Ep 205 – Metabolic dysfunction-associated steatotic liver disease and hepatitis

Continuous glucose monitoring (CGM) has moved from being a specialist technology used mainly in type 1 diabetes to becoming one of the most important developments in modern glucose management. What began as a way of collecting more frequent glucose measurements has evolved into a platform capable of displaying trends, predicting future glucose changes and, when integrated with insulin pumps, automatically influencing treatment. More recently, CGM has expanded into type 2 diabetes, consumer health, early diagnostic research and telemedicine, while artificial intelligence is opening the possibility of increasingly individualised prediction and decision support. At the same time, researchers are working on longer-lasting and potentially non-invasive sensors. In this episode, Dr Roger Henderson revisits how CGM developed, looks at where the technology is heading, what these advances could mean for clinical practice, and the challenges GPs need to consider as glucose monitoring becomes increasingly predictive and automated.

In this episode, Dr Roger Henderson discusses infectious mononucleosis, a common viral illness that can present a surprisingly complex diagnostic and clinical challenge. Most often associated with Epstein–Barr virus (EBV), infectious mononucleosis is particularly familiar in adolescents and young adults, where fever, pharyngitis, lymphadenopathy and fatigue can create a classic clinical picture. But recognising the syndrome is only the beginning. Similar presentations can occur with other infections, including acute HIV and cytomegalovirus, while complications such as airway obstruction and splenic rupture, although uncommon, require careful attention. Here, he explores how EBV infection presents, how to approach diagnosis and differential diagnosis, what evidence-based supportive management involves, and the key advice GPs should give patients about activity, recovery and potential complications.

In this episode, Dr Roger Henderson explores a fascinating and sometimes unsettling area of clinical practice: parasomnias. Sleep is something everyone experiences, but for some patients it is far from quiet or predictable: they may walk, shout, experience vivid nightmares or even physically act out their dreams, leaving both them and their partners confused, frightened or concerned about what these behaviours might mean. For GPs, recognising the pattern is crucial. Is the episode occurring early or late in the night? Is the patient confused or fully alert afterwards? Do they remember what happened, and could medication, another sleep disorder or an underlying neurological condition be contributing? Here, we cover the key clinical features of non-rapid eye movement (NREM) parasomnias, nightmare disorder and rapid eye movement (REM) sleep behaviour disorder, and discuss practical approaches to their assessment, differential diagnosis and management.

In this episode, Dr Roger Henderson discusses gallstone disease, one of the most common disorders affecting the biliary system and a frequent cause of abdominal pain, emergency presentations and gastrointestinal complications. He examines how gallstones develop, focusing on the metabolic, hormonal, genetic and environmental factors that contribute to their formation. The discussion then follows the clinical progression from asymptomatic cholelithiasis and biliary colic to acute cholecystitis, choledocholithiasis, ascending cholangitis and gallstone pancreatitis. Dr Henderson reviews the role of ultrasound, laboratory investigations, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in diagnosis, before considering current approaches to management, including laparoscopic cholecystectomy and endoscopic intervention. Finally, he highlights important complications and clinical red flags, providing a concise framework for recognising and managing gallstone disease in everyday medical practice.

In this episode, Dr Roger Henderson explores carotid artery stenosis and its role in the prevention of ischaemic stroke. Carotid disease is common, but managing it effectively is far from straightforward. The key clinical questions are not simply how narrow the artery is, but whether the stenosis is responsible for the patient's neurological symptoms, what mechanism is causing cerebral ischaemia, and whether revascularisation offers greater benefit than modern medical therapy. The episode explores the differences between symptomatic and asymptomatic carotid stenosis, the evidence supporting carotid endarterectomy, the importance of timing after transient ischaemic attack or stroke, and the evolving role of carotid stenting. It also considers plaque vulnerability, contemporary medical therapy and how these factors influence decisions about intervention in everyday clinical practice.