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Hello. Um Can you guys hear me? Can you please um say yes on the chat if you can. Um can you guys see and hear me? Um can you guys hear me? Perfect, right. So um today I'll be going through abdominal pain and nutrition as well as malnutrition and um disorders with nutrition. Um Yeah, so with nutrition, so firstly, wouldn't go through abdominal pain and then appetite and then disorders of appetite and fine and malnutrition. So these are the child that we're gonna cover, have a quick read right to start off. Um I it's very important um for us to classify abdominal pain and we can do that by looking at the site, the onset, the character, the radiation, the associated symptoms. Um the time course like has been progressing over time. Um, exacerbating factors meaning things that make it better worse as well as well as how un severe the pain is. And for our sites, we like to divide the ab into nine regions of four quadrants so that we could um locate where the pain is and describe it better, more accurately. I'm sure I'm I'm sure electors would have gone through Socrates already. So I'm not going to dwell on it, but it's just, um, it's just very important information to have when presenting history or when given history and being asked, um, questions about it. Right? It's in the nine quadrants in the right upper quadrant, you have your gallbladder and your liver in the, um, epigastric region, you have a stomach, your, uh, your JDN and your pancreas and in your left upper quadrant, you have your pancreas in your right flank, you have a kidney around your umbilicus. You've got a small bowel caecum, your retroperitoneal structures, meaning stuff like um stuff like you, you um you, your, I think I'm pretty sure your aorta and something, um something of that sort and your left like you got your kidney on your right lower cordron, you've got appendix on your cecum and on the suprapubic region, you've got a transverse colon, your bladder uterus. And then next for women and on your left, lower Cordran, you've got your sigmoid colon, right? So, um it's important to, to be able to um to discern between parietal and visceral pain. Parietal pain is pain originating from the membrane that surrounds organs. It's a well, um localized and sharp pain. And by that, I mean, whatever is inflamed, it directly maps onto the um skin, let's say the area of your skin on the surface. So it's very easy for you to point to the pain and sorry. Um I got my ii confused myself. Um the site of pain depends on embryo embryological origin. So it's important for us to see whether the organ um comes from the ectoderm, the endoderm or me and whatever because all of that really um because that's how you get referred pain. So for example, if you've got um some kind of parietal liver pain, you could have it um I going to have it referred to right shoulder tip because of diaphragm irritation. In terms of visceral pain, it's pain originating from the internal organs itself, which has somatic innervation. So that's when you like sharp and achy pain. And it's also quite important for us to discern between colicky versus constant, which is a more inflammatory kind of pain. So, colicky pain, as you can see from the chart on the right, it comes and goes in waves and it fluctuates in severity and to make this pain go away and, and make this pain better. People and patients try to attend. Um, they try to move and try to get comfortable and difficulty pain when a tube is obstructed. So think so. So, so think of bowel obstruction. You've got, you've got something obstructing bowels and biliary colic. You've got gallstones, um, obstructing the bile ducts and in ureter colic, you've got kidney stones, um, obstructing and blocking the, the ureters. And as you can see in the, on the right, people often describe uretero colic or kidney stones are the worst pain they have. And you could see how it peaks and thro and peaks and drops in, in intervals and fluctuates. That's a constant pain. It's more of an inflammatory and achy kind of pain. And this kind of pain can be made worse by movement. It stays here until the inflammation subsides. And that's why like nsaids work for uh for a constant inflammatory pain. And the pain is felt over the air of inflammation. And that's because of somatic innervation, like I said earlier. And it's, it's, it's very helpful to know what kind of pain you have because if someone told me that they have a colicky pain, then I can immediately think about having an obstructed um lumen or a duct somewhere. So first, the first condition that we're gonna go through would be appendicitis, which is the inflammation of the appendix uh of the appendix. It starts around the embolic and then it moves over to the right iliac fossa. It's kind of a gradual onset and it's a constant pain as well. It does not radiate, radiate and associated with it. You also get nausea and vomiting as well as a lack of appetite and fever. In terms of um exacerbating factors, it does get worse when you move and people describe it as a dull and achy kind of pain, but it's not particularly severe. And I think one important thing to remember in history is all in cases is that in appendicitis. If there is peritoneum um involvement, then you can get something called rebound tenderness, which is when you press down on the right alec fossa, they wouldn't um gri as you flinch. But once you release your hand, then that's when they start feeling the pain. And that's what r rebound tenderness is. The second condition that we're gonna be going through is bowel obstruction. And this time it's more central, um umbilical or hypergastric kind of pain. Um, it's the, the answer is gradual and like I've mentioned before, it's a thick tube or a thick lumen being obstructed. So I think of it as a colicky kind of pain, a pain that fluctuates, it does not radiate, but because your bowels are obstructed, you can have vomiting. Um, in terms of timing, you would have previous, um, colic kind of pain as well farting. Well, that improves pain because it kind of relieves pressure off, um, the bowel obstruction and it is more of kind of colicky pain. So how would you differentiate, um, ureter colic from biliary colic? You'd, um, I'm just gonna give you guys.