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Ella. Andres. Good eating on this. Oh, good evening. To those of you have drugs tonight. Welcome to the agent Healthcare, Siris Anatomy. And that's the serious gastrointestinal system. Week, uh, one is for to Cuba. Uh, I'm going to be going through the gastrointestinal Latin in this evening. I'm a third year medical student at Kitty Med School College, London. I've been taking up a habit of put in a weird different folks with me every week for light. When I'm teaching, this is me of Henry, the eighth at Hampton Court Palace. I was there doing the first date of end for a protest. A company, and thus yeah, just to show there is a lot of variability what people do alongside of health care, Uh, make the most nights session. I throw this every time we have a session. Just to try and remind people you know, they're always to learn from these best taking notes is good. And actually taking notes physically by hand is proven to be the best way to do it. Because you're involved. Multiple elements. Your brain. Yeah, and it's still things Best ask questions. The more you can, the more you participate them or you interact the better. Um the better you will learn things. And then finally, if you joy bits, please Do you get in contact with Morgan? Happy to get further sport third learning. Um, other reasons This please do get in contact email Address Anyone who wants to hold us on bask or any of its You can also find us on Instagram on on Facebook, both of them at atrial healthcare. Ah, here's where we are on our once month serious this week we on Tuesday we had our first set of case discussions The clinical scenario, clinical based learning. Now I think I'm get by it. I'm going to talk to But it was quite good session I thought in the end on the feedback. Seem to relate it to anyone who wants to get back. And we watch that you're welcome too. So, overall medal. Although the joining link which we sent out for it if you haven't got it, please didn't get in contact. Send it out again in December. We have our session and dying and palliative care. Here's where we are in our anatomy. Siris were gastrointestinal week next week will be neuro, and then we finish off with Head Neck and N. T. Josh. So far, I've been having quite good feedback. Actually, in the last couple sessions of the I haven't taught, they've been Doctor Tim and Hope, and I thought they were really, really good. Hopefully, you'll agree. Hopefully, we can follow it up with a good session today. So gastrointestinal system. Let me just quickly check shop it. I don't have a moderate of tonight. Something have to intermittently keep checking the Q and A. Please do our shots of questions, though, if you have any, um, and I'll keep checking back to see what's going on. So gastrointestinal system the afternoon. Um, I'll start with this so your gastrointestinal system runs from your mouth to your anus. Simply. It basically turns people into doughnuts. It's a tube that runs entire way through you. The food we eat never actually enters our tissues. It sort of sits in a gap in the middle of us and goes all the way through the pump, says Tonight, I'm not going to be talking about the liver, which is part sometimes and including the gastrointestinal system, which is here. I'm not talking about the spleen, which isn't really included, but it's in the abdomen just normally over here. Not talking about the pancreas, which is sometimes include usually sits around here if you want to go through the pancreas. The diabetes section we did over the summer is available on metal. That's got some interesting about pancreatic anatomy in it on. We'll do liver and spleen at sometime in the future. Otherwise all of the system, from your mouth to your anus tonight, the after and it you're welcome to put this in the chat if you want to. If not, just think about it. Your cells just what can you actually name in your abdomen? So my abdomen were meaning anything really below the diaphragm and above your pelvis to pelvic bones. We talked a bit about them on Tuesday if anyone was there, Um, that's basically in that sort of the bottom bit of your in the middle of your body. Um, think about things you can name in it for a second. Obviously, I mentioned a few organs. Just now. It's a list. These are the main ones I could come up with. I'm sure that's a mist because there's always something you miss, um, predominately people, the big organs, the think of probably your stomach, which actually is sort of right at the top. It does slightly come up into your four AKs, but it's below the diaphragm. So it's in the abdomen, your liver over on the right hand side goal bladder, which goes under your liver. Spleen on the left pancreas again in the middle. Uh, small intestine, the large intestine, your kidney, your ureters so you're attract. Except for your bladder. Your bladder is not really in your abdomen. It's more in your pelvis, but it can sometimes be included in the abdomen. Your