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Ok. OK. Yeah. Yeah. No. OK. OK. Yeah. Yes. All right. Brilliant. I think let's um make a start. Um Hopefully everyone can see my screen. Um Yeah, so welcome everyone um today. Uh So my name is Presha and I've also got Millie on the call. Er, we're fifth year students and we're going to be talking to you guys about hematemesis and Melina. So if you're new here, this is the teaching thing series. We do weekly tutorials um at 6 p.m. every Thursday and we try and focus on core presentations um and really sort of teaching you guys skills on how to be able to diagnose patients just from signs and symptoms and looking at lots of different cases. Um if you aren't following teaching things, there is a following uh follow button on medal. Uh and that will keep you up to date with all of our events. So let's crack on with today's uh lesson, our learning objective on the screen. So we want to be able to identify differentials for hematemesis. Um Melina that's number one, be able to recognize life threatening conditions uh relating to the upper gi tract and also understand how to assess and manage a patient. Um And we also want to be able to uh risk stratify patients who present with upper gi bleeding. Uh So we're going to be talking about sort of the Glasgow Blatchford score and the Rockall School and how that helps us guide management decisions. So, uh everything's about the UK and Malay now. So here are your relevant conditions um ations that you need to know. Um I'm not gonna read them out. I'll let you guys just have a read of the slide and I think we can move on. So before we begin, we have some SBA S to test you guys. So I'll give you maybe a minute to attempt the SBA S. There's only three. So give it your best shot and then we'll go through the SBA S at the end of the session um and see whether you know, you guys um were able to get the right answers. So here's the first one. Amazing. I've got some answers in the chat if you can note down your answer because we will go through um the reasoning at the end of the lesson rather than just now. So just make a note of the answer you got. Um And I think we should be hopefully ready to move on to the next one. All right, that's been about a minute. So here is your last SBA amazing. OK. That's been a minute. Uh Like I said, just keep a note of your answers and then we'll go through at the end. So let's have some key concepts of hematosis and Melina. So I think it's important we first go through some definitions. So hematemesis just means vomiting of blood, the blood is fresh, it's going to appear bright red. However, if it's been sitting in the stomach for some time and it's been a uh sort of exposed to the gastric acid, it's going to look like coffee grounds. That's like a keyword that often comes up in sbs or even patients might express. Um and that's because the blood has sort of partially been digested. So it, it changes, the sort of presentation. Melina is just the passage of black uh tarry stools. Um The black color is coming from your digestive hemoglobin. Um So it means that, you know, the bleeding has had some time to be processed by the digestive system and that's why um that is going to present. So your upper gi bleed might present slightly different to your lower gi bleed, which will present with sort of bright red uh blood in the stools. So, going into um hemato KTS, um that's the passage of fresh blood uh in with the stools. So it can be because of the lower gi tract. So, things we're thinking of are things like diverticular disease, hemorrhoids, um colorectal cancer. However, if there's been like a massive upper gi bleed, the blood can pass through the gi tract, um fast enough that it doesn't get digested and it can appear as, um um this presentation instead. And I just added in this little like disclaimer, uh hemoptysis. Uh that's when you're coughing up blood from your respiratory tract. And it's important that you are able to differentiate this uh whilst talking to the patient. So obviously, if it's hemoptysis, they're going to be presenting with specific signs relating to like pneumonia or TB. So if they've had a cough, if they're breathless, et cetera, so very much like what doctors say, you get a lot of information from the history. Um You want to try and ask those questions to make sure you've differentiated between whether it's coming from the gi tract or if it's coming from the respiratory system. So, um what is the difference between upper upper gi and lower gi bleeding? Is it just um in relationship to the ligament of TRS? So an upper gi bleed is going to be proximal to this ligament and a lower gi bleed is going to be distal. Um and that's pretty much all there is to that. So, questions to explore in the history, um we're gonna make the session super interactive. So if you guys can jot down some questions you might wanna explore in a gi bleeding history. Amazing. So I've got one answer so far, appearance of blood and