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Sorry, I think I'm making it worse. I don't know what I did there. Huh? Sorry, I'll just leave it like this. All the, the most important thing is for you to see the slides. So, hi, my name is A II AM, uh, neurology F two at the Royal currently. And I'll just be trying my best to summarize general surgery for you. Um, in context of your finals, I know most of you are preparing for your osk coming up next month if I'm correct. Um, so I'll try to make it as relevant to that as possible. Um, I don't want to go too much into detail because, um, I feel like you can study that if that makes sense. Yeah, great. So essentially what I want to talk to today about is how to take a good history from a patient presenting with a primarily surgical condition even though as you know, patients. Ok, good. Even though as you know, patients don't come with, uh, surgical patients or medical patients, it's usually, um, a combination of multiple things, but in a case of eos they usually would try to make it mainly one thing just so you're not so confused. So we try to see how to take a good history from that perspective and how to perform a focused exam depending on the history of presenting complaint, and then forming a differential diagnosis depending on the results of the clinical review structure, initial investigations on common surgical presentations and um also struct your management in acute settings of surgical emergencies and also just in general and then just a little bit of management of surgical patients perioperatively. So pre and POSTOP Yeah, great. So as you know, for os first thing is name, rule, identify consent positioning and asking about pain, please remember to wash your hands, plus or minus, wear gloves, depending on the um infection prevention controls there. So for the history taking, I know most of you are used to Socrates, but for the acute abdomen, something I kind of prefer because I feel like it gives you a better understanding of the um what's it called? It gives you a better understanding of what you're actually the history you're trying to take is senior COPD Sarah, which essentially is as you can see, it's a site. So you're trying to find out where the pain is. Exactly. And if it spreads as you all know that one and the character, usually people would ask if it's sharp or it's dull or something that would be important to also know is um if it's the type that they would have to stay put or they feel like they just keep, keep moving. You can't really call that severity because they might not really tell you that it helps them feel better by moving or not by moving. But you might just also just see that they're not able to rest. You wouldn't probably see that in your a but it might be useful for you in the future if has an e on your call to see someone and you literally can see them being restless. Um, onset is important knowing when, but also knowing how it progresses is important. Periodicity is important as well because you need to know if, um, time of day varies with their symptoms or it depends on if like it's related to food or if it's over minutes or hours. Um, and like if it's getting worse or it's getting better, um, might also tell you how serious it is. Duration will also tell you how long it's been as, you know, severity is how bad we all know the um, um, one out of 10, 1 being the no pain, 10 being the most pain you've ever felt. And associates symptoms are very, very important in surgery because that kind of makes us have an idea of where we're going with this because as you know, the abdomen has multiple organs and the surgery symptoms can also help us in knowing what we are doing with it. Um, relieving factors are also very important um set forward food analgesia and aggravating factors as well. And history is important to know if it's the first time patient is experiencing these things. Um Yeah, and also history. My in this case, sorry, I what my history in this case can also be past medical history. I say this because sometimes some people wait until after they done the entire history taking before they ask about past medical history. And I think it's important to mention it here after you're done with this part of the acute abdomen. I say this because sometimes for some patients, you kind of also want to know some things like um if they have a past medication of an, of an abdominal condition in this part because it also makes you have an idea of what you'd forgot to ask. Um because if they say they have a history of Crohn's for instance, or um they've had a cholecystectomy, you kind of have an idea that not to ask or to ask some things if that makes sense. Um Yeah, so I'd like to access early enough into the History Day game. The next thing I just wanted to do a quick example. So I really appreciate for people to meet their eyes with the first person. Um would be a 33 year old female with constant epigastric pain aggravated by movement and associated with hematemesis. So what would be your primary differential? Oh, can you hear? Could it be like a, a peptic ulcer or something. Yeah, it's most likely is, uh, peptic ulcer. Um, yeah, you are. That's, that's the, what I was going for with this one. But if, um, what would you think if she was woken up with the pain? It doesn't have to be, it could be somebody else. But what would you think if she was woken up with the pain and it was relieved by eating no ideas. A duodenal ulcer, it would be due now. So, yeah, I think and then if it's a 656 year old with right upper part in pain fever and jaundice, you already know what that is. That's um acute cholangitis, ascending cholangitis. Pardon? Is it ascending cholangitis? Um Yeah, it could be ascending cholangitis. Yeah. And what is the, what's it called? If it, what is the, the? OK. What is the triad? But I'm trying. Yeah. Um as well. So if he also had shock and hypertension and confusion, then we'd, that would be sorry, I can't see anyone. So I'm really hoping that I really want participation. So the septic like um from a gi so if they had shock, if they had hypertension and if they had confusion, that would, that would be PTA. Do you know the name of the PTA? I'm talking about the name Raynauds PTA. Yeah, thank you. So, essentially it's so, thank you. Then the next would be 70 year old gentleman with diffuse abdominal pain, green vomit first, then constipation. No flatus and distension. What would that be? Small ball obstruction? Yeah. And if the constipation came first and then it's brown vomit, what would that be? Like? Large bowel obstruction? It would be. And then if the person had a history of atrial fibrillation or cardiovascular disease and the pain was severe and unrelieved by analgesia, what would you think that was ischemic? Um, yeah. So acute mesenteric ischemic. Oh, exactly. Um, and what would you check really quickly as an f one to diagn do lactate the Laiba? So, 40 year old female with left iliac fossa, abdominal pain with painful bowel motion. What else would you like to know?