adrenal glands sit about kidneys. Your appendix is part of the large intestine, the greater and lesser men Tums or talk about tonight. These are things that probably also the greater mental, is probably the largest organ in your body that you've never heard off. We'll talk about it a bit. It's a surprise that actually exists. No one really have thinks about it. Lots of blood, vessels and nerves as well. On Dmard SOLs, you got the muscles in front of your abdomen, and again we'll talk about that, uh, gastrointestinal system within that is some of it is just the GI system on this simply is your digestive and excretory tracks. So from your mouth to your anus Ah, it's how we ingest digest and he just food in in Just Digest Aegis, Um, any basic makes us into one long doughnut. We'll start in the mouth. Seems the most logical place to start is why, with the gas, just a system I really like gastrointestinal Atta me because it's nice and complicated. But there's an obvious place to start on, an obvious place to finish. Let's think of it that way around. So start with the mouth. It's the beginning here. We have teeth on the tongue. We used to up food charlies into a wet mush on that swallow it as a bonus of bolus basically being a ball, Um, when it swallowed possible something called the epiglottis into your esophagus and stomach esophagus, basically the food pipe. You also have the trachea, which is your windpipe. Those both for the things that line your throat, soften us, sits behind the trachea that appears in front, suffocates the back, and you think all the epiglottis which is a flap which basically covers the trachea when you swallow on, because the epiglottis the rest of time to stop you basically swallowing a huge amount of air when you're breathing. But when you swallow a serious of muscles contract, it pushes forward the epiglottis to cover the trachea so that you're eso the your soft yes, food goes down your esophagus and it lays. He stops you from, Uh, yeah, basically stops you from from breathing in your food or drink. And quite common, uh, not common common problem is that people who can't have got problems with swallowing muscles. Sometimes that doesn't happen is they'll try and swallow something and it will go into their lungs rather than into their stomach. And I see a lot with some neurological problems in my patients with neurological problems. Um, worth noting is that your nasal cavity so the bit where you your nose leads to is actually continuous with the oral cavity. So if you laugh and you have food in your back, your throat airconditioning up from your lungs and it can push that food up into your nose. That's what sometimes people have, like water come out the nose or milk or some of this if they're drinking when they laugh. Um, generally, it's not office. It looks like quite a large cavity. Here is actually quite a lot of bony and and cartilaginous structure is back there. So it is quite difficult for solid food to end up in your nose, though it can happen. So not something you could say never, but it shouldn't happen. There is also interesting. Get the back. Your throat is your tonsils. You've got serious tonsils, and they're mostly to do with immune system. Trying to prevent you from getting last infections is a little bacteria in the mouth. There's our tonsils, actually. So we got the for in jail tonsils, which are at the top basically up your nose. So near the back of the nose tubal tonsils, which sort of run down the sides but again, from some of the nose to the mouth, the ones you see normally, or your palatine tonsils at the back of the throat and your lingual tonsil of the base of the tongue. Normally, when people have tonsillitis, the ones that inflame is the palatine tonsils you can get for Angela tonsillitis and you can get lingual tonsillitis and actually can get you well, tonsillitis. But you don't see it very well, but the Palatine tonsils swelling up and closing over the back of the throat. Um, your esophagus, Your self adjust basically, is the food pipe. It transports food from the mouth to the stomach and liquid and sometimes gas. Um, and whatever else it is, you've decided to swell up. So that action man that you decided was a good idea for lunch? This is where he would be going if he wasn't so large. Um, the lining of it really want you to remember you need to remember is gone, You cosa Niko PSA is sort of the soft inner layer. This is sort of rapidly replicating cells that replace the trip over quite short lifetime on. This is what protects the rest of it from getting inflamed getting damaged on. Then it's got a muscle of a muscular layer. The muscular area and the adventitial, which keeps nicely firm on, stops it from sort of swelling out massively and collapsing in on itself. Um, that gives it's a structure other than that. Yet mucosa, uh, bits of that will break off regularly, and it's used to basically stop it or getting nasally inflamed, damaged. If you got a burn, for example, to the to the esophagus