Episode 51 - December 1, 2017 AFP: American Family Physician

AFP: American Family Physician Podcast

American Academy of Family Physicians

Medicine, Americanfamilyphysician, Afppodcast, Familymedicinepodcast, Afp, Clinicalpodcast, Aafp, Health & Fitness, Primarycarepodcast, Medicinepodcast, Aafppodcast

2.4 • 649 Ratings

🗓️ 16 December 2017

⏱️ 19 minutes

🔗️ Recording | iTunes | RSS

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Summary

Elevated liver transaminase levels (1:10), topical capsaicin for treatment of chronic neuropathic pain (6:30), hyperosmolar hyperglycemic state (9:00), local anaesthesia for IUD insertion (13:50), USPSTF recommendation updates (15:30), and "Where I Listen" (17:20).

Transcript

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0:00.0	Welcome to the American Family Physician Podcast for the December 1st, 2017 issue. I'm Jake. I'm Evan.
0:08.3	I'm Sue. I'm Joanna. And we are residents and faculty, mostly residents, of the University of Arizona College of Medicine Phoenix Family Medicine residency.
0:17.6	This time on the podcast, we're going to talk about elevated liver transaminase levels,
0:22.2	topical capsaic for treatment of chronic neuropathic pain, hyperosmolar hyperglycemic state.
0:28.5	We'll have an F-Pen looking at local anesthesia for IUD insertion, and we'll have an editorial
0:33.4	that looks at USPSTF recommendation updates for 2016.
0:37.9	Be sure to stick around after the podcast for a Where I Listen segment on CBT.
0:44.3	The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians, the editor of American Family Physician or Banner Health.
0:51.4	Do not use this podcast for medical advice. Instead, see your own family doctor for medical care.
1:20.6	All right, let's kick things off with mildly elevated liver transaminase levels, causes and evaluation by Doctors O, Hustead, Ali, and Pansuri.
1:22.4	Let's get straight to it.
1:26.7	What is the cutoff for transaminases to be considered mildly elevated?
1:27.3	Anyone?
1:28.2	100.
1:29.1	Close.
1:34.6	It's defined as less than five times the upper limit of normal.
1:39.1	Anything greater than that should prompt immediate evaluation, which is outside the scope of this discussion. But what, if any, is the significance of a mildly elevated transaminase level?
1:45.1	It signifies hepaticellular damage.
1:47.9	ALT, remember the L is for liver, is usually more specific for liver injury, while AST can be caused by a number of extra hepatic disorders like thyroid disorders, celiac disease, homolysis, and muscle disorders.
2:03.5	Interestingly, the A-S-T-AL-T ratio may tell us something. For example, AST-ALT ratio greater than
2:11.3	two may suggest alcoholic liver disease, while the ratio less than one is seen in N-A-F-L.
2:17.5	Guys, this is really exciting because this is one of those certainties that we glom on to early in med school.
	...

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