Board Pearls

Board Pearls
  • 4.8 (4)
  • Medicine
  • Series

The most complete gastroenterology board-review podcast on the web, and it is entirely free. This is the GI series from Board Pearls: board review built around clinical reasoning, not recall. Every episode takes one high-yield topic and works it the way you would on rounds: a case to anchor it, the framework that sorts the differential, and the specific decisions the exam rewards. No trivia, no textbook dictation, just the thinking that earns the point. Over 100 episodes span the full blueprint across nine modules (esophagus, stomach and duodenum, small bowel, colon, pelvic floor, liver, pancreas and biliary, endoscopy, and the cross-cutting topics), grouped by chapter and built from the guidelines and pivotal trials the boards are written from: ACG, AGA, AASLD, and ASGE. Pair it with the written curriculum, question bank, and AI tutor at boardpearls.com. Questions or feedback: hello@boardpearls.com.

  1. Episode 1

    Chapter 31, Ep 1 of 4: GI Emergencies: Massive Upper GI Bleed

    A massive upper GI bleed is a resuscitation problem before it is an endoscopy problem, because the decisions that drive outcome happen in the first hour. The episode follows a man on warfarin and ibuprofen who arrives in shock. It starts with restrictive transfusion and the point where a massive transfusion protocol takes over. It then covers drug-specific anticoagulant reversal and whether it must finish before the scope, erythromycin before endoscopy and tranexamic acid never, and intubation for airway protection. Next come the timing of endoscopy, dual therapy for high-risk stigmata, and embolization or surgery when endoscopy fails. A second patient with an old aortic graft and a herald bleed shows the cause that cannot be missed.   Topics covered Resuscitation before endoscopy Restrictive transfusion thresholds Massive transfusion protocol and calcium Anticoagulant reversal Reversal and the timing of endoscopy Erythromycin and tranexamic acid Airway protection before EGD Timing of endoscopy Dual therapy, embolization, and surgery Aortoenteric fistula and the herald bleed     Key decisions Transfuse red cells below a hemoglobin of 7 g/dL with a target of 7 to 9, raise the threshold to 8 with active acute coronary syndrome, and transfuse on clinical grounds when the patient is visibly exsanguinating. Activate a massive transfusion protocol when bleeding continues despite initial resuscitation, with red cells, plasma, and platelets in a 1:1:1 ratio, and check and replace calcium. Reverse warfarin in life-threatening bleeding with 4F-PCC rather than plasma, add vitamin K for sustained reversal, give idarucizumab 5 g IV for dabigatran, and use 4F-PCC for apixaban, rivaroxaban, and edoxaban because andexanet alfa was withdrawn. Do not delay endoscopy for an INR of 1.5 to 2.5, but reverse an INR above 2.5 before endoscopy in most situations. Give IV erythromycin 250 mg over 20 to 30 minutes, 30 to 90 minutes before endoscopy, to clear the stomach, and do not give tranexamic acid in acute upper bleeding. Intubate before the scope for grade 3 to 4 hepatic encephalopathy, massive hematemesis with aspiration risk, hemodynamic collapse, or inability to protect the airway. Scope non-variceal bleeding within 24 hours and variceal bleeding within 12 hours, and reserve endoscopy under 6 hours for unstabilizable massive hemorrhage or a suspected aortoenteric fistula. Treat high-risk stigmata with epinephrine plus a second modality, send failures to angiographic embolization (gastroduodenal artery for posterior bulb ulcers, left gastric artery for lesser curve ulcers), and operate when embolization fails. In a patient with a prior aortic graft and a herald bleed, get CT angiography before EGD or surgery, and send a confirmed fistula to surgery.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Introduction and the first patient (01:56) - Restrictive transfusion targets (03:18) - Massive transfusion protocol and calcium (04:13) - Reversing warfarin and DOACs (05:33) - Erythromycin yes, tranexamic acid no (06:24) - Securing the airway first (07:01) - How soon to scope (07:59) - Endoscopic therapy for high-risk ulcers (08:33) - Embolization and surgery after failure (09:27) - Aortoenteric fistula and the herald bleed

  2. Episode 2

    Chapter 31, Ep 2 of 4: GI Emergencies: Lower Bleeding and Ischemia

    This episode is organized around one idea: in both lower bleeding and bowel ischemia, the next step depends on stability and on the cause, not on the label. For lower bleeding, the order is to exclude an upper source with the BUN to creatinine ratio, stabilize, do anoscopy, then choose colonoscopy for the stable patient or CT angiography for the unstable one, and clip or band a bleeding diverticulum. Pain before blood points to colon ischemia and, if right-sided, to the mesenteric arteries. Acute mesenteric ischemia follows: recognize pain out of proportion to the examination, get CT angiography despite a normal lactate, resuscitate, then treat by cause or operate for peritoneal signs.   Topics covered Excluding an upper source in lower bleeding Anoscopy and stabilization Oakland score and disposition CT angiography versus colonoscopy Diverticular bleeding and clips Post-polypectomy bleeding and angiodysplasia Colon ischemia severity and antibiotics Acute mesenteric ischemia recognition and CT angiography Resuscitation without vasopressors Embolus, thrombosis, nonocclusive and venous causes     Key decisions Suspect an upper source when the BUN to creatinine ratio is above thirty, and do upper endoscopy first when it is about forty with a fast pulse. Perform bedside anoscopy before referring for colonoscopy, and manage patients with an Oakland score of eight or below as outpatients. Send a stable patient to colonoscopy twelve to twenty-four hours after rapid preparation with four liters of polyethylene glycol, and send an unstable patient first to CT angiography with embolization if positive. Treat diverticular stigmata and post-polypectomy bleeding with clips or band ligation rather than deep thermal therapy, because of perforation risk. Treat mild colon ischemia with fluids and bowel rest, and add antibiotics when the white count is above fifteen thousand, the BUN is above twenty, or ulceration is severe; image the mesenteric vessels in isolated right colon ischemia. Order CT angiography with arterial and portal venous phases for pain out of proportion to the examination, and do not wait for or be reassured by a lactate. Resuscitate with crystalloid and broad-spectrum antibiotics while avoiding vasopressors, and proceed to laparotomy with a second look at twenty-four to forty-eight hours for peritoneal signs. Match treatment to cause: remove an embolus, revascularize a thrombosed SMA origin, give intra-arterial papaverine at thirty to sixty milligrams an hour for nonocclusive ischemia, and anticoagulate mesenteric venous thrombosis.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Episode overview and cases (01:02) - Painless maroon stools case (02:44) - Anoscopy and stabilization (03:02) - CT angiography versus colonoscopy (05:42) - Diverticular bleeding and clips (07:36) - Pain first: colon ischemia (09:14) - Acute mesenteric ischemia presentation (11:53) - Treatment depends on the cause (13:25) - Thrombosis, nonocclusive, and venous causes (16:32) - Board traps and summary

  3. Episode 3

    Chapter 31, Ep 3 of 4: GI Emergencies: Esophageal Emergencies

    The organizing idea is that urgency follows how fast an injury escalates. The episode starts with a food impaction, where complete obstruction means endoscopy within six hours, glucagon rarely helps, nothing is pushed blindly, and biopsies look for eosinophilic esophagitis. It then moves to the two-hour button battery and the removal windows for sharp, long, wide, magnetic, blunt, and drug-packet objects. Next comes Boerhaave syndrome: the Mackler triad, CT with water-soluble contrast, antibiotics with antifungals in severe disease, and the twenty-four-hour line between primary repair and a covered stent. It ends with caustic ingestion: airway first, what never to do, and the Zargar grade deciding disposition.   Topics covered Food bolus impaction and the six-hour rule Glucagon and blind pushing Eosinophilic esophagitis biopsies Button battery and the two-hour clock Removal windows by object type Drug packets Boerhaave syndrome and the Mackler triad CT, antibiotics, and antifungals Repair versus stent at twenty-four hours Caustic ingestion and Zargar grades     Key decisions Perform endoscopy within six hours, and sooner if possible, for esophageal obstruction with inability to manage secretions, a sharp esophageal object, or a disc battery, and remove an esophageal disc battery within two hours. Do not let glucagon, which is given as 1 mg intravenously and works in under twenty percent, delay endoscopy, and never push a bolus blindly with a nasogastric tube or bougie. Take at least four biopsies each from the proximal and distal esophagus at the first impaction without a known diagnosis, looking for fifteen eosinophils per high-power field. Remove sharp gastric or duodenal objects, objects longer than six centimeters, and high-power magnets within twenty-four hours, remove objects wider than two and a half centimeters from the stomach, and follow blunt objects past the duodenum with serial radiographs. Never retrieve drug packets endoscopically, and observe the patient under monitoring with laparotomy for symptoms of a leak. Suspect Boerhaave even with an incomplete Mackler triad or a normal chest film, and confirm with CT using water-soluble oral contrast, not barium. Give piperacillin-tazobactam or meropenem, add fluconazole or micafungin from the start in severe disease, and place a nasogastric tube only under fluoroscopy. Repair primarily with drainage within twenty-four hours of a perforation, and after that use a covered self-expanding metal stent with drainage. After caustic ingestion, intubate early for stridor, drooling, voice change, or extensive burns, avoid emesis, charcoal, neutralizers, and blind tubes, and scope within about twelve to twenty-four hours but not after forty-eight.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Episode overview (01:11) - Steak impaction and the six-hour rule (03:54) - Eosinophilic esophagitis underneath the bolus (04:49) - Button battery and the two-hour clock (05:38) - Removal windows for other objects (07:39) - Boerhaave syndrome and the Mackler triad (09:43) - CT, contrast, and antimicrobial coverage (11:36) - Repair or stent by time (13:19) - Caustic ingestion: airway and what to avoid (14:44) - Zargar grades and disposition

  4. Episode 4

    Chapter 31, Ep 4 of 4: GI Emergencies: Ogilvie Syndrome

    Acute colonic pseudo-obstruction is massive colonic dilation without a mechanical blockage, driven by autonomic imbalance that opioids, surgery, and electrolyte disturbances unmask. The episode follows a 76-year-old man after hip surgery through four ordered steps. First, CT excludes mechanical obstruction, volvulus, and toxic megacolon, and sets a baseline cecal diameter. Second, supportive care corrects electrolytes, stops opioids, and decompresses with tubes, resolving about 80 percent of cases. Third, a cecum over 12 centimeters or persistent distension triggers neostigmine, given on a monitor after contraindications are checked. Fourth, colonoscopic decompression follows if neostigmine fails or is contraindicated, and surgery is reserved for perforation, peritonitis, or failure of everything else.   Topics covered Pathophysiology of colonic pseudo-obstruction Precipitants and who gets it CT to exclude mechanical obstruction Supportive care bundle Methylnaltrexone for opioid cases Cecal diameter and perforation risk Neostigmine dosing and monitoring Contraindications to neostigmine Colonoscopic decompression technique Indications for surgery     Key decisions Obtain CT of the abdomen and pelvis with contrast before treating, to exclude mechanical obstruction, volvulus, and toxic megacolon, and record the baseline cecal diameter. In a stable patient with a cecum below 12 centimeters, start 48 to 72 hours of supportive care: nothing by mouth, nasogastric and rectal tubes, mobilization, position changes, electrolyte correction, and stopping opioids and anticholinergics. Correct potassium, magnesium, calcium, and phosphate, since electrolyte disturbances unmask the autonomic imbalance. Escalate when the cecum exceeds 12 centimeters, distension persists beyond 48 to 72 hours despite supportive care, or perforation is impending. Give neostigmine 2 milligrams intravenously over 3 to 5 minutes with cardiac monitoring and atropine 1 milligram at the bedside, optionally with glycopyrrolate to blunt bradycardia. Withhold neostigmine for mechanical obstruction, recent myocardial infarction, severe bradyarrhythmia, active reactive airway disease, seizure history, peritoneal signs, suspected ischemia, perforation, or hypersensitivity. Use colonoscopic decompression when neostigmine fails, is contraindicated, or cannot be repeated, with no prep, minimal carbon dioxide insufflation, no narcotic sedation, a check for ischemia, and a decompression tube placed in the right colon. Send the patient to surgery for perforation, peritonitis, clinical deterioration, or a cecum that stays above 12 centimeters after medical and endoscopic options are exhausted.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Welcome and episode overview (00:35) - The post-hip-surgery patient (01:00) - Diagnosis and autonomic mechanism (02:55) - CT to exclude mechanical causes (03:46) - The supportive care bundle (05:07) - Cecal diameter and escalation triggers (05:59) - Neostigmine dosing and monitoring (06:56) - Checking neostigmine contraindications (08:32) - Colonoscopic decompression technique (09:31) - Surgery as the last step

