US. February 2023. Accessed February 15, 2026. https://bestpractice.bmj.com/topics/en-us/3000164.

3) Karikaran A, Carroll AH, Benn L, Okorie N, Bellaire CP, Puvanesarajah V, Mesfin A. Cauda Equina Syndrome: A Review of Classification, Diagnosis, Treatment, and Best Practices. JBJS Rev. 2025 Feb 12;13(2). doi: 10.2106/JBJS.RVW.24.00156. PMID: 39937930.

4) Lavy C, Marks P, Dangas K, Todd N. Cauda equina syndrome-a practical guide to definition and classification. Int Orthop. 2022; 46(2):165-169. [PDF]

In this episode, we review small bowel obstruction (SBO)—a common surgical emergency that can rapidly progress to ischemia, perforation, and sepsis if not recognized early. We break down the pathophysiology of mechanical obstruction, classic risk factors such as prior abdominal surgery and adhesions, and the key clinical findings that distinguish partial from complete obstruction. The discussion highlights the critical role of CT imaging, initial conservative management with bowel rest and nasogastric decompression, 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) Klingbeil KD, Wu JX, Osuna-Garcia A, Livingston EH. Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression. Surg Open Sci. 2022 Nov 7;12:62-67. doi: 10.1016/j.sopen.2022.10.002. PMID: 36992798; PMCID: PMC10040372.

3) Schick MA, Kashyap S, Collier SA, et al. Small Bowel Obstruction. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448079/

4) Aka AA, Wright JP, DeBeche-Adams T. Small Bowel Obstruction. Clin Colon Rectal Surg. 2021 Jul;34(4):219-226. doi: 10.1055/s-0041-1725204. Epub 2021 Jul 20. PMID: 34305470; PMCID: PMC8292006.

In this episode, we review peritonitis, a medical and surgical emergency characterized by acute inflammation of the peritoneum with high risk of sepsis and shock. We break down the different types—spontaneous bacterial peritonitis (SBP), secondary peritonitis, peritoneal dialysis–related infection, and tertiary peritonitis—along with their distinct mechanisms and management strategies. The discussion highlights key diagnostic steps, including the critical role of paracentesis, and emphasizes early empiric antibiotics and timely source control when indicated.

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) Kumar D, Garg I, Sarwar AH, Kumar L, Kumar V, Ramrakhia S, Naz S, Jamil A, Iqbal ZQ, Kumar B. Causes of Acute Peritonitis and Its Complication. Cureus. 2021 May 28;13(5):e15301. doi: 10.7759/cureus.15301. PMID: 34221758; PMCID: PMC8237913.

3) Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scandinavian Journal of Surgery. 2021;110(2):139-149. doi:10.1177/1457496920984078

In this episode, we review percutaneous endoscopic gastrostomy (PEG) tube placement, a commonly performed procedure for long-term enteral access. We discuss indications such as chronic dysphagia and upper GI obstruction, key contraindications, and the relevant anatomy required for safe placement. The episode walks through the pull technique step-by-step, emphasizing site selection, infection prevention, and complication avoidance. We also cover post-procedure management, tube care, and troubleshooting common issues.

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) Vudayagiri L, Hoilat GJ, Gemma R. Percutaneous Endoscopic Gastrostomy Tube. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535371/

3) Liu X, Yang Z, He S, Wang G. Percutaneous endoscopic gastrostomy. Int J Gastrointest Interv 2021;10:42-48. https://doi.org/10.18528/ijgii210015

4) Wei M, Ho E, Hegde P. An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit. J Thorac Dis 2021;13(8):5277-5296. doi: 10.21037/jtd-19-3728

In this episode, we break down acute pancreatitis, a common and potentially life-threatening cause of acute abdominal pain. We review the pathophysiology of premature enzyme activation leading to pancreatic autodigestion and systemic inflammation, along with key risk factors including gallstones, alcohol use, and hypertriglyceridemia. The discussion highlights diagnostic criteria, appropriate imaging selection, early aggressive fluid resuscitation, and complication recognition. Emphasis is placed on the critical first 24–48 hours and the importance of identifying and treating the underlying cause to prevent recurrence.

