<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=us-ascii">
<meta name="Generator" content="Microsoft Word 15 (filtered medium)">
<!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:"Tms Rmn";
panose-1:2 2 6 3 4 5 5 2 3 4;}
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Aptos;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
font-size:12.0pt;
font-family:"Aptos",sans-serif;
mso-ligatures:standardcontextual;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#467886;
text-decoration:underline;}
span.EmailStyle19
{mso-style-type:personal-reply;
font-family:"Aptos",sans-serif;
color:windowtext;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;
mso-ligatures:none;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style>
</head>
<body lang="EN-US" link="#467886" vlink="#96607D" style="word-wrap:break-word">
<div class="WordSection1">
<p class="MsoNormal"><span style="font-size:11.0pt">See below from Dr. Fisher…<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<div>
<div>
<div>
<div>
<div>
<div>
<p class="MsoNormal" style="background:white"><b><span style="font-family:"Arial",sans-serif;color:#ED7D31;mso-ligatures:none">Laura R. Gerstner, DHSc, MHA, PA-C </span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#201F1E;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:#595959;mso-ligatures:none">Chair & Program Director<o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:#595959;mso-ligatures:none">Campbell University Physician Assistant Program</span><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#201F1E;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:#595959;mso-ligatures:none">Mailing Address: P.O. Box 1090, Buies Creek, NC 27506</span><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#201F1E;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:#595959;mso-ligatures:none">Physical Address: 4150 U.S. 421 S., Lillington, NC 27546</span><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#201F1E;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="font-size:10.0pt;font-family:Wingdings;color:#595959;mso-ligatures:none">(</span><span style="font-size:10.0pt;font-family:"Tms Rmn",serif;color:#595959;mso-ligatures:none">: </span><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:#595959;mso-ligatures:none">910.893-1252
|</span><span style="font-size:10.0pt;font-family:Wingdings;color:#595959;mso-ligatures:none">*</span><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#595959;mso-ligatures:none">:</span><b><span style="font-size:10.0pt;font-family:"Calibri",sans-serif;color:navy;mso-ligatures:none"> </span></b><u><span style="font-size:10.0pt;font-family:"Calibri",sans-serif;color:#595959;mso-ligatures:none"><a href="mailto:gerstnerl@campbell.edu"><span style="color:blue">gerstnerl@campbell.edu</span></a></span></u><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#201F1E;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#201F1E;mso-ligatures:none">she/her/hers<o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:black"><o:p> </o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:black"><a href="https://apps.exxat.com/public/steps/Campbell-PA/Home"><span style="color:blue;border:none windowtext 1.0pt;padding:0in">https://apps.exxat.com/public/steps/Campbell-PA/Home</span></a><o:p></o:p></span></p>
</div>
</div>
</div>
</div>
</div>
</div>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<div>
<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;mso-ligatures:none">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;mso-ligatures:none"> Fisher, Susan <Susan.Fisher@pfeiffer.edu>
<br>
<b>Sent:</b> Thursday, January 22, 2026 12:45 PM<br>
<b>To:</b> Gerstner, Laura R. <reedl@campbell.edu><br>
<b>Subject:</b> EXTERNAL EMAIL: Follow up from class yesterday<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<div style="border:solid #9C6500 1.0pt;padding:2.0pt 2.0pt 2.0pt 2.0pt" id="footer">
<p class="MsoNormal" style="background:#FFEB9C"><span style="color:black;mso-ligatures:none">CAUTION: This email originated from outside of Campbell University. Do not click links or open attachments unless you recognize the sender and know the content is safe.</span><span style="mso-ligatures:none"><o:p></o:p></span></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Greetings,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Below is some follow up from class yesterday. Here is the link to a short Medscape article on the use of antibiotics for appendicitis. It looks like we initially started using antibiotics over surgery for
some patients about 10 years ago. This article looks at the incidence of a second bout of appendicitis and notes that antibiotic treatment of appendicitis is acceptable.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><a href="https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/119514">Antibiotics for Uncomplicated Acute Appendicitis Still Acceptable at 10 Years | MedPage Today</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">I also looked at GLP1 medications and the risk of gallbladder disease. GLP1 receptor agonist use does increase the risk of cholelithiasis and cholecystitis by a number of mechanisms. Gallbladder disease arises
at a median of ~180 days of use, but has occurred as early as 7 days of use.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Some of the mechanisms are:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Alteration of bile composition by increasing the cholesterol secretion into bile; this can increase the saturation of bile with cholesterol which can promote the formation of cholesterol stones<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Rapid weight loss which can occur with GLP1 RA use also increases the risk of gallbladder disease. The rapid weight loss can again result in supersaturation of cholesterol in bile, other metabolic disturbances
and other alterations in bile composition.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Further, rapid weight loss decreases the secretion of cholecystokinin. This decreases gallbladder motility and delays gallbladder emptying which can lead to the formation of cholesterol crystals and cholelithiasis.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">GLP1 also inhibits the release of cholecystokinin leading to the altered motility and delayed emptying.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC12279493/">https://pmc.ncbi.nlm.nih.gov/articles/PMC12279493/</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790392">https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790392</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Sincerely,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Greer Fisher<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><b><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">S. Greer Fisher, DSc, PA-C</span></b><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none"> <i><o:p></o:p></i></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none"><o:p> </o:p></span></i></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">Master of Science in Physician Assistant Studies<o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">Center for Health Sciences</span><span style="font-family:"Calibri",sans-serif;color:black;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">P.O. Box 960 | 48380 US Hwy 52</span><span style="color:black;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">Misenheimer, NC 28109</span><span style="color:black;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">Office 704-463-3723 | Fax 704-463-1363</span><span style="font-family:"Times New Roman",serif;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none"><a href="https://www.pfeiffer.edu/program/master-of-science-in-physician-assistant-studies/"><span style="color:blue">https://www.pfeiffer.edu/program/master-of-science-in-physician-assistant-studies/</span></a><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white"><span style="color:black"><a href="http://www.pfeiffer.edu/" target="_blank"><i><span style="font-size:8.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none;text-decoration:none"><img border="0" width="162" height="115" style="width:1.6875in;height:1.1979in" id="Picture_x0020_1" src="cid:image001.png@01DC8B9C.FF032EF0" alt="Text
Description automatically generated with low confidence"></span></i></a></span><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:black;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal" style="background:white;vertical-align:baseline"><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:black;border:none windowtext 1.0pt;padding:0in;mso-ligatures:none">This email, including attachments, is intended for
the person(s) or company named and may contain legally privileged information. Unauthorized disclosure, copying or use of this information is prohibited. If you are not an intended recipient, you may not review, copy or distribute this message. If you received
this communication in error, please notify the sender immediately by email and delete the original message.</span></i><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;mso-ligatures:none"><o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
</div>
</body>
</html>