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EN_B00000_S06513_W000004 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Yeah, the impact it would have on people's life. There's a great book by John Ronson called So You've Been Publicly Shamed. Yeah. And it talks all about someone might have done something wrong, but the backlash well and truly goes overboard in regard. It's the outrage.",
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EN_B00000_S06513_W000005 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " I think it also elevates us and what we want to do. Like when you have an experience like that, you start to think, oh look at the impact he had. What could I be doing for people at a very micro level to do that same experience?",
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EN_B00000_S06513_W000006 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " So, so what are some of the radio shows around the world that you keep an eye on or that you enjoy?",
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EN_B00000_S06513_W000007 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Well I think, uh, like Mr97, like one of the things that I feel that I learnt from listening to Howard Stern. So I only found out about Howard Stern October.",
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EN_B00000_S06513_W000008 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Last year, and I went really deep, like I had a Sirius XM radio in our rental car in the U.S.",
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EN_B00000_S06513_W000009 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " I took from it was what I love about Howard Stern is as much about the characters and the producers as it is him.",
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EN_B00000_S06513_W000010 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " And then I started to relate it back to what I love about Kyle and Jack as well and having that ensemble cast and being able to, uh, I feel like if you are talent, it takes a certain amount of pressure off when you have an ensemble team that can all be celebrated. And so on a given day,",
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EN_B00000_S06513_W000011 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " You know, Kyle or Jackie O, if they're tired, they can have the support of you guys to be creating that content.",
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EN_B00000_S06513_W000012 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " And so uhm, uh, the, the international side of things, when you are on a red carpet, uh, or you're, you're doing a press junket or whatever it is, are there characters, I'm thinking of like Elvis Duran's show in New York, they've got the, um,",
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EN_B00000_S06513_W000013 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " The crazy character, I'm trying to think of his name, the bald, uh, bald dude. But do you get to, do you befriend the international radio people or?",
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EN_B00000_S06513_W000014 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000015 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " It feels like our radio has the reputation of having people with a lot of mental health, uh, challenges. Oh, I'm a mess. Yeah, and, and uhm, I mean, what's that experience been like for you over the years and how have you dealt with it in having such a public facing job?",
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EN_B00000_S06513_W000016 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000017 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Early days where we went really honest and people still talk about the things that we spoke about in that episode. Uh, have there been, you know,",
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EN_B00000_S06513_W000018 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, Kyle and Jack made the switch and how much of a big deal that was. The studios are always, you know, top notch. Do you get a sense that, uh, there's going to be a lot of change in, in the coming, coming years to show formats or how it's distributed?",
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EN_B00000_S06513_W000019 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " That's so exciting. Well, I think you're such a, as I said, the ensemble stuff is such a, uh, massive part of that show. And I think that, um, every time I tune in and I hear a bit that you do, I see, I see the value that you bring.",
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EN_B00000_S06513_W000020 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000021 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000022 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " It's a lifestyle thing too, right? Like if we didn't enjoy doing it, it'd be fucked. But, and that's what like some people would say, ah, I want to do a podcast, but I hate doing it. I hate doing it. It's like, don't do it.",
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EN_B00000_S06513_W000023 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, we want to do a podcast because we want to connect with great people. We want to create great work. We want, uh, something that we can put out every single day. And so the podcast is the overarching thing, but that's, if that's the reason.",
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EN_B00000_S06513_W000024 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000025 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Yeah, what does it mean to have a podcast? Is it longer conversations? Is it because you want to explore a topic that's interesting to you? But uhm, yeah, definitely. I think you're right in the biggest barrier for people is that they don't start.",
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EN_B00000_S06513_W000026 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000027 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000028 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06513_W000029 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " What other formats, what other opportunities can people hear you talking about this stuff? Because I think people are really interested.",
