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Ok. Right. Hi. Um I'm here. Yeah, so um hi. Um, welcome back to SK 101 again. Um We're gonna go through abdominal um examination today and if you are watching online, Joselyn should be there, um monitoring the chart, um, Yasmin as well. Um They'll be able to go through it, go through stuff with it. Um, the session should be relatively short if you're online. Um And then in person it should be relatively short as well, but a bit more extended. Um But thank you again for coming today. Um And if you're in Cardiff, I think Cat Mo Molly and Rosie should be there as well. So they'll go through um the actual examination at the end and I'm in not Anchor real and I'll be there. Um cool and um it's gonna be an interactive session. So, um I think, um, don't be that today. Right. So, um, just plan plan for today. Uh as far as the scale 101, we're not, we're not planning and teaching you guys that that's why you need us. So we're just hoping that we can pick things up and polish you guys for your final, final scale. Um, I hope you guys have, um, watched the link that I sent. Um, yeah, if you haven't, that's fine, we'll go through it. But, um, it would ha it would be a lot better if you did and then once the online sessions done we'll go through the actual practical side of the examination. Um, oh, right before we start, what's the first time everything you need to do? And I'm, I keep emphasizing this if you've ever been to my sessions before again, we've got a few answers from uh from north. Any anything online. Nothing yet. We've got wash hands, we've got wash our hands. Yeah. Ok. So wash hands good. Um and you um people who are here with me have said that what else? There's one more thing I will actually make sure that you guys don't forget today. Right? Mm. Ok. I got some response here. Anyone from Cardiff or in? I don't know if you guys had this already introduce yourself. Yeah. So one thing please don't forget because it's so easy to figure out when you're in a stressful situation which is why I keep emphasizing every single session. Um So with introducing with your full name. Not. Hi, my, I'm Bob. Ok. What's that? None of that? Hi. My name is Miss, I'm 1/4 year medical student, full name designation. And then can I confirm your name and date of birth? You can go for age but you need to actually ask for date of birth. You can ask for age if you for a struggle to actually calculate the age, it would help you. The date of birth don't accept. Yeah, any questions. Ok. We've gone through this before as well. So now the actual abdominal examination just gonna quickly go through it because Christmas, sorry. Um we are not uh seeing the slides. Oh yeah, sorry, Joselyn. So just there we go, we can see the heart failure. That's a nice. Yeah. So um yeah, so a as with any other session. So I would go again, look, feel palpate. Os uh yeah, os palpate auscultate remove in. No. So the same thing look general inspection and what are you looking for? And eight the best side of your calendar? We've got someone saying eight, any answers from Tusla. Not yet. Are you guys? We've got Bowser Stoma if they look yellow? Ok, good spot on. You are thinking where I'm heading with those legs. But um yeah, so any anything like anything even small mention it to your examiner? So um it could even be that they have like a tablet fallen off the bed like one tablet. Well unlikely, but if you do see it actually say it could because that could actually mean the patient is non compliant. It could mean the patient is on medication. So it could actually mean a lot. So whatever you see, just mention it, if you don't see anything at all. Then um on, on general inspection, patient looks alert, comfortable um in that. Yeah or ch right. And then same thing go all the way from hand, all the way up neck face. Um and then come down to the actual part and then end through the leg. Um One little thing that people always ask is where do you do the lymph node examination? You can either do it as you go. So when you're, when you're at the neck face or you can do it right at the end, only because when you do the um lymph node, you need to always stand at the back when you do that, make sure you actually tell the patient that you're at the back doing it. Don't just randomly go back and put your fingers in cause that's actually very scary. And I have done that in a where I think it was a year exam and I think I put the tuning fork right into the vision of like who are you trying to hit me or something? So why don't you do, please make sure you safety that you actually tell them what you're doing. Um Right before I instead of actually going through this uh in detail, how do we have a little spot quiz? So um the, yeah, so those are the kind of things that we're, we're oh sorry next night. So jaundice is something you can commonly see in gastro patients. Next, you can see what is astro if you see a syringe or multiple syringes or I don't know IV drug user. So any signs of that and why is that relevant cause liver uh liver failure? Um one that causes IV drink. Right. And next slide would be sorry. Mm Yeah. Vomit. No. So um again, patient, vomiting nausea, very classic abdominal sign gene sign actually because it could show bowel obstruction, possibly, right? So a as you said, anything you see, just mention it, the other common one would be um IV fluids, patient could be having a cataract, just mention it. Um Right. Next. So um do complete the examination and you need to always say at the end of your examination when you present. Um So the main common things to think about are think about like phism. So mouth um and D belo. So we're thinking um swabs, we're thinking um hernial orphise, we're thinking genitalia. So anything like P RPV. Um yeah, any of those examinations and then the basic ones like urine dip are stool culture then depends on the context for everything else, right? And the other thing you need to know um the nine quadrant so important. Um OK, how will we quickly do? OK, just list out any differentials you can think. And I've got a uh teaching there with the organs. So, so let's start with right, upper quadrant, what do you call cystitis? We're gonna cholecystitis here. Yeah. Good. Ascending cholangitis. Yeah. And someone said the same thing on the chart as well. Um Ascending cholangitis. Yeah. Hepatitis. Yeah. So, anything to do with the liver and then you go into the epigastric pancreatitis. Yeah. Pancreatitis. Good, good. Yes. Ulcer, good. And there's one thing if this calcium comes up in pt your single best answer option would be pancreatitis or mhm. Pain radiating to the back could be pancreatitis or pain, pain AAA that's the other thing. So um yeah, five. Um and yeah, then you got the left hypochondriac. So it's, yeah, spleen. So splenic rupture and yeah. Um DK A normally presents with diffuse abdomen so it can be anywhere. Um And then yeah, right. So anything right, upper quadrant area. So that would be the hypochondriac or the um lumbar region. So gallbladder, the other thing with the lumbar region, very common kidney stones. Um The pain would be radiating down to the groin so long to groin pain. Um and look for any weight loss or anything. So kidney uh cancer, stuff like that. Um And then unlit again, could be pancreatitis ish or um duodenum. So again, anything general and then left lumbar would be the same as right lumbar and right iliac. What do you always need to check in the right iliac for the pain if it's a particular demographic because it hurt. Yeah. So I if you don't say I will to complete the examination, I would do a pregnancy test. That would be an automatic fail because you need to do that on a young female patient. But what's the other differential? So, appendicitis or in a young female patient? Ectopic pregnancy? Yeah. Um So yeah, stick to the basics. Um Progress test would be the more complicated. Weird, wonderful one. I'll keep, keep it simple. Um Sorry. Uh just finishing off with the last slide. So um hypergastric um bladder stuff. So any urological problems could go there or any obs and timing issues could go there. Um And then left iliac tends to be diuretic lysis. That's the common one. And OK. Right. Moving on. Uh Right. So I will give 10 seconds, 15 seconds and then if you, if you want, you guys can shout out the answer or you can write on the chart um or if you're really shy, just grab a piece of paper and then write down the answers. OK. Yeah. Right. So let's start off 10 seconds. So, and you can answer now and Jo Flynn, if there's anything on the chart, just shout out. We've got Leukonychia, we've got Leukonychia on the chart. So, um good le le here. What does that show? Take some white cells underneath the nail bed? Mhm. Loss of the. So that might indicate chronic liver disease. Yeah. So um it's a sign of liver disease. Basically a good thing with a exam. Most of the stuff with the liver disease. If you don't know that, um, cause that comes up with a lot of presentation, but that being said there are some which we will go through if it is not liver disease. So anything else, if you're not sure if you're absolutely not sure you can give it a go. Uh, no guarantee. It would be that. Yeah. Ok. Next, um, that where does it came on? You know anyone on the chart? We've not had anything so far. Ok. Um So it's um, so it's colony. What does that show? Why? Why is it that two? Sorry, what did you say? Ok. Good, good guess. Thank you. Is it no nutrition? Anyone from online I've got hemochromatosis. Sotos. Yeah. Right. It actually, I definitely didn't see anemia right. Next one. 10 seconds. Sure. Ok. That's good. Clubbing. Ok. We've got clubbing here. Any other answers? Mm. Not yet. Ok. And that's why I'm guessing people are writing with pen and paper, traditional methods. Um Yeah. So plumbing. Yeah. And how do you test for it? You ask the patient to? I would say uh can you copy what I do rather than taking all the time to actually explain what to do with our fingers? Just say, could you copy what I'm doing easy and then um what's the window called? Yeah, it's gone window trauma. Um and the, it's, if you have a, if you, if you see a white diamond, um that's indicative of there are multiple reasons for clubbing actually. So in one of them liver disease. Yeah. Um What Respi OK. Tumor falls, co PD clubbing or no clubbing? Uh Well, isn't it specifically wrong? S I see if we did. Um So CO PD is one condition where you don't have club. I'm just saying it cause I remember doing this when I was a med student so that can come up in your exam. So just let me know. Um Right. What's that? Um Excellent. Yeah. So gynecomastia. Um Yeah, basically big breast in men. Um What is that? Sure. Yeah, it's like, but it can also because you've got low circulating testosterone or because you're converting all your testosterone to estrogen. Yeah. So it's actually due to hormonal balance, imbalance, liver disease. What's that next? Like? Thanks. OK. Let's give it a try and see if it was on the um on online any answers. Not yet. We've got Linea Nigra and stretch marks. Yeah. Yeah. Good. Both words count um classic terminal um not terminology. No stress marks. You can see that in pregnancy or you can see that in the game of like liver disease kinda. Yeah. Yeah. OK. Move on on. No. Um So, so uh just just to um that's fine. You don't need to play it. It's a video. Hello. Hi, sorry. Um Sorry to cut across. Um I just wanted to clarify the um the picture that you just had up. I from my understanding um Lya Negros when someone, when they get, when someone's pregnant and they get a black line from the belly button centrally down to the pubic bone, I don't think, and please correct me if I'm wrong. Uh, just to clarify, I don't think the picture you've got up there is Linea nigra. But I'm very, yeah, that could be that this is actually stretch mark. Yeah. So there's actually stress and so from the top n I don't know the exact physiology but I think it's something to do with um you make more of a certain hormone. Um And then um melanin increases it in that, that single black stripe which you only see in pregnant women. So stretch marks are different to that. I just wanted to clarify but like I said, if I'm wrong, I'm very willing to be told that I'm wrong. Thank you. K um fine. OK. Um Yeah, the next video um is actually someone doing that um which I'll just say it flapping tremor or asterisk is um the main thing to make sure that you say in an exam is actually to keep their hands straight, not like that, not like a flapping bird, keep hands straight. And what I normally say is actually ask them to hold it straight, but before coughing the risk back, um cause like this can actually show you if they have tremors normally cause you don't want them to just be there and start tremoring Yeah, and fluffing tremor again, chronic liver disease. Um Right. Next one caput medusa. Yeah, well done. Um Yeah, it's basically a sign of portal hypertension. Um So it just means hypertension within the portal veins to the liver. Um Yeah, and it was meant to be the like the hair of the Greek God. I mean to say um yeah, next plastic gastroc signs, ascites, ascites in the belly. So um one common examiner tip and um my examiner, the student tip would be um so I, so you need to do the tapping precaution, start from the middle of the belly button. No, not belly button but about it and then go away from you and then, and then ask the patient to roll away from you. So the yeah, so that's hold on. No, no, go all the way to the other side. So tap tap, tap away from you and then ask the patient to roll towards you. So just think of it as safety for a patient as well. So patient can see it, patient can see the beautiful place. Um And then the idea is that you're actually meant to wait for a couple of minutes, seconds for an escape. Um And then tap and if they have fluid, which is what ascites means, it would actually come down due to gravity. So then you'll actually hear a bit of a difference. That's it. If you're in person, we'll practice it. But if you're not then prac make sure you practice with your flatmate or a friend or your group. What makes quite a few? Mhm. She, so just anyone, um, not yet maybe focus on the metacarpal ar areas guys, then you might be able to spot something. Ok. So I send re and yeah, it's res um contracture again, plastic sign in an alcoholic patient. Yeah. Um yeah, we'll go through it later on this one if you were here in the session last week. Um last time. Um we did go through this as well since the asthma. Um basically deposit of cholesterol. What does that mean? High cholesterol ie high hyperlipidemia. It's a genetic condition. Uh What's this next slide you have? This is where it comes good. We'll got answers from here. Anyone online? Mhm. Ok. Yeah. OK. So it's a entalis N you nor. So normally you're actually to look under the armpit, but the idea, so I haven't put the armpit because I had a feeling you guys would know about the armpit. So, um and put the neck and the whole idea is that it comes in your flexure area. So anywhere that's uh flex ie on the or neck or groins, we don't need to do groins in your escape, but just anywhere that is flexed basically. And those you normally see in like diabetes patients. Yeah, that's what you need to know. Uh last one, maybe the last one. So common simple is actually IV drug drug user, it's called a track mark. That's what you need to look for when you are in the arm. So a lot of people, including me used to do hand and then go straight up to the neck. There is something in between the arm and that's why you need to look for track marks. Um, uh, any, like actual, uh, so track marks, stretch mark, not stretch marks, but any kind of marks. You could also have patients who have been on lines look for canal, stuff like that. Yeah. Um And oh, what's this ending with the, this one? I can go this point if you get this not the most accurate picture to be fair, but we've got the fistula on the chart. Yeah. Yeah. Well done Jack and Ahmed. Um Yeah, a fistula. So that's something to keep an eye out for as well. So anyone with a scar on the wrist. Um And what does that mean if patient has to that? So patient has gone through dialysis? So we're thinking KD. Cool. Uh last one. Sorry. Im just a Levi get Spider Nevi if I see. So how many can you see in this picture? Three? And is that an issue if it's only three? And then everything is fine? You drink Spider New one? When would you need to be like, oh my gosh. Yeah. I mean having Spider. Yes, it is a sign of getting liver disease. But when do you know exactly CYA that spread? What do you mean by widespread? Mhm. More than five. Yeah. Yeah. Well done Jack again. Um, it's more than five, so, five is the cut off. So, if you have less than five it's ok. But more than five. Is that like severe, actual, um, something you need to be aware of? Um, so something, I, if this comes up in an exam it would be nice to actually count device on that. Right? That one, I promise. Second last one. But yeah, called candidiasis. Hum. Is it like an thanks. No go or is it the one that you get with HIV? Ok. We've got differentials here now. So we've got, so someone here has mentioned can candidiasis which is a good differential. So I take why is it relevant? The gastro so OK, I did challenge you guys. II would think this. Yeah, so um I was trying to actually show glossitis more like an inflammation of the tongue. So it's gonna be a bit more reddish but then you can also have a white pale patch. Um candidiasis and like in uh planus is the other two differentials you can have um but those you, so you differentiate them by scratching it but that that's not a gastro thing. You don't need to know that right now. Um But yeah, glossitis, indefinite, I think glossitis you can get it in um plumber Vinson syndrome as well if you um it's one of the gastro, I think you get like iron deficiency anemia and then, um, the glossitis and something else. I forgot what it is. But, yeah, Joselyn, sorry, can you repeat that? Cos we, I think, I think, um, one of the gastro uh syndrome is called Plumber Vinson syndrome. And then it's include like iron deficiency anemia, glossitis and something else. I think it's a triad. So maybe you can like, look it up people lumber medicine syndrome. Yeah. Thank you. OK. Last one. Yeah. Mhm OK. So we've got someone saying mouth icer. Yes. Can we? I'm gonna be a bit harsher. Let's try and have actual organs. Sorry, you're doing good. I'm just trying to make sure you're all properly prepared, polished. You normally see this in IBD patients and this is called aphthous ulcer. Um It's basically an ulcer at more towards the corner of the mouth rather than anywhere in the mouth. So that's the difference, right? Um OK. You can take a piece of paper um or we can go through it but these are the scars. Um I know this is a bit of a memorization thing but you do need to, it would be nice if you actually know the scar things. So if anyone is brave enough, let's do this very quick start with a Sure you can tell me the name or why it's indication abdominal scar, how they used to perform Cesarean sections. No, Cesarean Cesarean. I will give you a clue. It's h because uterus would be all the way down and yeah, midline. Good, well done. Midline LA to me. Uh, actually no LA to me. Sorry, it should be midline open. Basically, midline is gone. Just any open surgery me. Mhm. Any anyone Joselyn 91. Um, not that I've s oh, midline laparotomy. Uh, that would be a, I think not. But so. Ok. So B is basically called the paramedian skull. Um It's for other organs. So like spleen kidney again, open but then not midline. Ok. C oh, that's a common one. Let's see what we have here. Anything just on our side, not on our side. Med school has taught you to be medics, not surgeons. Ok. I take that back but let's get you balanced. Um Right. So that's called a closure skull. And it's actually for like what's on the, right? No, I sure she should be on the other side. But vacuum means sleep. Possibly. If it's on the other side, it could be gallbladder. Ok. Um Right. And then we have d so think about the Oregon that's there actually adrenal glands, ee effects um any of those. So any resections, anything like anything upper gi, right. And then we got e anyone, there's only one thing that it can be if you don't know, think about the origin, which could be that Joselyn. Um Nothing yet the kidneys or the liver kidneys good. So, Nephrectomy Yeah. Ok. Um And then we've got ef oh uh it's that the bleak appendectomy scar appendicectomy. It's actually called the mcburney. Like from the mcburney sign. We'll go through that. Um And then we have G G is also append a appendicectomy. Yeah. So F and G appendix H very important. So that's the one with all the obs and G one. So C section, which is why in an OSC it's so important that you actually expose the patient so you can properly see all the abdomen because csection scars, you don't normally see them unless you actually look for it. Yeah, because a lot of patients will actually um like discover it pretty much. Ok. Um And it's called F Financial. I think it's in like financial parts when you have a baby basically. Ok. Right. Um So this should give you all the answers. We'll upload all the slides. So you, you still have access to all. Um I see and the last thing was a stoma. Um There is only two stomas you need to know. Um Ileostomy and Colostomy. Ileostomies tend to be a bit more outward bulging and it's called sprouting. Um So the one you can see on the left corner of the screen would be ileostomy. Um It's from Ilium and then the other one would be called Colo csom and that tends to be a bit more flatter. Um Yeah, nose, uh nose problems, fasting. Yeah. So these are things you need to look out for. So, yeah, quick if you stoma, just mention where it is. Um If it's mainly on the right iliac fossa, I ileostomy tends to be the left would be common um type of stoma. Um Then see, check what's around it, if there are any granulomas infections, anything like that. Um Yeah, so that's fine. But it is something that could come up in an exam because remember what, what we did say last time as well. Um Patio, it's easier to bring a patient that's n not acute like rather than bring someone septic you something less acute would make sense. Uh Stoma is something that could come up potentially. Uh Yeah. So what's that? And if you did say hernia, what hernia? So it's a unb hernia and that's the other thing you need to learn um the types of hernia. So unb epigastric, sorry, I think we're on the wrong picture. Next slide. I think we're on stoma. Do you wanna go through this or no? Next slide? 00 This about some SOMA and then Stoma, sorry, long day umbilical hernia. And then next slide that's the types of hernias. Um Yeah, just you if you do see one mention it oy point as examination point, ho feel it and then ask them to cough because they, so the things you need to look for is can you reduce it if you press? It doesn't go, doesn't go in and what happens when they cough? Like does it come out when you cough? Because her 10 to come out when you cough right next slide and we're, we're done with this spot diagnosis. Sorry. That was small. And, but yeah, these are our suggestions and what could come up doesn't mean the spot will come up but just something for you to look out for. Um And then next slide, that's a quick summary. I think we've kinda done most of it except for well palpation. We did go through the SI TS one. You also need to palpate the liver. So you go start from the right across all the way up. Um And then you're looking for the point of the liver itch. You'll feel a slight difference when you palpate, I mean for us and then auscultate, you're looking for bowel sounds, things you could hear are no bowel sounds or the absent bowel sounds or tingling, bowel sounds or normal bowel sounds. And then, um you need to also remember to do uh renal bruiting and abdominal aorta because a is still in our differentials, as we said initially and then don't forget the legs. We're looking for edema, which could also be sign of liver failure. Um Yeah, next slide and that just, yeah, just to conclude. So as we always say, just keep practicing with your friends, um form a study group if you have an elderly and it's more of a practicing and ping it, time it or in December. Yeah. Start timing and practice with timing. Yeah. And that's it. If there are any questions, feel free to pop it on the chart and then if the, if those online could actually do the, not that feedback form that's for the in person. Um And then if it does online can just, yeah, if you have any questions just uh, feel free to ask in the chat. And if you're in Cardiff, then Cat Rosie and um Molly would get like they can go through the actual examination and then we'll also do it here. Yeah. Thank. Thank you, Asma. Bye.