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) Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA. 2021;325(4):382–390. doi:10.1001/jama.2020.20317

3) Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med 2016;375:1972-1981. DOI: 10.1056/NEJMra1505202

4) Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs. 2022 Aug;82(12):1251-1276. doi: 10.1007/s40265-022-01766-4. Epub 2022 Sep 8. PMID: 36074322; PMCID: PMC9454414.

In this episode, we provide a practical, evidence-based review of abdominal drains—when to use them, how to place them safely, and how to manage them postoperatively. We discuss indications, contraindications, drain selection (passive vs. closed-suction systems), and key procedural steps to optimize positioning and minimize complications. The episode also covers postoperative monitoring, biochemical analysis of drain output for early detection of leaks, and criteria for timely removal.

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) Rekavari SG, Mahakalkar C. Prophylactic Intra-abdominal Drains in Major Elective Surgeries: A Comprehensive Review. Cureus. 2024 Feb 12;16(2):e54056. doi: 10.7759/cureus.54056. PMID: 38481916; PMCID: PMC10933947

3) Ramesh BA, Evans JT, Marietta M, et al. Suction Drains. [Updated 2025 Feb 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557687/

In this episode, we review intussusception, a common pediatric abdominal emergency most often seen in children 6–36 months old. We break down the pathophysiology of telescoping bowel leading to venous congestion, ischemia, and potential perforation, along with the classic presentation of intermittent severe abdominal pain, vomiting, and the late finding of currant jelly stools. The discussion highlights key diagnostic tools such as ultrasound with the "target sign," and emphasizes evidence-based management with air or contrast enema reduction.

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) McCollough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin North Am. 2003 Nov;21(4):909-35. doi: 10.1016/s0733-8627(03)00090-7. PMID: 14708813.

3) Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B. Intussusception: clinical presentations and imaging characteristics. Pediatr Emerg Care. 2012 Sep;28(9):842-4. doi: 10.1097/PEC.0b013e318267a75e. PMID: 22929138.

In this episode, we break down portal hypertension with a clear, clinically focused approach. We review the hemodynamic basis of elevated portal pressure, the development of portosystemic collateral circulation, and the classic signs such as splenomegaly, ascites, and varices. The discussion highlights diagnostic strategies, including Doppler ultrasound and endoscopic screening, and emphasizes evidence-based management to prevent variceal bleeding and treat complications.

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) García-Pagán JC, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol. 2012 Aug;57(2):458-61. doi: 10.1016/j.jhep.2012.03.007. Epub 2012 Apr 12. PMID: 22504334.

3) Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol. 2013 Feb;7(2):141-55. doi: 10.1586/egh.12.83. PMID: 23363263.

4) Tapper EB, Parikh ND. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 2023 May 9;329(18):1589-1602. doi: 10.1001/jama.2023.5997. PMID: 37159031; PMCID: PMC10843851.

In this episode, we break down cirrhosis using a clinically focused, high-yield framework. We review the pathophysiology of chronic liver injury leading to fibrosis, portal hypertension, and synthetic dysfunction, along with classic history and physical exam findings. The discussion highlights key laboratory and imaging clues, severity scoring with Child-Pugh and MELD, and essential management strategies for complications such as ascites, varices, hepatic encephalopathy, and spontaneous bacterial peritonitis. We also emphasize prevention, surveillance for hepatocellular carcinoma, and early transplant referral.

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) Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician. 2006 Sep 1;74(5):756-62. PMID: 16970019.

3) Lewis JH, Stine JG. Review article: prescribing medications in patients with cirrhosis - a practical guide. Aliment Pharmacol Ther. 2013 Jun;37(12):1132-56. doi: 10.1111/apt.12324. Epub 2013 May 3. PMID: 23638982.

4) Singal AK, Mathurin P. Diagnosis and Treatment of Alcohol-Associated Liver Disease: A Review. JAMA. 2021 Jul 13;326(2):165-176. doi: 10.1001/jama.2021.7683. PMID: 34255003.