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EN_B00000_S06523_W000000 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06523_W000001 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06523_W000002 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06523_W000008 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06523_W000010 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Amazing. Well, it has definitely been an eye-opening hour for me and I'm sure for Clarissa too. And I just so appreciate the work that you've done. I had the opportunity to read your first book, but not your second book yet, though I am aware of it. In fact, I told Clarissa, I was like, oh my gosh, there's a second book. I don't want to get through a second book in such a short amount of time, but it's definitely on my Libby list.",
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EN_B00000_S06523_W000011 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " So I'm gonna get to read that soon. Thanks. Thanks. So before you go, before you go, we always want to know what's next for you. And then we have a signature question. So what's next for you?",
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EN_B00000_S06533_W000000 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000002 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " But for the most part, the, uh, the diagnosis and treatment remains, uh, pretty similar to what it was before.",
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EN_B00000_S06533_W000003 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uhm, so this will come up on the USMLE, Peptic Ulcer Disease and Gastritis are the number two causes of epigastric pain. So, uh, you do want to understand these approaches, uh, and, and how we go about treating this. It will come up on the test.",
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EN_B00000_S06533_W000004 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " If you haven't had the opportunity yet, please consider subscribing to my Patreon page at www.patreon.com forward slash PWBMD. You can get there by clicking the link below in the description of the video or on the I button on the upper right hand corner of your screen and it should link you up. If you consider chipping in a dollar a month,",
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EN_B00000_S06533_W000005 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Little bit goes a very long way to help keep these videos free. And if you subscribe, you'll have access to some of my premium content in which I go over case reviews, how to formulate differential diagnosis, treatment plans, things that will come in handy for you in your clinical practice, and especially as you get ready to study for USMLE step three, which as you know,",
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EN_B00000_S06533_W000006 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000007 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000009 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000010 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000011 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.1511,
"duration": 8.535,
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"language": "en",
"speaker": "EN_B00000_S06533",
"text": " So when it comes to answering step two and step three questions where you're not given pathologic specimens, uh, it should be pretty straightforward to go at these.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000011.mp3"
} | EN_B00000_S06533_W000011.mp3 | [
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EN_B00000_S06533_W000012 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.2715,
"duration": 16.622,
"id": "EN_B00000_S06533_W000012",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " So as you know, the causes of epigastric pain, the number one cause is idiopathic. However, when you do know the cause, the number one cause, if you've ever worked in an ER, you would know that the number one cause is certainly GERD, and GERD often presents as chest pain. I would say,",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000012.mp3"
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EN_B00000_S06533_W000013 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.0895,
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"id": "EN_B00000_S06533_W000013",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " 95% of the patients who come into the ER with quote unquote chest pain actually have reflux disease. And it makes sense because when you have reflux, it's actually going up the esophagus, the pain, and the esophagus goes right through your chest.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000013.mp3"
} | EN_B00000_S06533_W000013.mp3 | [
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EN_B00000_S06533_W000014 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"speaker": "EN_B00000_S06533",
"text": " Uh, so whether or not that presents as epigastric pain, uh, you know, we don't really know, but, uh, we can safely say that the number one cause of epigastric pain is GERD just because it's so common.",
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EN_B00000_S06533_W000015 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Beyond that, peptic ulcer disease and gastritis are the number two causes. Pancreatitis, a little bit further down, certainly causes pain, but the pain scale is going to be way higher when it's, uh, pancreatitis, especially in its acute form.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000015.mp3"
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EN_B00000_S06533_W000016 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"duration": 6.793,
"id": "EN_B00000_S06533_W000016",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Look for a history of alcoholism in patients with pancreatitis. Typically the pain is so bad it goes right through to the back.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000016.mp3"
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EN_B00000_S06533_W000017 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000017",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uh, so these patients are in really severe pain. Like I said, look for a history of alcoholism. Not always present, but it is in many cases. Others include esophagitis, cholecystitis, cholelithiasis, cholangitis, diverticulitis. Uh, those are not epigastric pain, but they can be referred.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000017.mp3"
