Ep 232 – Umbilical hernia

Umbilical hernias are common in infancy but can also occur in adulthood. In this episode, Dr Kate Chesterman discusses how these hernias are likely to present in childhood. She covers the chances of spontaneous resolution and the indications for referral and surgery. She then compares this with the presentation and management of an umbilical hernia in an adult, again considering underlying causes and indications for treatment.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/surgery/ep-232-umbilical-hernia Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson focuses on nasopharyngeal carcinoma, an uncommon head and neck malignancy in many parts of the world, but one with distinctive epidemiology, biology and patterns of presentation. It has a strong association with Epstein–Barr virus (EBV), occurs with striking geographical and ethnic variation, and often presents with cervical lymphadenopathy rather than obvious symptoms from the primary tumour. The episode looks at the current WHO histological classification, the role of EBV and host factors, the clinical features that should raise suspicion, and how the disease is investigated and staged. It then reviews the principles of modern treatment, including radiotherapy, chemotherapy and multidisciplinary management, and discusses prognosis and post-treatment surveillance.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-231-nasopharyngeal-cancer Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr James Waldron is joined by Dr Rik Fijten, a GP with an extended role in gastroenterology, to discuss hepatitis B, the third instalment in a four-part hepatology series. Why are emergency departments (EDs) finding so much hepatitis B through opt-out blood-borne virus testing? Who is most at risk and why is hepatitis B such an important health inequalities issue? The discussion covers how hepatitis B is often missed, what primary care can do better, and how earlier detection can help prevent cirrhosis and liver cancer.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-230-hepatitis-b Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

Continuous glucose monitoring (CGM) has moved from being a specialist technology used mainly in type 1 diabetes to becoming one of the most important developments in modern glucose management. What began as a way of collecting more frequent glucose measurements has evolved into a platform capable of displaying trends, predicting future glucose changes and, when integrated with insulin pumps, automatically influencing treatment. More recently, CGM has expanded into type 2 diabetes, consumer health, early diagnostic research and telemedicine, while artificial intelligence is opening the possibility of increasingly individualised prediction and decision support. At the same time, researchers are working on longer-lasting and potentially non-invasive sensors. In this episode, Dr Roger Henderson revisits how CGM developed, looks at where the technology is heading, what these advances could mean for clinical practice, and the challenges GPs need to consider as glucose monitoring becomes increasingly predictive and automated.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-229-continuous-glucose-monitoringDid you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson discusses infectious mononucleosis, a common viral illness that can present a surprisingly complex diagnostic and clinical challenge. Most often associated with Epstein–Barr virus (EBV), infectious mononucleosis is particularly familiar in adolescents and young adults, where fever, pharyngitis, lymphadenopathy and fatigue can create a classic clinical picture. But recognising the syndrome is only the beginning. Similar presentations can occur with other infections, including acute HIV and cytomegalovirus, while complications such as airway obstruction and splenic rupture, although uncommon, require careful attention. Here, he explores how EBV infection presents, how to approach diagnosis and differential diagnosis, what evidence-based supportive management involves, and the key advice GPs should give patients about activity, recovery and potential complications.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-228-infectious-mononucleosis Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson explores a fascinating and sometimes unsettling area of clinical practice: parasomnias. Sleep is something everyone experiences, but for some patients it is far from quiet or predictable: they may walk, shout, experience vivid nightmares or even physically act out their dreams, leaving both them and their partners confused, frightened or concerned about what these behaviours might mean. For GPs, recognising the pattern is crucial. Is the episode occurring early or late in the night? Is the patient confused or fully alert afterwards? Do they remember what happened, and could medication, another sleep disorder or an underlying neurological condition be contributing? Here, we cover the key clinical features of non-rapid eye movement (NREM) parasomnias, nightmare disorder and rapid eye movement (REM) sleep behaviour disorder, and discuss practical approaches to their assessment, differential diagnosis and management.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/neurology/ep-227-parasomnia Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson discusses gallstone disease, one of the most common disorders affecting the biliary system and a frequent cause of abdominal pain, emergency presentations and gastrointestinal complications. He examines how gallstones develop, focusing on the metabolic, hormonal, genetic and environmental factors that contribute to their formation. The discussion then follows the clinical progression from asymptomatic cholelithiasis and biliary colic to acute cholecystitis, choledocholithiasis, ascending cholangitis and gallstone pancreatitis. Dr Henderson reviews the role of ultrasound, laboratory investigations, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in diagnosis, before considering current approaches to management, including laparoscopic cholecystectomy and endoscopic intervention. Finally, he highlights important complications and clinical red flags, providing a concise framework for recognising and managing gallstone disease in everyday medical practice.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-226-gallstones Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson explores carotid artery stenosis and its role in the prevention of ischaemic stroke. Carotid disease is common, but managing it effectively is far from straightforward. The key clinical questions are not simply how narrow the artery is, but whether the stenosis is responsible for the patient's neurological symptoms, what mechanism is causing cerebral ischaemia, and whether revascularisation offers greater benefit than modern medical therapy. The episode explores the differences between symptomatic and asymptomatic carotid stenosis, the evidence supporting carotid endarterectomy, the importance of timing after transient ischaemic attack or stroke, and the evolving role of carotid stenting. It also considers plaque vulnerability, contemporary medical therapy and how these factors influence decisions about intervention in everyday clinical practice.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-225-carotid-artery-stenosis Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson discusses unstable angina and its place within the spectrum of acute coronary syndrome. Although advances in high-sensitivity troponin testing mean that unstable angina is diagnosed less frequently than in the past, recognising the clinical syndrome remains essential. For GPs, the challenge is distinguishing acute myocardial ischaemia from other causes of chest discomfort, while identifying those patients who require urgent investigation and treatment. The episode covers the underlying pathophysiology, the clinical features that should raise suspicion and the role of the electrocardiogram and high-sensitivity troponin in contemporary diagnosis. It also explores risk stratification, antiplatelet and anticoagulant therapy, symptom management, indications for invasive assessment and secondary prevention. Most importantly, it considers how careful clinical reasoning can help GPs identify high-risk patients early and avoid missing alternative life-threatening diagnoses.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-224-unstable-angina Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

In this episode, Dr Roger Henderson explores cystic fibrosis, a condition that has undergone one of the most remarkable transformations in modern medicine. Once considered almost exclusively a life-limiting childhood disease, cystic fibrosis is now increasingly recognised as a chronic condition extending well into adult life, thanks to major advances in diagnosis, multidisciplinary care and targeted therapies. The episode covers the underlying genetics and pathophysiology, the multisystem nature of the disease and key features of diagnosis and management, along with the revolutionary impact of cystic fibrosis transmembrane conductance regulator modulators. It also considers the continuing importance of holistic, multidisciplinary care and what the future may hold for patients living with cystic fibrosis.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/respiratory-and-chest-medicine/ep-223-cystic-fibrosis Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.