that's them burned. The esophagus would damage the mucosa, and it burnt away enough because it could cause damage and scarring. Um, that's better. What I said in words. The other bit, it's worth knowing. They have a really important bit with the esophagus. And actually, it's just the point where the esophagus meets the stomach. Uh, which is the gastroesophageal gastroesophageal flexion, Basically the point where they need there's a sink turn the gastroesophageal sphincter. The point of this that shuts when food enters the stomach to stop food going back up on it. Also is there to sort of stop acids from the stomach going up into the esophagus because they can damage it. The stomach is quite a well protected bag full of nasty stuff like acid on the softer gets doesn't really like that. That stuff is much softer and more reactive. Um, and so you've got this center to stop the acid coming back up. Uh, it also stops gas escaping the stomach. So when people belt little book. That means the sphincter is open to allow gas up into the esophagus and then out when patients get heartburn. This means that some of the acid has leeched out on. That could be what's happening in against soft your reflux. You can get a thing. It was hernia. So the hiatus hernia, simply put, is where most commonly, a portion of the stomach lining has gone through that sinker, so the sphincter can go longer properly shut on. That means you can have continuous leaching off of stomach contents back into the esophagus, and that's not great. It's not very pleasant thing to have. It's not that dangerous. It's just not a very nice thing. You constantly will get things like bile bile. Get stomach contents chime. That's a little little chime coming back up into the mouth. It will be sort of a very bitter, acidic taste. It will burn. It could do nasty things to your teeth. Your teeth are meant to be completely exposed to acid on. It can cause damage to your esophagus for it being they're continuously speaking of stomach, go on the stomach again with the stomach. What you need to know really the most part. You just need to sort of know the body of it is. You got the body of your stomach. That's the main part of it. The the Codeine A is the point where the esophagus meets the stomach. You know, think of the fund US. A lot of organs have a fund us that's basically with the upper most part of it. You're a uterine fund. It's so the top of the uterus is called a fund. Us basically a fun. This is is the in the stomach is where, I guess, builds up. So it's effectively the bubble at the top that filled with gas. When it gets too full, you can feel bloated. But also when you belch, it expels that gas out. Um and yeah, it's basically there because the process of digestion gas is a released. If you've swallowed some gas, this is where it will go, and it's basically at the gas storage. On the last bit remember about actual structure is the pylorus, which is the bottom of it. The point where it meets the duodenum on this is something we'll talk about in a bit more detail in second. Yes, the pylorus, the body, the Kadena and the Funders. And realistically, if you remember, just three of those pylorus body funders. Um, other than that, the actual structure of the stomach is quest. Right forward. It's a bag, um, the bag that contract rhythmic A little bit over time to sort of contents out there. There is very limited quantity of how much can be pushed out a time. We'll talk about that again in a second when we talk more about pylorus. Other than that, it's got three different layers off nostril. A chewer. This gets it quite protection and the ability to contract, um, your longer shooting layer, your circulation and your bleakly watching to remember about them longer. TUNEL is stripes down the middle, circular stripes across, making a ring. If you were to cut through the whole thing and oblique just means it's it's sort of an angle to the two of them. This makes your stomach quite impermeable, is quite difficult to puncture of stomach or for stomach to burst, which is good because it contains a lot of stuff we don't want loose in the gut. Other than that, sometimes we refer to the top you talked refer to sort of the top of the stomach is the lesser curvature. That's the smaller one and the greater curvature of the bottom. And other than that, that that really does cover everything that stomach has to offer in terms of this sort of external structure. Inside, it has, since gastric folds these just folds of muscle on. They make the surface area bit bigger, meaning that you've got more ability to not absorb. Actually, stomach doesn't really do any absorption, but it it's mortar. Do with the production of the acids you need on a great surface area to sort of blend the contact, the normal contents, the acid, the block acid sodium chloride, potassium chloride. Um, with whatever it is or digesting, mix them all together properly. To begin that that digestive process. I want to see that it is to process a little bit adjusting to start in the mouth with amylase additions. Book Yeah, that the North Field goes through the pylorus stinker. I think I've got bit about the pool or extinct in a second. Um, potentially. This is mostly what I've just said, but in words like a seven people feel bloated. This is because the funders is overfilled on the basic being up to release that gas is what will release bloating. You can't have bloating further down when gas it in the intestines. Um, there is a difference in how you feel that. But most bloating should be that the funders being over and actually simple things like making the person lie on their left hand side can actually just move that gas bubble into the curry into the Cardura cardia on, then allow that to them be released. So just moving over to the left or giving certain products that make more gas release so that you just overloaded and it forces the Kadena Open Cardia open. Um, they're quite simple ways to relieve bloating. Most people don't really think about lying on their left when they do it, but actually, because of where the stomach and the ears and the funding is, that can, uh, minute, like the air bubble. Teo, release it. Yeah, but the pool or extinct that. So it released about rate of about 250 to 300 mL an hour. So basically, this controls how quickly your stomach empties and how quickly isn't tell you feel maybe that you need to eat again. There is a limit to how much or see the size of your stomach. If you eat a lot over a prolonged period, your stomach does stretch so you can contain mawr food more liquid. But the rate at which empties is fairly constant for individuals. Some people have very slow emptying stomach, which means that they can stay for for a lot longer. And this can cause of problems. They can't really a large meal. Um, and some people will lead to quickest. They feel empty quicker that generally it's around the 250 to 300 million hour. Um yeah, Jack connections. No questions, No questions. Do for free to ask questions. If you have any start moving on, we'll move on to the small intestine. Um, small intestine is divided into three segments. The duodenum, jejunum and ileum just duodenum with the spelling on it. Just remember, it's duodenum and know do water in them, which is apparently away. Some Americans pronounce it, Um, certainly they do in the TV Serious family guy. They could do it. The water numb on duodenum. It sounds more professional. It's bit cleaner is a word. It was better. Small intestine is is your main site of absorption for nutrients. Pretty much all macro nutrients are absorbed here. Most know maker. Most micro nutrients are absorbed here. If you don't know the difference from Akron, Like rheumatic row is sort of protein, fat and carbohydrate. Micro is basically everything else. Um, I think also, actually, water might be a macro nutrients, but I think that's water might be category. All together, actually, depending on what source you read from, um, three services. Georgina was the point of which digestive enzymes are injected. They come from the pancreas and the liver. They enter, uh, Judy? No. Uh, ask that the judge in, um, in the ileum, basically most of the absorption from the liquid that comes through. Ah, what differentiates the judge in, um, in the ileum is a bit vague, Really. The two of them have different cell, some different proportions of cells I can't remember. Don't think there was a specific anatomical van market, which the to differentiate is just sort of when the cells different, the cells change the Georgine, um, into the jejunum is a bit more obvious again. It's cell differences, but it's absorbed versus sort of transport. The duodenum is very transport. It looks a lot more that stomach the judge in, um starts having absorption surfaced on in Villa I and Microvillus, which I'll mention a bit more in a second. Um, when the Judean um, you have the single the ampulla Varta. Just remember that is called that to be honestly, don't need. It's not something that comes up a huge amount. But if they ask you what is called a sample or Varta, Um, basically, that is the point at which, uh, digestive enzymes from the pancreas and the liver are injected into the chime from the stomach. Um, and that comes from the common biliary common bile duct and the colon pancreatic duct, which are the the sources from the pancreas and the liver via the gall bladder. Um, this is a whole load. About what? What is the difference between the judgment and the ileum? Like I said, really, it does get a bit niche, um, effectively, they there for absorbing slightly different things. You need both of them to get a very good absorption. Um, Ville eye is one of the big things that separates the small intestine from the large intestine and from the the duodenum. In this case, the just a minute, um, from the duodenum. Ah, ville I, If you don't know they are, there's a small finger like projections that project out on the inside surface and basically make the surface area much larger there. Sort of, uh, what's a good way to describe them? Yeah, finger like projections there. Then in turn, color in microvillus. Effectively this sort of a bit of a fuzzy surface. And it means that mawr, basically when that time comes into contact with that surface, is a greater likelihood that that particular bit of nutrients floating around in the chime will come into contact with absorption surface and therefore being absorbed on. Then your intestines loops around lots. That's partly to get more of it in the intestine, but also it is more likely that increases turbulence, so the liquid chime is more like his and edge more like to come to contact with absorption site and therefore more like to become absorbed. Um, I don't if that's the best explanation I could ever come up with for them, but that's the sort of what's going on it. It's the Chinese sort of moving around. And we're hoping that that time comes into contact with surface, that we can take what we want out of the time on. Leave the bits we don't particularly want. Um, let me check gyn So I don't know how well I explained that. No, no question. Still, that's fine. Um, after the ileum within half the colon or the large intestine? Both far. Okay, really, Colon is the way we will describe it A lot more. Um, in medicine, large intestine. I think it is perfect acceptable for basic anatomy, but we refer to the elements of it by the name of the colon. Um, it's divided to four segments. I think this diagram actually explain that better. So I'll show you here before sure the writing You have your ascending colon. So this is basically a bit going upwards. This is from the point where the ileum meets up to sort of comes up to just under the liver, sort of quite high on the right hand side. Your transversus colon goes across and then you're descending colon goes back down and then you have the sigmoid colon. Sigmoid basically means that s shaped sort of goes up and then down into the rectum. The rectum is where we start feces for expulsion. Uh, the other weird thing is the appendix are talking about been born a second. Um, your large intestine predominantly does. Your colon does predominately water absorption. It also takes up a lot of electrolytes, so things like calcium, potassium and sodium on chloride will be about two in sodium chloride. Potassium chloride. Um, any sort issue with the large intestine and infection here. Damage here. Inflammation. Here. Kenly really mess up your water absorption and therefore cause diarrhea because it leaves water in the stool. So you get watery stools. So things like ulcerative colitis or crone's disease, which are in flat inflammatory disorders anything causes bleeding or anything that, like cholera, sort of infection, something that permeates the boundary and allows it stops. The ability to absorb the water very effectively will cause that to be far too much water in the gut, um, dependent steal. But I want to point out literally, it's that tiny, little true shin here. Normally it lies. Next toe lives along the the descending colon, uh, just snugly tucked in next to it. But actually appendix is just a small, blind ended sac. Blend ended pouch. Traditionally it was immune or bacterial reservoirs. It had a lot of immune cells in it or had a lot of beneficial bacteria that we were using for digestion. And it sort of remained untouched area and area where food doesn't tend to go because it's sort of out of the way. I was able to be used to breeding ground for bacteria to then re enter the gut to help with digestion or protection. Because we do like we like bacteria in the gut. We need some bacteria in the gut to fight off bad bacteria and to help it a gestion. Um, patients who have it removed don't tend to see a massive difference in there in their life. There is some evidence that having a having your appendix removed a younger age get you an increased risk of things like Crone's disease also colitis. So generally we like to have an appendix. There is a benefit to keeping it on. We wouldn't recommend going around just removing everyone's appendix for the sake of it. But I'm sure people have heard of a thing called appendicitis. Appendicitis is inflammation of the appendix. It can be quite dangerous if it gets very, very inflamed. It can rupture and release bacteria and release bowel contents into the abdomen on. This is really, really bad. So if it becomes inflamed or damaged, we remove it. Unless we can treat it, make it go back down, actually, and there is a lot of evidence that you should try and keep it rather than get rid of it, and getting rid of it should be a bit more. The last ditch effort, um, bottle of C is better to remove it safely than to let it explode on its own. Um, yeah, Appendicitis is a variety of reasons that might happen and know all of them the best known. Generally it's because of some sort of infection or basically contents of the bowel getting into the appendix and not getting out again. Like I said, it blind ended. So actually, if it's not contracting or being squished, whatever goes into it won't come back out. And so you can end up with basically like fecal matter in the appendix that just stays there and festers neck and cause inflammation. Likewise, you know some other things that cause information of it. It's a bit Mrs to what causes it. And in most cases you don't ever find out directly what caused a particular appendicitis questions that that's fine. So, uh, that's the appendix. Here is your rectum. I don't really know why that looks. They faint the writing. I should have made that bit clearer. But yet the rectum is a place where fecal matter is stored prior to expulsion. Hopefully a time in place of your choosing that you can have fecal incontinence and people, um, open their bowels when they're not planning to or when they don't intend to. In this case, I have shown it alongside a female anatomy office with the uterus and the vagina. Um, anatomically female anatomy, to be precise on this, just to show sort of where those ally in relation to one another, quite common cause of something like incontinence on. So urinary incontinence, more like actually, urinary retention can be constipation. So if you have too much stool in the rectum, it can expand and I could put pressure on the muscles, which then puts pressure on the urethra and make it difficult to avoid the bladder to empty the bladder like quest. For example, pregnancy can cause constipation because, obviously, as that uterus gets really big full of baby, that could put pressure on the rectum and make it difficult for stool to pass by an exit. So that's also have an overlying together is put relevant. Um, the rectum in the anus. The anus is instinct. Er, this should hopefully stop the exit of stool when you're not planning for it to happen. Above the anus is another sphincter, which they sort of work in tandem to stop fecal matter coming out. Obviously, anything that's all compresses your abdomen. We'll put a little pressure on these, so having a backup stinker is also very useful. We then also have the final flexion of the sigmoid colon, and when these are at rest effectively when instead of standing position doing things that being active, doing things, these are in a position where it's sort of kinks effectively that that sort of the tubing so it makes it unlikely for large quantities of stool to pass by and meet those sinkers, which then internal. So it gives you an increased increased decreased likelihood off incontinence or increased stability in the sense, um, feces sisters basically made up of a combination of under jested material and waste products. We inject waste into it, um, and hopefully get rid of it. When you choose to, they're Ah, yeah, The to flex is the dorsal flexion. The perineal flexion basically kinks in the tube to stop the feces basically sitting on top of the anal sphincter. Um, and then when you're mostly release these, line up a bit more to allow start pass by and the anal sphincter opens and your release. That's the anatomy side of it, very quickly gone over. We're just going to go through some warm medical and pathological bits quickly, and let me just check to make sure there are no questions. At the moment, I still see none. Like I said, Do ask them if you have thumb, let me cough quickly. Just, um, get a dry throat coming on. So the abdominal history what? We haven't mentioned a huge mountain during all serious, but I hope people say no. A large part of medicine of any sort of healthcare making diagnosis and the like is the history sometimes called the patient interview in parts of the world. But in the UK, we call patient history of the at the history, and this is basically asking questions and finding out information about what's been going on in the past in this case, relating to the abdomen abdominal symptoms Onda It is roughly 80% of your if you're a doctor, it's roughly 80% of your your tool kit asking questions, finding out relevant information, funny out on irrelevant information of working out, whether it is relevant or not, and using that to build up diagnoses. And it some. Some of the fingers we keep getting given a medical school is that roughly 80% of diagnosis has done purely from the history. That's about any tests about the examination, just asking questions and talking to the patient about what's been going on. Is you the answer roughly 80% of the time? So here's some bits about asking to find out more information about abdominal problems. These are all going to be very briefly, Bullet pointed This actually this part of Power Point. I took directly from my notes with the gastrointestinal consultant and, like learning it from them, oversee often agitated them and make them a bit more expensive. But the the's a basis of very brief bullet points about what you need to find out about start appetite of appetite is someone's desire to eat. Is their appetite good? Is there tight? Bad? Has it not changed? Has it become? Are they more hungry? Are they less hungry? Are they actually enjoying their food? Do they normally enjoy their food? Um, you know, some people can eat lots of food and not actually enjoy it. That's doing it because they feel hungry, but they're not enjoying eating. Some will eat very little, but they're enjoying it. It's all have these all tied together on the opiates, then. Is this due to an illness, or is this a mental health thing? So when people some people, when their side will eat, are they sad and therefore the reading war? Or did they actually feel like they need to eat more and vice versa is quite important questions think about with appetite, the patient's weight generally weight loss certainly unintentional weight loss is bad. If you're deliberately trying to lose weight, find that's acceptable. But if you just suddenly begin losing weight and you're not planning on it, that's generally isn't a good sign. Um, because it means that something going on in which we're using, um, or energy or you're not able to take in food to see once were on, but not a good a stock it sign. So how much weight have has a patient lost and in what time? Period on again was intentional. How much of this weight loss was intentional? If you're losing a lot of weight very quickly, it could be quite a bad sign. It's a sign that something in your body is taking up a lot of energy on before you're using up your fat reserves. You're using up your your protein in some cases in your muscles. Um, that's that's not necessary. That's know, often a good sign and certain certain quite aggressive cancers can present with quite some weight loss. My question of are things things are causing you to struggle to digest. So if you've got a flare up of something like Crone's disease, patting absorbing very much from the food and therefore you're losing weight because your body is having to use your reserves to replace what you would have had from eating like what they are so that that is actually weight gain. Weight gaining doesn't tend to be a bad thing. There are a couple of conditions that causing to gain weight, but they don't tend to kill you or they want to be very dangerous in the sort of the short term. In the long term, they could be a problem, But we can still sort of now, um, I don't have have put it at this point, I might have No, Uh, yes, I have, actually. This large abdomen, there are five common reasons why someone will have a large abdomen and we'll talk about that in a second. But if you gained weight quickly, actually, rapid weight gain could be a hormonal problem. Could be a mental health problem there eating way more than they should. Um, but actually, often it's not necessarily due to fat. We'll talk about them here. So the five common reasons someone has a large abdomen, fat fluid, flatus, fetus or feces fact obviously is they put on weight. They've got on abdomen that's full of vessel, Visceral for peripheral fat fluid are they're just holding onto lots of liquids. This thing called ascites on this, basically is that got fluid, but it's no in the right place is this is fluid in the in the space between around their tissues and around their cells. Interstitial fluid is the word. Um, and this isn't a great thing. Over this can have to be a sign of certain diseases. Flatus is are they bloated? Is it just full of gas? You can have quite quite a large abdomen, actually quite distended abdomen. Um, if you've got a lot of gas in there and this could be, you know, they have not passed gas, this could be there's something causing them to build up a lot of gas. Um, if they think like a feet, a bowel, compaction, something, something. Basically making an impermeable barrier in the digestive system, they can fill up with gas quite quickly. This could be very uncomfortable. But once you relieve that once you allow the gas to pass by, the discomfort will go away quite quickly. Fetus are the full of a baby are the pregnant off. So that would cause thumb over the period of about nine months to develop quite a lot of body to develop a quite a large abdomen and put on a fair bit of weight. Um, obviously, if they're not pregnant and they look pregnant, that's not great. But it was surprised how many patients don't realize they're actually pregnant. Um, you just all my belly is getting really large, and I'm no longer having a period, and things like this would probably Normally you go are maybe I'm pregnant. People don't tend to. They do tend to realize, but you'd be amazed how many people don't or don't realize till quite late on on the last one is feces. Are they constipated? Are they're not passing out there, not parting stool. Are you retaining a lot of that in their abdomen? Are they just full of a lot of poop? Um, And again, in this case, things like laxatives could be quite could tell. Move it. But actually you can have the single the fecal compaction, and that could be basically a lot of feces built up in a into a effectively, like a wall, a very solid blockage that won't past. And it causes a