#215 Gallbladder & Biliary Testing: 5 Pearls Segment

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 CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising 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 CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising 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 CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising 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 CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising 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 CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.🔹Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 🔹Transcript and Shownotes:  01:57 | Understanding MASLD as a Systemic Disease 05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease 08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan) 16:15 | Lifestyle Treatment & Weight Loss Targets 19:00 | ESSENCE Trial: Semaglutide for MASH 21:58 | MAESTRO-NASH Trial: Resmetirom 27:27 | Future Treatments for MASH 30:51 | Key Takeaways for Clinicians Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver FibrosisFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes. 🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here. 🔹Transcript and Shownotes:  02: 19 | Pearl 1: Blood Pressure Targets 09: 40 | Pearl 2: Timing Medications and Dialyzability 15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients 22: 57 | Putting It All Together: The Medication Hierarchy Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume OverloadFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Why is fluid management the most important part of dialysis care? This episode explores the fundamentals of hemodialysis, why ESKD patients have unique physiology, and how volume overload, not just hypertension, drives many complications. Learn practical pearls on dry weight, sodium restriction, diuretics, and the strategies that can reduce hospitalizations and improve patient outcomes. 🔹Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 🔹Transcript and Shownotes:  02:49 | Pearl 1: Foundations of Dialysis09:21 | Pearl 2: Distinct Physiology11:42 | Pearl 3: Why is fluid management so important?19:43 | Pearl 4: Fluid Management Pro-tips25:31 | Pearl 5: Diuretics in Patients with Residual Kidney FunctionTags: CoreIM, Internal Medicine, Medical Education, Nephrology, Dialysis, End-stage kidney disease, Hypertension, Kidney Health, Dry Weight, Volume OverloadFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Can AI manage post-op atrial fibrillation or does medicine still require human judgment? Using post-op AFib as a case study, we explore where algorithms help, where evidence falls short, and why clinical context still matters. When evidence is incomplete, and every patient is different, can AI truly practice medicine or only assist the clinicians who do? This episode explores the space between algorithms, uncertainty, and human judgment in modern medical care. 🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.🔹Transcript and Shownotes:  02:51 | Broad workup for reversible causes and other etiologies of AFib that may occur post-op05:10 | Considerations for management of post-op atrial fibrillation13:00 | Stroke risk in atrial fibrillation20:49 | Outpatient management of atrial fibrillation 25:54 | The role of AI in medical decision-makingTags: CoreIM, Internal Medicine, Medical Education, Atrial Fibrillation, Cardiology, Open EvidenceFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

We start with a gripping story of seizures and use it as a jumping-off point to unpack practical pearls for in-flight emergencies. Along the way: what’s actually in the emergency medical kit, when planes divert, how ground medical support works, altitude physiology, legal protections, and how to stay calm when medicine suddenly happens at 35,000 feet. By the end, you may still sweat a little…but hopefully less than before.🔹Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 🔹Transcript and Shownotes:  04:40 | Emergency Medical Kit (EMK) Standard Contents08:50 | Role of Ground-Based Medical Support & Flight Diversion Decision-Making19:35 | Interpreting Hypoxia at Altitude22:06 | In-Flight Liability23:35 | Common Chief Concerns & Useful Additional Medications24:53 | How to Be Resourceful in an Austere EnvironmentTags: CoreIM, Internal Medicine, Medical Education, In-flight Care, Medical Emergencies, Clinical Reasoning, Seizure Management, Hypoxia, Airway Management, Cardiac Emergency, Syncope, Respiratory DistressFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out CovePure and use my code CovePure.com/coreim for a great deal: https://covepure.com* Check out ElevenReader and use my code PODCAST for a great deal: https://elevenreader.io* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy