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Hello. Um Thank you for joining the session. I know there aren't that many people attending yet. Um, but I'll start presenting and then the content will be available on demand. Um, and then any questions you can just pop it in the chart. I'll start presenting then. Um, I'm has now I'm a fy two doctor um, in, um, Agro Social Hospital working in Dudley area. Um Today we will be discussing um, common general surgical conditions that we see when we are on call. Um, just if any questions you guys can, um, put it on the chat and I'll, um, try and answer them because, um, it's just gonna be me presenting by myself. I hope you all can see the slides. Can you all see the slide or he can put something in the chat? Um, because I don't wanna be talking while it's not, um, you guys can't hear me it. Ok? I'll just ta go ahead and start anyways. A, ok. So as I said, Ih now we'll start with these common conditions in general surgery. We'll be discussing four different cases. Four different cases, come with four different diagnoses and we'll look at the investigations and the management for these conditions. So, case one is a 22 year old male presenting with 24 hours of generalized abdominal pain which later, um, localized to his right lower quadrant. Um, he, which is also associated with nausea, reduced appetite and, uh, a mild fever. He does not have any urinary tract symptoms or any bowel symptoms, no diarrhea or constipation, but particularly, and he has not had this, um, similar episode previously. So in this kind of case, when a patient is presenting with these kind of symptoms, um, what would you be doing? Thank you, Ariba. Um I'm glad you guys can hear me and see the slides. So any, any ideas, what kind of things you would do in terms of investigations when a patient is presenting with these symptoms. So you would start with a history and an examination. So, and then, um, this is the history that we've got. So next step would be examining the patient and, um, then we would, um, kinda request all the investigations that's necessary. So in terms of examination, he has a low grade fever of 37.8 he's tender in the mcburney's point. This is where midway between the umbilicus and the superior, um, anterior superior iliac spine. So it's basically in the right lower quadrant. Um That's where he's tender and then you do the robing sign robing sign is when you palpate on the left iliac fossa, the patient feels the pain on the, in the right iliac fossa. Um And then there will be the, so sign as shown in the picture here um in the bottom um right picture where the patient is lying down on their left side and then you passively flex their um hip and then they feel the pain in their kind of. Um so as area um deeper in the um left iliac fossa, so these signs are positive um when they have um so when you examine this patient, when you palpate the abdomen, there is no guarding or rebound tenderness. So we request some bloods, the bloods come back and you see the white blood cells on the CRP are high. And as usual with anyone presenting with an abdominal pain, you would do a urinalysis just to rule out the urinary tract infection or um urinary um calculi. So it comes back negative and then you go on to further investigate with imaging in the imaging. The ultrasound scan shows signs of you will see the report and then it'll say signs of appendicitis. Um if the ultrasound, it was not um showing you anything much, um then you would request a ct abdomen. Obviously, all of this will be read by the general surgical um sh or the red and then they will be making these decisions. And as F ones or medical students, you guys need to be aware of these things when you are relieving the patient. So you can escalate appropriately. And then on the ct abdomen, you would see fat stranding around the appendix and then um it would be um dilated as well. And then, so you by this, by now, you guys would know what the diagnosis is. It's, yeah, it's acute appendicitis. And then with acute appendicitis, when you initially diagnose, make sure your patients are hydrated, you give them uh adequate analgesia, keep them nil by mouth and prescribe them the IV anti antibiotics. And then obviously, the definite management for these um patients is um laparoscopy, laparoscopic appendicectomy or um if it was complicated, then they could change it to an open um surgery or if patients are not fit for laparoscopic um surgery, then they would go for an open surgery and, and main complications of a appendicitis when it's really severe. What they can get is they can form abscesses within the peritoneum. Um, they could get peritonitis or perforation. So these are some of the complications that you need to monitor your patients for any questions. So far. I'm just going to keep it quite quick and concise because obviously, it's almost seven in the evening and it's supposed to be like supplementary for your um assessments to revise. Um, so let's not drag it on forever. So, moving on to case two, we have a 65 year old female presenting with a three day history of worsening colicky abdominal pain. So further history she is presenting with abdominal distension, she is nauseous and also vomiting. So these are the key, um, symptoms that she is having and you ask further about her bowel motions and so on. You find out that she has absolute constipation. She has not opened her bowels or she is unable to pass flights. So her past medical history includes mainly surgical history. She has prior abdominal surgery done 10 years ago for hysterectomy. So again, next steps, you go into examinations and investigations, anything that you guys think you might find in the examination or investigations, you can drop, drop it in the chart. So examination wise, obviously, you'll do an uh, do an abdominal examination, listen to your bowel sounds, palpate. Um, and then you would request your routine investigations, the basics, the blood, the urine test and so on. So on. Examination of the abdomen, you, um, the abdomen is tympanic to percussion and um, it's distended. You listen to listen for the bowel sounds which is high pitched bowel sounds that you hear there is no peritonism. She is not too tender. Um, and then you request the bloods which shows that she is dehydrated and she might have some electrolyte imbalances. Not necessarily, the infection markers wouldn't be raised unless there is any, um, what