  5. Episode 5

    Chapter 32, Ep 1 of 4: GI Nutrition: Deciding to Feed and How

    The organizing idea is that feeding is a decision with risks on both sides: starved patients can be harmed by food, and inflamed patients can be mislabeled as starved. The episode begins with a starved man with alcohol use disorder, covering refeeding risk, thiamine before glucose, and a slow start. It then turns to a septic woman whose low albumin is not malnutrition, the GLIM criteria, and when support is indicated. Last, it follows a man with oropharyngeal cancer through choosing the gut, picking a nasal tube or PEG, introducer placement, a buried bumper, other PEG problems, and tube-feed diarrhea. A woman with advanced dementia shows who should not get a tube.   Topics covered Refeeding syndrome physiology Thiamine before glucose and Wernicke encephalopathy NICE criteria for refeeding risk Slow calorie start and electrolyte monitoring Albumin and prealbumin as inflammatory markers GLIM criteria and nutrition screening Indications for nutrition support Enteral versus parenteral nutrition Nasal tube versus PEG and placement technique PEG complications and tube-feed diarrhea     Key decisions Give thiamine before any glucose in an at-risk patient, 200 to 300 mg daily for refeeding prevention, or 500 mg intravenously three times daily for 2 to 3 days if Wernicke encephalopathy is suspected. Call a patient high risk for refeeding with a BMI under 16, weight loss over 15 percent in 3 to 6 months, more than 10 days of negligible intake, or low potassium, phosphate, or magnesium, or any two of the lesser criteria. Start high-risk patients at 10 to 20 kilocalories per kilogram per day, advance over 4 to 7 days, check electrolytes twice daily for 72 hours, and hold calories while phosphate is falling. Do not diagnose malnutrition or start parenteral nutrition from a low albumin or prealbumin, and use GLIM, which needs one phenotypic and one etiologic criterion. Start nutrition support when intake will be inadequate for more than 7 days or malabsorption causes weight loss, through the gut if it works. Use a nasal tube for less than 4 to 6 weeks and a PEG beyond that, with the introducer technique in oropharyngeal cancer and one dose of cefazolin 1 g intravenously 30 minutes before. Do not place a PEG in advanced dementia, and treat pain with a tube that will not flush or rotate as buried bumper, removed endoscopically or surgically. In tube-feed diarrhea, review sorbitol-containing medications, antibiotics, and C. difficile before changing the formula.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Episode overview and patients (00:58) - Starved patient and refeeding risk (02:58) - Thiamine before glucose (05:30) - Starting slowly and monitoring electrolytes (06:29) - Low albumin is not malnutrition (07:52) - GLIM criteria and screening tools (11:08) - Choosing the gut and the tube (12:19) - Introducer PEG in oropharyngeal cancer (14:17) - Buried bumper and PEG problems (15:38) - Tube-feed diarrhea and formula choice

  6. Episode 6

    Chapter 32, Ep 2 of 4: GI Nutrition: Parenteral Nutrition and Short Gut

    The organizing idea is that parenteral nutrition is for a gut that cannot be used, and that a short gut is judged by the anatomy left, not the length lost. The episode starts with who qualifies for parenteral nutrition, then counts calories, avoids precipitation in the bag, chooses lipid and cycling, and handles line infection, gallstones, and liver disease. It then shows who is harmed by it. It turns to short bowel syndrome: anatomy and prognosis, ileal loss, oral rehydration, drugs, cholestyramine, teduglutide with colonoscopy, and the colon's two problems, oxalate stones and D-lactic acidosis.   Topics covered Indications for parenteral nutrition Calorie counting and dextrose Calcium, phosphate, and acetate in the bag Mixed lipid emulsions and cycling Line infection and locks Gallstones and liver disease from parenteral nutrition When parenteral nutrition harms Short bowel anatomy and prognosis Oral rehydration, drugs, and cholestyramine Teduglutide, oxalate stones, and D-lactic acidosis     Key decisions Start parenteral nutrition only when the gut cannot be used, as in intestinal failure, ileus beyond seven days, severe pancreatitis that won't tolerate enteral feeding, transplant mucositis, or refractory high-output stomas, and not for low albumin, cancer cachexia, or mild pancreatitis. Prescribe 25 to 30 kilocalories per kilogram and 1 to 1.2 grams per kilogram of amino acids, count dextrose at 3.4 kilocalories per gram, and give lipid twice weekly to prevent essential fatty acid deficiency. Keep calcium and phosphate within validated solubility limits and use acetate, not bicarbonate, as the buffer. Give long-term patients a mixed lipid emulsion rather than pure soybean and cycle feeding over 12 to 18 hours to protect the liver. Salvage an infected catheter with systemic antibiotics plus a lock when the organism allows, and add ethanol or taurolidine locks after recurrent infections. Give any enteral intake the patient can absorb, even 20 to 30 percent of needs, to reduce gallbladder stasis and liver injury, and refer for intestinal transplantation when liver failure is established, infections recur, or venous access is lost. Use a sodium-glucose oral rehydration solution with plain water limited, loperamide before meals, high-dose PPI, and hyperphagia, and give cholestyramine only for 30 to 100 centimeters of ileal resection. Check colonoscopy within six months before starting teduglutide, at one year, and every five years, avoid it in active gastrointestinal malignancy, and in patients with a colon use a low-oxalate diet with calcium at meals and request D-lactate when confusion follows carbohydrate.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Episode overview and cases (01:23) - Who needs parenteral nutrition (02:34) - Calories and dextrose counting (03:36) - Calcium, phosphate, and acetate (04:02) - Lipid choice and cycling (05:12) - Line infection, gallbladder, and liver (08:06) - When parenteral nutrition harms (09:22) - Short bowel anatomy and prognosis (11:16) - Fluids, drugs, and cholestyramine (13:21) - Teduglutide and colon complications

  7. Episode 7

    Chapter 32, Ep 3 of 4: GI Nutrition: Vitamins and Essential Fats

    Each vitamin and essential fatty acid is traced from its job in the body to the picture its deficiency or excess makes. The episode starts with cholestasis and cholestyramine, which cause all four fat-soluble deficiencies, then covers vitamin D repletion, vitamin E, and vitamin K with warfarin and antibiotics. It turns to vitamin A excess mimicking cryptogenic cirrhosis, then essential fatty acid deficiency and why MCT oil cannot prevent it. The water-soluble section follows B12 absorption, confirmation of a borderline level, folate, and bacterial overgrowth, then pellagra, pyridoxine, thiamine, vitamin C, and biotin.   Topics covered Fat-soluble vitamin deficiency in cholestasis Vitamin A deficiency and night blindness Vitamin D repletion with calcium Vitamin E deficiency Vitamin K, warfarin, and antibiotics Vitamin A hepatotoxicity Essential fatty acid deficiency and MCT oil B12 absorption steps and deficiency Folate deficiency and bacterial overgrowth Pellagra, pyridoxine, thiamine, vitamin C, and biotin     Key decisions When one fat-soluble vitamin deficiency is found in a patient with cholestasis or on cholestyramine, look for the other three, because all four depend on bile salts. Replete vitamin D when 25-hydroxyvitamin D is below 30 ng/mL, or below 20 by a stricter cutoff, using ergocalciferol 50,000 units weekly for 8 to 12 weeks or cholecalciferol 1,000 to 5,000 units daily, always with calcium and a repeat level. Watch the INR closely in a patient on warfarin who is fasting and receiving broad-spectrum antibiotics, and replace vitamin K under the skin or by mouth, giving intravenous vitamin K slowly because of anaphylaxis risk. Ask about supplements by name in unexplained cirrhosis, because chronic vitamin A intake of 50,000 units a day or more causes stellate cell fibrosis, and stop the vitamin A. Diagnose essential fatty acid deficiency with a triene-to-tetraene ratio above 0.2 and treat with intravenous long-chain lipid, since MCT oil cannot prevent or treat it. Confirm a borderline serum B12 of 200 to 400 pg/mL with methylmalonic acid and homocysteine, check B12 before ever starting folate, and replace with intramuscular cyanocobalamin 1,000 micrograms weekly for one to two months and then monthly. Look for and treat small intestinal bacterial overgrowth when B12 is low and folate is high, and give B12 for life when the terminal ileum has been resected because oral B12 fails. Give thiamine before any glucose and treat suspected Wernicke encephalopathy empirically with 500 mg intravenously three times daily for two to three days, then 250 mg daily for five to seven days. Treat pellagra with nicotinamide 250 to 500 mg daily and give pyridoxine 25 to 50 mg daily with long-term isoniazid.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Episode overview and cases ahead (01:03) - Cholestasis and fat-soluble deficiencies (03:04) - Vitamin D repletion and bone (04:56) - Vitamin K, warfarin, and antibiotics (05:55) - Vitamin A excess and cirrhosis (07:12) - Essential fatty acids and MCT oil (09:02) - B12 deficiency, folate, and SIBO (13:32) - Pellagra and pyridoxine (15:21) - Thiamine, vitamin C, and biotin (17:46) - Board traps and episode summary