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EN_B00000_S06533_W000018 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, to maybe refer isn't the best word, but they can, uh, they, they can manifest in the epigastric area, but they'll typically, uh, if you ask these patients, they're, they will have pain elsewhere. So with esophagitis, that pain will often go from.",
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EN_B00000_S06533_W000019 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000019",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uhm, look for alarm signs like weight loss and anemia, fatigue and things like that.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000019.mp3"
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EN_B00000_S06533_W000020 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"language": "en",
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"text": " Uh, so that can be gastric, esophageal, pancreatic, these can all cause epigastric pain, and then referred or misappropriated pain, kind of going along the same lines as these others that I put up here. Pelvic pain can get referred up to the epigastric area, so if you're dealing with a woman of childbearing age, you always have to consider the possibility of a pregnancy.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000020.mp3"
} | EN_B00000_S06533_W000020.mp3 | [
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EN_B00000_S06533_W000021 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000021",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uhm, and so a pregnancy test is always good to get in any, uh, woman of childbearing age who, uh,",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000021.mp3"
} | EN_B00000_S06533_W000021.mp3 | [
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EN_B00000_S06533_W000022 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.3184,
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"id": "EN_B00000_S06533_W000022",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Who has abdominal pain. It's a very cheap test, very easy to get.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000022.mp3"
} | EN_B00000_S06533_W000022.mp3 | [
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EN_B00000_S06533_W000023 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.1792,
"duration": 4.252,
"id": "EN_B00000_S06533_W000023",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uhm, and you can rule out one of the more, uh, problematic",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000023.mp3"
} | EN_B00000_S06533_W000023.mp3 | [
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EN_B00000_S06533_W000024 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000024",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " That should just be a reflex for you. So you need to remember to order a pregnancy test when you're dealing with a woman of childbearing age who has abdominal pain, even though it may look like an ulcer or may look like pancreatitis or may look like GERD. If you're dealing with a woman of childbearing age and she has abdominal pain, please, please, please get a pregnancy test.",
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EN_B00000_S06533_W000025 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"speaker": "EN_B00000_S06533",
"text": " It is a focal ulceration of the stomach or duodenal tissue.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000025.mp3"
} | EN_B00000_S06533_W000025.mp3 | [
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EN_B00000_S06533_W000026 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"language": "en",
"speaker": "EN_B00000_S06533",
"text": " The profile of this pain is that it tends to occur after eating. A lot of times patients will refer to this as a gnawing pain that comes and goes in waves. Now, you may read in review books that with gastric ulcers it tends to occur during eating or maybe very briefly after eating.",
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EN_B00000_S06533_W000027 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000027",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Whereas with duodenal ulcers, it tends to be relieved by eating and then comes on a few hours after eating, post-prandial. That's not always reliable.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000027.mp3"
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EN_B00000_S06533_W000028 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"speaker": "EN_B00000_S06533",
"text": " So you really can't differentiate between gastric and duodenal ulcer by symptoms alone. And it really doesn't matter because the causes are the same. So we're always thinking NSAIDs or H. pylori.",
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EN_B00000_S06533_W000029 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000029",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " You know, step one, I think when I took step one, I did get a question on, uh, gastric or duodenal ulcers, although I took step one, like,",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000029.mp3"
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3379,
3062,
355,
3965,
3566,
1857,
3379,
3508,
2528,
3946,
1140,
1966,
3138... |
EN_B00000_S06533_W000030 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.3682,
"duration": 11.676,
"id": "EN_B00000_S06533_W000030",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " In, for all intents and purposes, when you're practicing clinically, it doesn't matter and it's really not reliable to go on the nature of the symptoms as far as eating, does it go away or does it not.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000030.mp3"
} | EN_B00000_S06533_W000030.mp3 | [
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EN_B00000_S06533_W000031 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.3194,
"duration": 11.74,
"id": "EN_B00000_S06533_W000031",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uhm, so that's just a rule of thumb, but really you can't rely on that. The only way that you can know definitively if it's gastric versus duodenal is to do a scope. And that's not something we're gonna do on all patients.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000031.mp3"
