#215 Gallbladder & Biliary Testing: 5 Pearls Segment

“Should you stop screening for colorectal cancer (CRC) at 75?” This episode explores how to individualize screening decisions based on life expectancy, prior colonoscopy findings, and procedural risks. Learn how to navigate these nuanced conversations, avoid age-based assumptions, and use strategies like mailed FIT kits and offering screening choices to help more patients get screened.🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here!🔹Transcript and Show Notes01:18 | Screening >75 yo?10:06 | Takeaways on Colorectal Cancer Screening After 75 10:37 | Systems thinking: How do we get to an 80% screening rateTags: Core IM, Internal Medicine, Colorectal Cancer Screening, Gastroenterology, Cancer Screening Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

“What’s the best way to screen?” This episode breaks down the pros, limitations, and follow-up needs of FIT, Cologuard, CT colonography, and colonoscopy to help you choose the right CRC screening option for your patients. Also learn practical colonoscopy surveillance intervals based on polyp size, number, and pathology.🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here!🔹Transcript and Show Notes01:24 | Screening Options Besides Colonoscopy11:22 | How FIT, FIT-DNA, and CT colonography differ and when each makes sense.12:52 | Colonoscopy and Frequency19:29 | How adenoma number, size, and histology guide surveillance intervals. Tags: Core IM, Internal Medicine, Colorectal Cancer Screening, Gastroenterology, Cancer Screening Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

“The triglycerides are high. Now what?” This episode breaks down a practical approach to elevated TGs, from knowing when to check ApoB or non-HDL-C to choosing lifestyle changes, lipid-lowering medications, and when to suspect an underlying genetic disorder. 🔹Transcript and Show Notes02:17 | Check a non-HDL-C or ApoB if TGs are ≥150 mg/dL 07:18 | Address waist circumference and lifestyle before meds for high TGs10:52 | Dr. Watson’s 3-day carbohydrate responsiveness trial 17:07 | Order a fasting or nonfasting lipid panel?19:00 | When do you reach for TG-lowering medications? 25:26 | Familial chylomicronemia syndrome (FCS)Tags: CoreIM, Medical Education, Hypertriglyceridemia, ACC AHA lipid guidelines, lipid guidelines 2026, cardiovascular risk Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

“Too young for colon cancer.” This episode unpacks the red flags of early-onset colorectal cancer (CRC), from blood in the stool and iron deficiency anemia to persistent abdominal pain and changes in bowel habits, and offers practical pearls for closing the clinical loop. Also learn why a “negative” family history may need a yearly refresh.🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here!🔹Transcript and Show Notes01:45 | Colorectal cancer rising in younger adults 06:42 | Why screening starts at age 4508:15 | What may be driving early-onset colorectal cancer 13:37| Key takeaways: symptoms, follow-up, and family history Tags: Colorectal Cancer Screening, Internal Medicine, Gastroenterology, Cancer Screening, OncologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

“It didn’t work.” This episode breaks down practical treatment options (dosing options for naltrexone, acamprosate, topiramate, gabapentin) and counseling pearls to help you meet patients where they are and support their recovery. Also discover blind spots in detox and rehab centers.🔹Transcript and Show Notes🔹 Explore ACP’s Substance Use Disorder Education Hub for videos and an AI-powered patient simulation to practice alcohol-use conversations: https://www.coreimpodcast.com/SUDhubAlcohol Use and Chronic Health Conditions Mini Video Series01:55 | #1: Naltrexone12:06 | #2 Acamprosate16:15 | #3: Topiramate21:12 | #4: Other meds29:31 | #5: Detox and rehab blind spots Tags: CoreIM, Medical Education, Addiction Medicine, Alcohol Withdrawal, Addiction Treatment, GLP-1, pharmacologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Have you ever lost a patient and found yourself thinking about them long after the shift ended? This episode explores the grief clinicians can carry after a patient dies, including the losses that aren’t always obvious. We also discuss ways to work through that grief, recognize when it becomes complicated, and lean on your team for support.  🔹Transcript and Shownotes04:12 | What is Clinician Grief?10:02 | Types of Losses10:22 | Loss of a close relationship with a particular patient12:56 | Loss due to a professional's identification with the pain of family members13:56 | Loss of one's unmet goals and expectations and one's professional self-image and role18:47 | Loss related to one's personal system of beliefs and assumptions about life21:30 | Past unresolved losses or anticipated future losses23:29 | The death of the self25:44 | CopingTags: CoreIM, Medical Education, Clinician Wellbeing, Burnout, Secondary Traumatic Stress, Complicated Grief, Coping With Grief, Medical humanities, medical ethicsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How to choose between RUQ ultrasound, CT, HIDA, MRCP, EUS, and ERCP based on the clinical picture? When should you move from diagnostic imaging to therapeutic ERCP, and what should you know about sphincterotomy, stents, and stone removal? Plus, how to interpret bile duct dilation without jumping straight to obstruction?🔹Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹Transcript and Shownotes02:11 | Pearl 1: Gallbladder Problems Spectrum07:33 | Pearl 2: Choose Imaging Strategically: Start with RUQUS, Escalate as Needed14:34 | Pearl 3: Biliary Tree Diagnostics19:19 | Pearl 4: Invasives that are Diagnostic and Therapeutic27:06 | Pearl 5: Stenting in ERCPTags: CoreIM, Internal Medicine, Medical Education, Gallstones, Cholecystitis, Biliary Disease, ERCP, Biliary ImagingFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause. 🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.🔹Transcript and Shownotes6:46 | Pearl 1: Key Principles15:13 | Pearl 2: Fluids in hyponatremia26: 03 | Pearl 3: Solutes in hyponatremia management35:49 | Pearl 4: Lasix in hyponatremia management40:05 | Pearl 5: EtiologiesTags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine OsmolalityFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.🔹Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 🔹Transcript and Shownotes03:00 | Diagnosing Hypertension 04:10 | When to Start Combination Therapy Instead of Monotherapy 07:00 | Choosing First-Line Therapy Using the ACT Framework 13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors 16:02 | Choosing the Right ARB: Candesartan vs Losartan 18:39 | Comparing Potency & Duration Across First-Line Antihypertensives 20:54 | Amlodipine Edema: Why It Happens and How to Fix It 23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects 29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IMFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Learn from primary care docs what has been practiced and changed from the 2026 ACC/AHA Lipid Guidelines! Learn how the new CPR framework (Calculate, Personalize, Reclassify) and PREVENT risk calculator change statin decisions, why LDL targets are back, and when to use Lp(a), ApoB, and coronary artery calcium (CAC) testing. Discover updated risk-enhancing factors, expanded indications for non-statin therapies, and practical strategies to personalize lipid management for both primary and secondary🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.🔹Transcript and Shownotes:  01:17 | Highlight #1 & #2: CPR and PREVENT Score03:14 | Highlight #3: Updated ASCVD Risk Categories Using the PREVENT Score05:30 | Highlight #4: LDL Targets Are Back07:20 | Highlight #5: High-Risk Conditions That Bypass the PREVENT Score08:41 | Highlight #6: Lp(a) Screening for Everyone11:51 | Highlight #7: When to Use ApoB Testing13:16 | Highlight #8: Reproductive Risk Factors15:29 | Highlight #9: Using CAC to Guide Statin Therapy19:09 | Highlight #10: Non-Statin TherapiesTags: CoreIM, Internal Medicine, Medical Education, Cholesterol, Statins, LDL, ASCVD, Preventive Cardiology, LpA, ApoB, CAC, ACC2026, Cardiology, PrimaryCare Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.ioAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy