Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

So that's that. Um All right. I'm getting confused with the screens. I'm looking at uh Cool. Let me try and share my screen from this one. So that shouldn't be a very confusing thing. And then we go here, share this, hide this and go back to this. That should look. All right. Yep, I can see it. Can you try to change your slides? Yeah, I can see it as well. Yeah. Moving. All right. Yeah. Yeah, it's moving. Cool. Uh All right. Um I will quickly introduce you and then you can um take it away. I was just sending the link to someone from work. Uh Do you have the new link just so that I can send it to them? I will see it in the chart. I got it, got it, found it, I think just very quickly send them because a few of them might be able to watch. So they wanted to c Right. That's done then. Um Am I still sharing my screen? Yes. Uh Yes, you are cool. Uh Let me hide things that should not be there whenever it happens. Cool. That's not, that's not uh yeah. Happy. You are cool. Um Thank you everyone for joining. So today we have Orestes talking more about general surgery specific to my CS. So, Orestes is an ST six in general and collateral surgery in the Northwest London Deanery. At the moment, he is undertaking his time model program for research to complete a phd in IVD and pouch surgery at Saint Mark National Bowel Hospital and academic Institute at in Burial College. Estes is passionate about education and training, having led and facilitated in multiple practical skills workshops and delivered lectures in national and local courses and events and he will be teaching us more about general surgery. Hi, thank you. Thank you, Kyle. Uh Thank you everyone for joining tonight. Um So mainly I think the idea is this is uh kind of based towards um MRC S level and I think you've branded us uh part A um which obviously kind of difficult to prep in terms of aiming at um um the, the multiple choice questions. So I think the way I've kind of struck to this is to, to go through um uh mainly some of the pathologies. Uh and then I think the intention is not for this to be a lecture of all the things you should know because actually that is your own uh kind of studying time um where you learn those things and remember them. I think it's more, it's going to be more of an overview of the possible pathologies and uh kind of highlight a few key things to look at. So, uh for you to do afterwards, um I've got two screens at the same time, so I think I can, uh I'm actually looking at the chart as well. So if you want to ask anything, um I'm more than happy to, to kind of stop and explain that more or uh kind of change the direction or talk about different things. Uh So, yeah, feel free to pop in the chat, uh Whatever you like. Um So yeah, I was gonna say, uh first of all, uh it's all about also thinking about um how the questions are gonna be and what exactly you're gonna be asked to do. Um, specifically if this is for part A uh And you're looking at questions which are more about pathologies or those, uh which are like um scenarios in the, um in those questions where they ask you about the next steps and the management. Sorry, I've done my exam a few years back. So, uh I don't remember them that well. Uh I think the main things to say here is that uh follow some general principles. So read the question really well, uh understand what they're asking. Uh Sometimes they're gonna be uh three questions. So they're gonna be asking you what's the next most appropriate step. So your knowledge might be that you understand this scenario and, you know, this is not a pathology and ends up having that kind of operation. But the question might actually be asking what's the immediate next step, which could be just um something like fluid or cation for sepsis. So, bearing all those things in mind, mind, um your ABCD S are really important to approach problems in an ABCD fashion. Uh Your CPC six does take priority and at the level of MRC S, that's what they actually want to see that you have a structure and that you go through um specific steps and you do the first line management, same thing for ATLS principles for trauma. And I think sometimes the questions may, might be kind of highlighting escalation and prioritization, um issues and ideas. So if they're asking about which patient needs to go first and, and all that, so we're gonna touch upon some key things that uh make things more urgent than others. Now, in terms of um general surgical emergencies, uh and I'm mainly gonna focus on um kind of intraabdominal. Uh obviously, you've got uh differentials for all your different areas of the abdomen depending on where the pain is because most usually the the the case presentation will be someone presenting with pain. So what I found really helpful is to, to have an idea of your anatomy. So when you look at a patient that you examine uh you, you kind of picture in front of you which organ lines where and that actually helps you with the pathologist. So I'm not gonna just go, I'm not gonna go through the list of them, uh, just bear in mind. Uh, where, where is, what? So that, uh, you know, what you're examining for now, as an overview of the things I'm gonna touch upon today, uh, we'll talk about, uh, the biliary pathology. So, biliary tree and, uh, all those, um, kind of presentations. Um, I've kind of grouped perforations, uh, into a wider group, but then they can be sub uh specified into which part of the gi tract they refer to. Um then uh obstructions. Uh There's some important concepts there. Uh Some difference between small and large bowel and the important one of the competent versus in acal valve in large bowels, which is somewhat poorly understood. And you can have three questions on that, uh touch upon hernias with the obstructions and then some other pathologies which are kind of individual like appendicitis, diverticulitis and uh ischemia ischemic bowel. Now, um I'm starting with one with that. Uh Obviously, I will be focusing on mentioning the pathologies. I see as part of my uh kind of general surgery on calls, but it's not always uh an abdominal emergency. It's not always um as a general surgical emergency. So things to bear in mind is from surgical pathologist, surgical, other specialty pathologies, uh ectopics in pelvic pains. Uh So pregnancy tests are, are key and should be done. Um, initially at the very initial presentation as long uh with, with the urine dip, um your urine dip is also gonna uh point uh towards one of the other direction about UTI S and um uh renal colleagues. So, if there's blood in the urine, uh uh it becomes uh the most likely diagnosis becomes of a urinary tract uh pathology. So, either a uti depending on your nitrates or uh a suspicion of a kidney stone uh based on blood in the urine with the appropriate management is CT Kub and a urology review. Uh diabetic ketoacidosis can cause diffuse abdominal pain. Um So, sugars should be checked, especially in people who are diabetic, but as well as people who may be undiagnosed diabetics, um I'm sure you all know about uh right upper quadrant pains and ruling out uh a lower lobe pneumonia which is uh radiating there. And then a pathology to never miss is a rupture AAA um usually can present with uh or an impending rupture to play um with left lumbar pain. Um And then you obviously have to do your scans and have your, your suspicion and the other clinical um findings. So, starting with the biliary emergencies, um I think this is a table uh kind of summarizing um the, the, the key things here. But I think what we need to start with is to understand the uh that pathologies with the bi within the biliary tree. The first bit to understand is the actual location of the stone. So, bilary path are most usually caused by gallstones. Uh, gallstones are located in the gallbladder. Um, obviously there is, um, a few things to say about how they get created. Uh, that's something, you know, you need to read and, uh, be able to either say or, or answer in the right. Um, multiple choice questions. Essentially the four biliary pathologies. Uh, we deal as in emergencies is bilary cholic, cholecystitis, cholangitis, and pancreatitis. So, starting with bilary colic, uh, your stones are in the gallbladder and they're causing kind of grumbling pains because they are there. Um, you don't have an infective component. Um, so there's no fever, there shouldn't be any raised white cells or CRP, um, which they can be very mildly raised. Um, in some of the cases the FTS, um, should be normal. Uh, although sometimes you can have an ALP, a raised, um, ALP and a, uh, and, uh,