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Ok. I'm like, uh, can some of these, uh, tell me that they would see the powerpoint? It just like a thumbs up anything. Uh, I can see but it is not presenting what, what does that mean? Uh, to be honest with you, um, oh, just, um, you see, you see, you see when you present the side show. Yeah. Yeah, I think that's what they mean that I've got to open on my screen though. Oh, maybe share your full screen. Uh. Ok. Yeah. Yeah, it's working out. Ok. Fine. Uh, ok. So, right. My name is Udit and today we'll be, we're gonna be going over the seventh case, which is of yours, which is the Crohn's complications. Um, so a quick overview, overview of the topics I'll first just go over Crohn's what it is, what it looks like, what the symptoms are, what the investigations are. And then I'll go over the tasks that, that you go through in your CSI. So the causes of abdominal pain, the differences between a small and large bowel obstruction, abdominal imaging, blood transfusions, the consequences of IOST toy and also stomas. So, to start with, uh, we should go over the c what Crohn's is. So it's a disease where it's a long term. It's a long term condition that causes inflammation of the lining of the digestive system. It can affect any part of the digestive system, from the mouth to the anus. But it most typically, most commonly occurs in the ilium and the colon, it's discontinuous in nature, which means it's not, it will not be a continuous uh amount of inflammation, but it, it will be in separate areas which are uh referred to as skip lesions. Um, the most common symptoms which I've seen are recurring diarrhea, abdominal pain and cramping, which gets worse after eating extreme tiredness, unintended weight loss and blood and mucous in the stool. The most common risk factor is smoking and it's a, it's a major risk factor for uh Crohn's disease. Um, and also a family history of Crohn's as well. The main, um, investigations you look into are a colonoscopy to look inside the, um, inside the bowel itself, uh inside the intestine itself as well as performing a biopsy of the tissue to check, as we mentioned earlier, that's transmural to, to identify the difference between Crohn's and other inflammatory conditions. And also they also perform blood tests, the standard white blood cells and the SR CRP and the like for inflammation. Um, so the first task is that the patient attends the ed with abdominal pain and associated symptoms. It can be caused by a variety of, um, diseases which can range from being benign to life threatening. Therefore, a full history as well as examination are essential for recognizing the cause of the patient's symptoms. So, using Socrates in the chat would be possible to, we'll go through row by row. So would it be possible for you guys to just put in some thoughts of what you think you'd see in appendicitis regarding the site, character symptoms and exacerbating factors. I'll let you know what the chart says. I've got, I mean, I've got it on my phone as well, so I can see that. Ok. Yeah, so. Ok. Um So as a couple of you mentioned that it is, it's actually it, yeah, it, it starts umbilical and then moves to the right lower quadrant. So it's a migration pain. Um Yeah, it's made worse by movement. Um, as well as coughing. Um Do you guys know what the sort of character, what sort of what the pain feels like to the patient? Yeah, the pain is constant and it can also be associated with also intermittent cramping. Um And then the associated symp associated symptoms tend to be the likes of anorexia, nausea, vomiting and inability to pass stool or wind. Um And there's also something known as a rosing sign where if you apply pressure to the lower left quadrant, it causes pain in the right due to irritation of the appen appendix. Um She, I'm not fall out of this quite the best. I'll just do this. Um, so, so in the small bowel you, so these are the, the differences in Cyle, I'll, I'll go through a row but the small bowel tends to be just a mal pain. It's known as a quality pain. Do any of you actually know what colicky pain means if you type b and if possible. Yeah. So quality pain comes and goes and the reason why, especially in this small bowel is because when the bowel contracts to cause movement, um, when there's a blockage, it can't move, it causes pain. So that's why it's a colicky pain and it, it, it's a severe pain that gets worse, the longer the obstruction persists. And also if it's a complete obstruction as well. Similarly, there's, there's weight loss, nausea, vomiting in the, in a full obstruction, you can't pass stool or wind. If it's a partial obstruction, you can pass normally wind but not stool and there's also bloating and distension. Um, and it's made worse by, in taking more. Obviously, cos you can't pass anything out. Um, pancreatitis is uh, epigastric pain and also left upper quadrant. Usually the location of the pancreas and radiates to the back. It's constant and severe with similar associated symptoms of nausea, vomiting, anorexia, and particularly dyspepsia and it's made worse by movement. And then cholecystitis, um, is constant upper quadrant pain. So, cholecystitis is, is, is the presence of, uh, kidney stones. Um, and if you raise the right shoulder, it's also constant pain. Uh, there's nausea and vomiting as well as, um, Murphy sign and eating fatty foods makes it worse. Um, so these are similar diseases that they're different diseases which have, which have similar, um, pains and, um, symptoms that to a, um, to Crohn's and which, so you'd need to consider all of these if you were to diagnose a patient or a patient came in with these sorts of symptoms. Um, so moving on, uh, the patient has a small bowel obstruction. The symptoms she shows are nausea and vomiting, abdominal pain, bloating, burping, not passing stool and not passing the wind. Um, in the chat, could you guys write why small bowel obstruction causes these symptoms? I mean, I did touch on it a bit, but it would be good to see if you guys are listening and could you just type in the chat? Yep. So, like I said, there's no lorax. It causes frankly most of the symptoms, it causes the nausea and the vomiting because nothing can be passed another retin. So it can, it has to come out from somewhere, um, as well as the burping and generally it causes bloating as well, which increases the, um, desire to birth. Um, the abdominal pain, as I mentioned before, it's a quality pain which is caused when the muscles in the intestine contract to try and move the stool and food further on which obviously it can't do with an obstruction which results in a lot.