abdominal pain

Doctors Lisa and Sara talk to Hepatitis C GP Champion Dr Lindsey Kent and Greater Manchester Peer Programme Manager Tony Horrocks for an overview of Hepatitis C. We cover the basics around the virus and prevalence, potential symptoms and at risk groups to consider when offering testing. We discuss the great work being done to eradicate Hepatitis C in Manchester (and around the UK) including Tony’s personal story as well as his work as a Peer Programme Manager. Wonderful to hear the success rate for cure with medications and how the team ‘leave no one behind’. 
Great listening for all of us working in General Practice.
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
 
Useful resources: 
NICE Clinical Knowledge Summaries Hepatitis C (last revised Sept 2022): https://cks.nice.org.uk/topics/hepatitis-c/
The Hepatitis C Trust UK Online Risk Checker: https://www.hepctrust.org.uk/hepatitis-c-risk-checker/
Order free Hepatitis C test UK: https://hepctest.nhs.uk/
Liverpool Hepatitis Interaction Checker: https://hep-druginteractions.org/checker
Greater Manchester and East Cheshire Hepatitis C Operational Delivery Network: https://research.cmft.nhs.uk/innovation-at-mft/hepatitis-c-operational-delivery-network-for-greater-manchester-and-east-cheshire
Aneesha Noonan’s podcast on Expanding hepatitis C elimination into Primary Care settings: https://youtu.be/U5TdLJdAGrI?si=Woy1nkVxfCztXaJY
Hep C U Later Primary Care Toolkit: https://www.hepculater.com/wp-content/uploads/2024/05/Primary-Care-Toolkit-Final-with-links-v2-with-updated-date.pdf
Hep C U Later’s ‘Hep C Elimination Successes’: https://www.hepculater.com/hepatitis-c-elimination-successes/
Hep C U Later: GP practices can run a case finding tools (these are already installed on systems within general practice). If you’re interested in running these tools with support from other organisations email [email protected] so we can link you to the right people. NHS England » NHS set to eliminate Hepatitis C ahead of rest of the world: https://www.england.nhs.uk/2022/12/nhs-set-to-eliminate-hepatitis-c/
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: [email protected]
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This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Locum Consultant Dr Caitriona MacDermott about assessing and managing constipation in Palliative Patients. A common symptom with a significant impact on people’s quality of life, the episode aims to get across the importance of the topic, the often multifactorial nature of clinical scenarios, the red flags not to miss and arm you with a logical and holistic approach to management. We discuss how management might differ for patients with certain conditions such as partial bowel obstruction, neurological causes, or liver disease. An important listen for those of us in the community looking after palliative patients. 
 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
 
Useful resources: 
Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf
Clinical Knowledge Summaries from NICE: Palliative Care - Constipation (Updated Feb 2024): https://cks.nice.org.uk/topics/palliative-care-constipation/
NICE CKS Table of Doses of Laxatives that can be used for Palliative Patients: https://cks.nice.org.uk/topics/palliative-care-constipation/prescribing-information/doses-of-laxatives/
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: [email protected]
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to GP Dr Charlotte Bădescu about Ovarian Cancer. We focus on the important learning points about cardinal and other features of presentations to better understand this cancer as an abdominal cancer with symptoms that can and do often present much earlier than the diagnosis is often picked up. She talks us through the value of CA125 tests and the reasons not to be overly reliant on them, though they can be a useful tool in the tool box. The usefulness of ultrasound scans, both pelvic and transvaginal, as well as clinician continuity is discussed.  We go through 2 hypothetical cases based on real examples as well as Charlotte’s own diagnosis. An excellent episode for picking up great learning points to avoid missing this diagnosis in your own patients. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
NICE Guidelines: Suspected Cancer, Recognition and Referral (Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers
NICE guidelines on Ovarian Cancer (Published April 2011): https://www.nice.org.uk/guidance/cg122
GP network & resources: https://targetovariancancer.org.uk/health-professionals/GPs
Nurses network & resources: https://targetovariancancer.org.uk/health-professionals/nurses
Patient resources: https://targetovariancancer.org.uk/support-for-you
Shine Cancer Support: https://shinecancersupport.org/
ForteenFish Free Ovarian Cancer Webinar (you will need to log-on and search Ovarian Cancer): https://www.fourteenfish.com/
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Sarah Taylor about the changes being made to how Primary Care Clinicians refer patients for Suspected Lower Gastrointestinal Cancers. These changes are discussed in the context of referring in the Greater Manchester area, but you can view the  joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology below. This will change the way we manage patients. To help, we go through some potential cases. Good tips for how to mitigate potential risks with the changes included. We hope you find this useful.
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG): https://www.bsg.org.uk/clinical-resource/faecal-immunochemical-testing-fit-in-patients-with-signs-or-symptoms-of-suspected-colorectal-cancer-crc-a-joint-guideline-from-the-acpgbi-and-the-bsg/
GatewayC FIT infographic: http://bit.ly/409mXUy
GatewayC Lower GI infographic: http://bit.ly/3XJpIKN
Raised Platelets and Cancer Risk: https://gpnotebook.com/en-au/simplepage.cfm?ID=x2019111783915921223
The Current NICE Guidelines last Updated December 2021: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#lower-gastrointestinal-tract-cancers
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara are joined by GP Dr Nikesh Vallabh, Consultant Cardiologist Dr Karthikeyan and Consultant Gastroenterologist Dr Bliss to discuss advice and guidance.
For those unfamiliar, the advice and guidance system came about to try to ease pressure on the long outpatient waiting lists, providing a different way of managing some cases. It is in place for a number of specialties for primary care clinicians to ask questions to consultants, getting an answer that will help guide patient care within a matter of short weeks at most. We talk about the system and where it can fit in to make a difference to patient care. We take the opportunity to go through some common themes and glean learning points from these to help our own practice.
Useful resources: 
Wigan, Wrightington and Leigh have their own LFTs guideline that should be available on the intranet or contact the local CCG
BMJ LFTs Algorithm 2017: https://www.bsg.org.uk/wp-content/uploads/2019/12/Guidelines-on-the-management-of-abnormal-liver-blood-tests.pdf
Greater Manchester Guidelines for managing patients with dyspepsia in primary care: https://gpexcellencegm.org.uk/resources/guidelines-for-managing-patients-with-dyspepsia-in-primary-care/#.YFEP4C2l23U
NICE guidelines Chronic Heart Failure in Adults: Diagnosis and Management (2018) https://www.nice.org.uk/guidance/ng106
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
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This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

We are joined by Paediatric Consultant Dr Christos Zipitis to discuss a great overview of infant feeding issues. It was fabulous to go over definitions, presentations and management of colic, gastro oesophageal reflux and reflux disease, lactose intolerance and cow's milk protein allergy. We later touch on the resource ICON designed to help parents cope with crying babies. Thoroughly worthwhile learning for all the general practice team. 
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The GP Infant Feeding Network (UK): https://gpifn.org.uk/infant-feeding/
Milk Allergy in Primary Care (MAP) Guideline 2019: https://gpifn.org.uk/imap/
GP Online, Feeding Problems in infants (2015): https://www.gponline.com/feeding-problems-infants/paediatrics/paediatrics/article/1377305
Medicines for Children Leaflets: https://www.medicinesforchildren.org.uk
NICE guidelines Food allergy in the under 19s: https://www.nice.org.uk/guidance/cg116
NICE Guidelines Gastro-oesophageal Reflux in children and young people, diagnosis and management: https://www.nice.org.uk/guidance/ng1/chapter/introduction
Thickeners and bowel obstruction discussion reference: Parmar RS et al. Bezoar and bowel obstruction associated with the use of anti-gatro-oesophageal reflux medication in neonates. Infant. 2015; 11(3): 94-5. https://www.infantjournal.co.uk/pdf/inf_063_str.pdf
Discussion on potential side effects of Proton Pump Inhibitors for babies:Cochrane review (2014): Pharmacological treatment of children with gastro‐oesophageal reflux  (see PPI section re possible increased risk of respiratory infections)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2/full?highlightAbstract=inhibitors%7Cside%7Ceffects%7Cinhibitor%7Ceffect%7Cpump%7Cproton
Long-term PPI use and association with gastric cancer: Ka Shing Cheung and Wei K Leung. Long-term use of PPIs and risk of gastric cancer: a review of the current evidence. Therapeutic Advances in Gastroenterology. 2019; 12: 1-11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415482/
ICON: Resource for parents about how to cope with crying babies: https://iconcope.org/
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We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast
___
This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Managing the common palliative symptoms of nausea, vomiting and constipation can make a world of difference to the quality of life of our patients. This week, Lisa and Sara are joined again by Drs Liam Hosie and Anna Murray to continue their discussion about managing palliative patients in general practice. 
We cover important features in a history that point to the cause of symptoms for nausea/vomiting and constipation. The causes of nausea and vomiting are then broken down to four categories and we consider what medications might work best for these. We go on to discuss managing constipation and point to a helpful guide for further reference.
Useful resources: 
Greater Manchester Medicines Management Group, Palliative Care Pain and Symptom Control for Adults (Fifth Edition, Nov 2019): http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf#search=%22nausea%22
NICE Clinical Knowledge Summaries, Palliative Care - Nausea and Vomiting: https://cks.nice.org.uk/topics/palliative-care-nausea-vomiting/
NICE Clinical Knowledge Summaries, Palliative Care - Constipation: https://cks.nice.org.uk/topics/palliative-care-constipation/
Wigan & Leigh Hospice Symptom Management Guidelines for the Care of Adults in the Last Hours or Days of Life (Community Version 3): https://d2abk28tx5gxte.cloudfront.net/app/uploads/2018/11/26165005/symptom_management_guidance_end_of_life_adults_community_v3.pdf
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Gastroenterologist Dr Bliss about Irritable Bowel Syndrome. 
***THIS EPISODE HAS BEEN RE-UPLOADED WITH ADDITIONAL INFORMATION ABOUT CA125 BLOOD TESTS***
Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
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This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.