} | EN_B00000_S06533_W000031.mp3 | [
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EN_B00000_S06533_W000032 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.0703,
"duration": 14.428,
"id": "EN_B00000_S06533_W000032",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " But as you're gonna see, it'll come a little bit more clear that it really doesn't matter so much because the way we are going to approach this is going to be the same regardless of whether we think it's gastric or we think it's duodenal.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000032.mp3"
} | EN_B00000_S06533_W000032.mp3 | [
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EN_B00000_S06533_W000033 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.1396,
"duration": 18.67,
"id": "EN_B00000_S06533_W000033",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Remember that ulcers can occur as part of a larger disease process, so certainly in Crohn's, remember that can affect anywhere from the mouth, you can get aftis ulcers in the mouth, all the way down to the rectum. Uh, so, Crohn's, you get ulcerations really anywhere. Uhm, whereas, uh,",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000033.mp3"
} | EN_B00000_S06533_W000033.mp3 | [
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EN_B00000_S06533_W000034 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.3075,
"duration": 19.933,
"id": "EN_B00000_S06533_W000034",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uhm, with Zollinger-Ellison syndrome, again, you can also get ulcers, but this, remember, Zollinger-Ellison syndrome is due to a gastrin-secreting tumor. Uh, so with Crohn's, look for people with lower GI symptoms, like diarrhea, uhm, and, uh, lower abdominal pain. Uh, they may have some alarm symptoms, like weight loss.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000034.mp3"
} | EN_B00000_S06533_W000034.mp3 | [
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EN_B00000_S06533_W000035 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.2166,
"duration": 14.635,
"id": "EN_B00000_S06533_W000035",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Zollinger-Ellison syndrome, it can be really tricky. It's very rare, thankfully. Uh, but look for a history of MEN1, uh, multiple endocrine neoplasia type 1. It tends to, uh, be present as part of that complex.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000035.mp3"
} | EN_B00000_S06533_W000035.mp3 | [
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EN_B00000_S06533_W000036 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.4002,
"duration": 4.348,
"id": "EN_B00000_S06533_W000036",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " So do keep in mind that ulcers can be a symptom of a larger disease process.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000036.mp3"
} | EN_B00000_S06533_W000036.mp3 | [
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EN_B00000_S06533_W000037 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.2931,
"duration": 15.375,
"id": "EN_B00000_S06533_W000037",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " The causes of peptic ulcer disease far and away, the most common causes are NSAID use, ongoing long-term NSAID use. So think a patient that is older, uh, maybe has osteoarthritis and is taking an NSAID long-term.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000037.mp3"
} | EN_B00000_S06533_W000037.mp3 | [
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EN_B00000_S06533_W000038 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.2786,
"duration": 9.966,
"id": "EN_B00000_S06533_W000038",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " And then Helicobacter pylori. Think of younger people who really don't have any other risk factors for peptic ulcer disease. Typically H. pylori is behind those.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000038.mp3"
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EN_B00000_S06533_W000039 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
"dnsmos": 3.3341,
"duration": 17.372,
"id": "EN_B00000_S06533_W000039",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uh, so these make up the majority of cases, and like I said, there are other syndromes that can manifest with ulcers. Head Trauma, remember that's your Cushing's Ulcer. Burns, remember that's your Curling Ulcer. Mechanical Ventilation, and then as mentioned, Crohn's Disease and Zollinger-Ellison Syndrome.",
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EN_B00000_S06533_W000040 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000041 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " The, uh, your approach is going to be a little bit more emergent and you're probably going to move on to endoscopy because you really want to find out what the cause is. Really, when we're talking about alarm symptoms, what we're worried about is cancer.",
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EN_B00000_S06533_W000042 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " And, uh, gastric cancer, esophageal cancer can mimic ulcer or disease as far as the pain, uh, goes. You know, you can get pain from those things. And so whenever you have a patient who has alarm symptoms, you want to, uh,",
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EN_B00000_S06533_W000043 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " You, you, you wanna take this into consideration. So if you have a patient with weight loss, anemia, heme-positive stools, or hematomasis. So I say heme-positive stools, really what I'm talking about is melanitis.",
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EN_B00000_S06533_W000044 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, heme positive would be like a lab result. Uh, so if they have dark, uh, dark stools, uh, if they have hematomasis, uh, we're thinking of a bleed. So anything consistent with a GI bleed.",
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EN_B00000_S06533_W000045 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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EN_B00000_S06533_W000046 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Not always, but, uh, but just bear in mind these symptoms and use your clinical judgement.",
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EN_B00000_S06533_W000047 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Almost always be part of your workup when you suspect an ulcer.",
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EN_B00000_S06533_W000048 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " So there are several commonly used ways to test. Serology is going to be the most sensitive. Now if a patient gets, uh, has an infection with H. pylori, they will always test positive on serology. Because you have an infection, you mount an immune response, so you'll, you'll, you'll have a positive serology.",
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EN_B00000_S06533_W000049 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, and it will always be positive even after you treat these patients. So this is the most sensitive test, uh, to diagnose H. pylori.",
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EN_B00000_S06533_W000050 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, but the most time-tested way is to actually look at it under a microscope. Obviously, this is going to require endoscopy, so it's not necessarily going to be the first thing that you go to. Certainly, if you have reason to want to scope these patients, if they have alarm signs, then yeah, sure, get a gastric biopsy while you're down there.",
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EN_B00000_S06533_W000051 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"duration": 14.295,
"id": "EN_B00000_S06533_W000051",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Uh, stool antigen checks for present infection. So this is really good to use if the patient doesn't respond to therapy. It's also very commonly used to see if the patient is actually responding to therapy. A stool antigen will go away.",
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EN_B00000_S06533_W000052 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " If the patient responds to therapy. So unlike the serology, a stool antigen, if you've actually resolved the H. pylori infection that will then test negative.",
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EN_B00000_S06533_W000053 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " Uh, so, serology will always be positive if the patient's ever had an infection with H. pylori, stool antigen will be positive if they have an active infection, but then within a few days of eradicating the H. pylori, it will then be negative.",
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EN_B00000_S06533_W000054 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " So it's a good test to check for response to therapy. And then there's the urea breath test. Uh, the problem with the urea breath test is that the patient has to discontinue their proton pump inhibitor for a couple weeks prior to doing the test. Sometimes these patients have been on proton pump inhibitors either over the counter or prescribed.",
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EN_B00000_S06533_W000055 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"language": "en",
"speaker": "EN_B00000_S06533",
"text": " And so, you know, the patient is going to have these symptoms. They're going to have pain. It's difficult to tell them to go off your, your PPI, uh, for some time, uh, prior to getting this test. So for that reason, stool antigen tends to be preferred. It's just easier.",
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EN_B00000_S06533_W000056 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"text": " The best first step in management of a patient with suspected peptic ulcer disease is therefore H. pylori serology. It is the most sensitive test. As long as they don't have any alarm symptoms that makes you think, well, maybe they have cancer or maybe they have an active bleed, then go ahead and get H. pylori serology as your initial step.",
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EN_B00000_S06533_W000057 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"speaker": "EN_B00000_S06533",
"text": " The most accurate test for H. pylori infection is gastric biopsy. That is your gold standard.",
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EN_B00000_S06533_W000058 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"speaker": "EN_B00000_S06533",
"text": " So going back to peptic ulcer disease, what are the symptoms? So it can be post-prandial epigastric pain, it can be pain with eating, it can wake the patient up in the middle of the night, uh, maybe this is quote unquote heartburn, they might describe it as heartburn that doesn't respond to antacids, or maybe they have alarm symptoms.",
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EN_B00000_S06533_W000059 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"duration": 16.124,
"id": "EN_B00000_S06533_W000059",
"language": "en",
"speaker": "EN_B00000_S06533",
"text": " Some of these or all of these can present and be the presentation of peptic ulcer disease. The history, you may have frequent NSAID use, very common in older people who have arthritis, they take NSAIDs and then they develop an ulcer.",
"wav": "EN_B00000/EN_B00000_S06533/mp3/EN_B00000_S06533_W000059.mp3"
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EN_B00000_S06533_W000060 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"id": "EN_B00000_S06533_W000060",
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"speaker": "EN_B00000_S06533",
"text": " Uhm, but they don't necessarily, you know, you can have a younger person who's never touched an insect in their life and then they develop an ulcer. So you don't have to have that. Roughly equal distribution between men and women.",
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EN_B00000_S06533_W000061 | hf://datasets/amphion/Emilia-Dataset@bcaad00d13e7c101485990a46e88f5884ffed3fc/EN/EN-B000003.tar | {
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"speaker": "EN_B00000_S06533",
"text": " Uh, diagnosis. So as we said, patients without alarm symptoms, the first thing that you should do is get an H. pylori serology. You're going to do a number of other things for these patients just to make sure that there's nothing else going on. So you're going to get a CBC checking for anemia. You're going to get a CMP.",
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