  8. Episode 8

    Chapter 32, Ep 4 of 4: GI Nutrition: Minerals and Trace Elements

    Each mineral and trace element has a specific biochemical job and a typical exposure or disease that tips it into deficiency or excess, so the exposure is asked about first. The episode starts with a man whose denture cream gives him zinc excess and copper deficiency that mimics B12 myeloneuropathy, then covers zinc deficiency and why zinc replacement is monitored. It moves to PPI-induced hypomagnesemia, manganese buildup in cholestasis on parenteral nutrition, and selenium and chromium deficiency from an unsupplemented bag. It then covers selenosis from Brazil nuts, iron replacement after gastric bypass, and why dietary calcium is preferred over pills.   Topics covered Zinc excess and copper deficiency Copper deficiency myeloneuropathy versus B12 Zinc deficiency and replacement PPI-induced hypomagnesemia Manganese toxicity on parenteral nutrition Selenium and chromium deficiency Selenosis from Brazil nuts Iron deficiency after gastric bypass Dietary calcium versus supplements Board traps for minerals     Key decisions When a myeloneuropathy looks like subacute combined degeneration but B12, MMA, and folate are normal, check serum copper and ceruloplasmin, and ask by name about denture cream and zinc supplements. Treat copper deficiency with oral copper, two milligrams daily, and remove the zinc source, such as switching to a zinc-free denture adhesive. When zinc deficiency is suspected from periorificial dermatitis, poor wound healing, or taste change, check a zinc level and, if low, give zinc sulfate, two hundred twenty milligrams daily (fifty milligrams elemental zinc), with monitoring because excess zinc causes copper deficiency. In a long-term PPI user with tetany, seizure, or arrhythmia and very low magnesium despite normal kidneys and no diuretic or alcohol use, stop the PPI where feasible, substitute an H2 blocker, and replace magnesium intravenously as magnesium sulfate if symptomatic and in hospital, or orally if an outpatient. Remove manganese from parenteral nutrition once cholestasis develops or once T1 hyperintensity of the globus pallidus is seen on MRI, whichever comes first. Consider selenium deficiency when a new cardiomyopathy appears on long-term unsupplemented parenteral nutrition, and chromium deficiency when unexplained glucose intolerance appears. Replace iron with oral ferrous sulfate, move to intravenous iron if it is not tolerated or not absorbed, and expect reticulocytes to rise within seven to ten days. Prefer dietary calcium over calcium supplements, taken with vitamin D, in patients whose bones are threatened.     This is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.   Questions or feedback: hello@boardpearls.com. (00:00) - Minerals and trace elements overview (01:00) - Unsteady gait and denture cream (02:10) - Copper deficiency mimics B12 (04:04) - Zinc deficiency and monitored replacement (05:08) - PPI-induced hypomagnesemia (06:43) - Manganese buildup on parenteral nutrition (08:01) - Selenium and chromium deficiency (08:46) - Selenosis from Brazil nuts (09:27) - Iron replacement after gastric bypass (10:11) - Calcium from food, not pills

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About

The most complete gastroenterology board-review podcast on the web, and it is entirely free. This is the GI series from Board Pearls: board review built around clinical reasoning, not recall. Every episode takes one high-yield topic and works it the way you would on rounds: a case to anchor it, the framework that sorts the differential, and the specific decisions the exam rewards. No trivia, no textbook dictation, just the thinking that earns the point. Over 100 episodes span the full blueprint across nine modules (esophagus, stomach and duodenum, small bowel, colon, pelvic floor, liver, pancreas and biliary, endoscopy, and the cross-cutting topics), grouped by chapter and built from the guidelines and pivotal trials the boards are written from: ACG, AGA, AASLD, and ASGE. Pair it with the written curriculum, question bank, and AI tutor at boardpearls.com. Questions or feedback: hello@boardpearls.com.

Information

  • Creator
    Board Pearls
  • Episodes
    116
  • Seasons
    9
  • Rating
    Clean
  • Copyright
    © 2025
  • Show Website
    Board Pearls