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Again. Lovely. It's live now. Ok. Hi everyone. Thank you for joining today's Osie series session with Osie Easy. Today is going to be the gastroenterology history taking and examination some of both session with Joe. I'm just going to quickly share the intro slides and then we can make a quick start. If you have any questions at any point throughout the session today, please feel free to put them in the chat and we can answer them um as soon as possible. Great. So I'm just gonna present my screen with the in slides now. Ok, great. Hopefully everyone can see that, but once again, we're osk easy. Thank you for joining today's session. We have a number of sub series within the main organization. So today you're watching an OSK Easy um OSK series session, but we also have finals Easy, which runs simultaneously. So look out for those events as well. We have met Tech Easy, which hosts um medical technology content. Um We have a media team with easy media and a social media where we frequently post revision resources and so on. So keep a lookout for all of the different branches uh before we begin a big thank you to our sponsors um Specifically Ki Medics um with regards to collaboration for our Sy Series. Um Also MDU NIH R and the Royal College of Surgeons of Edinburgh. We um GKI Medics is our excl a sponsor for the SY Series. I'm really proud to have them collaborating with us on this. It's a great online platform if you haven't. Um If you haven't reached it already. Um There's a number of different stations that can be simulated for ki practice if you're a card, if uni student or general ay practice for every other university. There's a number of flashcards, revision resources, checklist for examinations and so on. So it's a great resource to check out if you haven't already. Um This is a quick timeline of a story. I won't go in uh into it in too much detail, but essentially, we started off in March 2021 during the pandemic. And we've now um hosted over 450 online and both an event and our team is continuously growing over 100 and 30 members now. But if you'd like to be a part of the DM, please reach out to us. Um And here is just to show that we have an international audience um over the years and we really proud of reaching um these many people. We also have a number of in person events that we host at different universities. If you like us to teach an in person event that you think might be useful at your university. Please reach out to us on our gmail and we'd love to come. Um If you like to join our representatives team, you could scan this link here, but there's two different ones at the moment. Uh Both links are also available on our link tree. So if you'd like to join, um definitely do and then these are are different social handles. So if you're interested in following us and keeping up to date with any events that might be happening, um then please follow these and we also have a monthly newsletter that you can sign up to with any updates from the organization. And again, this is also available to sign up via the link tree. Great. So just a few general housekeeping points before we start off with today's session. So the session will be recorded and at the end of the meeting. Oh yeah, end of the session today, a feedback, a feedback link will be posted into the chat. And if you just give us some feedback through that link, you would then have access to all of the content from today's session at the end. Um So do keep a look out for that. Um And open it up, the slides and the recording will both be made available. And yeah, that's it for me. Please engage in the chat um and enjoy if you have any questions, please let us know. Great. I'm just gonna start sharing that now and hand over to Joe, who is the um teacher for today's session. Great. Thank you dear. I'm just gonna share my slides and then we'll get onto it. Ok. Can you see my slides dear? Yeah, I can see them. Cool. Ok, so yeah, welcome to the Gastroenterology station uh for the OSTEO series. And today we're going to cover the examination part of this station. So throughout the session, I be going through the examination and general tips for for the oy and the A ski, I'm gonna go over the abdominal examination and then throughout we're also gonna do some spot diagnosis and cover a few key gastro cases that you to use the framework for in, in your, in your real exams. I'll be asking lots of questions throughout the throughout the teaching session. So make sure to pop your answers in the chat and then I can look through the chat and then it can be a bit more interactive session and yeah, more, more fun for everyone. Ok. So when you first enter your ISK ISK station, uh you'll see something like this just outside. So make a note of who you are. What role you are, where you are is very important because for this, in this, in the department, the resources available are gonna be very different to the resources available uh in, in a GP er surgery for example and that will influence how you answer the the questions in the station. So the scenario for this uh for for this whole teaching teaching session is Alex Tonkin, a 21 year old man who presents to A&E with acute onset abdominal pain, perform a focused abdominal examination on this patient. After seven minutes, the examiner will stop you ask you to summarize your findings and present a differential diagnosis. Ok. So some general tips always examined from the right hand side of the bed. Uh be systematic in all the examinations. You do try and follow these steps. So inspect van pal palpate, percuss and auscultate do this in the same way each time and you'll be less likely to forget it uh to forget a step call the patient by their name throughout the examinations. You don't forget it because it looks, always looks really unprofessional if you forget the patient's name when you're presenting findings back to back to the examiner. So you say things like ah Mrs Smith, can you put your hands out in front of you, please? And then you're not, you're not gonna forget their name. Also ask how old does that make you? So you don't have to do any mental maths to work out how old they are from their date of birth. And also say there is no evidence of rather than I am looking for cos this just you can see this just sounds much more to say there is no evident uh you know, peripheral stigmata of gastrointestinal disease rather than, you know, I'm looking for Xanthoma, I'm looking for and so on. Yeah, finally, just be confident and show off. This is uh your time to show off and if you can get this examination down, uh if you can get the steps down really well then yeah, yeah, you can be, you can be really confident with it. So in introducing the exam, you can use the acronym wipe. So that's wash hands and do PPE introduce yourself with your full name and your role er which you know, being a, being 1/4 year medical student, patient's name and date of birth. Very important to confirm, explain the examination in simple terms to the patient and gain consent. Uh for the abdominal abdominal examination, you will need to ask the patient to undress from the waist up. So ask the patient to do this and you can offer a chaperone as well. If you think this is appropriate, then adjust the bed to 45 degrees ex adequately expose the patient like I've said and check if the patient has any pain before you begin. Cos this gives you your empathy points str straight off the bat. Ok. So the the general process of the abdominal examination is gonna be similar to other ones. So we'll start with the hands, we'll move up the arms to the armpits. We'll have a look good quick, look at the neck, have a look at the face, uh the eyes, the mouth, then we'll come down to the chest, have a look at the abdomen and finally, we'll finish off uh with, with both the legs. Ok. So I've written down a quick summary here that you can use for your revision. Uh So first of all, look at the patient uh for a general inspection and then look at all the objects and equipment surrounding the patient, make it really obvious that you're doing this to the examiner that you're taking time to look around the bed. So they can see you're doing that general inspection first. So the patients, the first thing you can notice and comment on is are they comfortable at rest or are they visibly in pain? Are there any obvious abdominal scars that you can see we'll go into uh those scars later on in, in, in the teaching session. Are they Cachexic? So this is uh if there's cachexia, it's, if there's a loss of muscle mass that's not entirely down, not, not entirely reversed by, by good nutrition. And it's often indicative of uh underlying malignancy. Are there any hernias in the abdomen? Is that general pala is the patient jaundiced or is the abdomen distended? All things that you can notice about the patient just by looking at them from the end of the bed. Ok. Some objects and equipment around the bed that uh relevant to a gastro station include mobility aids. Is, is the patient of IV access. Are there any stoma bags on the patient? Is there a catheter in situ? Is it draining? Uh, what sort of urine is draining? Are they having parenteral nutrition? So, that's uh, nutrition, food that's going in intravenously. Is there medication? Do they have a feeding tube in situ or is there a surgical drain in the abdomen? And what, what is it draining? Ok. So that's a, a quick bit, you can do that.