backup of gas and fluid and feces in the abdomen that in the intestines. And this could be quite dangerous because actually that can get very solid build up in it can cause ruptures, tears on back early moving that that compaction out could be quite difficult camera to require things that surgery to actually physically take it out. Robin, that laxative that you'd hope you can move it with laxatives. Don't. If you have a patient who has got that, who has got a compaction, don't give them laxatives because you're unlikely to move the blockage. What you're like to do is just pile more stuff in behind the blockage and increase the likelihood of them having having a rupture tear. Um, this Basia doing right back up to the top of dysphasia dysphagia is the ability to swallow. You also don't phase here with a don't know if a zero, which is opting for Dino Feige. My pronunciation of this was not great, but it's a word you don't come across a lot a dynasty. Asia is painful swallowing that's likely 70 of the muscles or committed something in the way Um, you can get dysphagia because off anxiety you're feeling uncomfortable. You hang of a panic, maybe, and you can't swallow or it can be a problem with the muscles. Or it could be a problem with a blockage. There's a few things that come in with it. Um, if you have a problem where you can swallow from your mouth, but it gets somewhere down the throat part way and then can go any further and I ever get stuck or come straight back up, Um, this can be due to something like a strict something in the way a stricture cancer, Um, or it could be due to really bad reflux. So it's going into your stomach and then coming straight back up again because it's absolutely nothing stopping it, doing so, uh, you get some of this. Do some infection information's sense of infections. Candida candidate being If it's a fungal infection, it's the same thing that causes vaginal fresh, um, but all fascial for thrush because you get fresh into the joint and get fresh with the anus. You want to get candida in the throat effectively. Thrush of the throat. Um, the important question to ask you, really, it's when patients can't swallow is where, you know. Is it not leaving your mouth? Is it going a little bit down and coming straight back again? Is it going quite a long way down, then coming back up? You could also get trapped food. Bolus is the thing where they swallowed it and it gets stuck part way down, and they can't swallow anymore past it. You think it's my involved choking. If it's quite high up, they might choke because it causes the epiglottis to shut over and stop the the windpipe, the trachea from being functional so you can't breathe. But if it's further down, actually, you could be breathing perfectly normally. You're just not able to get any more food goes down. Um, just we kind of scary, but they're quite manageable. However, you can pull it back up using tools with the patient sedated, or drink something physiolysis sick, like a like a busy drink, and that can slowly dissolve it. You can evolve quarter of vomiting because it will trigger it's come back off again, but it'll slowly break it down and you can get things passed. It again. But generally an advice with that one is if they've got a trap food bolus, send it hospital or, if you're in hospital, see a doctor. When you see one of the like more senior people in the hospital, the deal with it nausea and vomiting quite common. I'm sure everyone's had north here. At some point, everyone's probably vomited at some point. This happens. Um, nausea. Committed to all sorts of things. It's not a very diagnostic sign. Being nauseous, committed all sorts. Everything from, you know, anxiety toe reactions to drugs toe God knows what, like they're all sores, things coming. Nausea, um, important to ask, Is it when you're eating or is it a long time on If it is when you're eating? Is it when after you've been eating? Um, because that comes to determine sort of where the North is coming from. So if you've eaten and then like the next half, now you're nauseous. That could be in your stomach, whereas if you nausea, you'll see it's a bit later on. It could because going to the intestine problems further down, um, vomiting. On the other hand, if you're nauseous before you vomit is different from if you just vomit and you have no warning before it happens, How much do you vomit? Is it a little bit? Is it a lot? Is it your emptying your stomach, or is it just you're bringing something up from your esophagus on? What's in it? Is it? Is it liquid vomit? Is it liquid and solid? Is it just solid? Is it just food eyes there, blood in your vomit? That could be a sign of having a bleed in your esophagus or in your stomach, even if their bile. That means it's come from your duodenum. Where while is injected into the digestive system, bile is sort of a green mucky goose poop. If you listen, goose poop the sort of very green, slimy stuff. Bile tends to look a bit like that, bit more liquidy, but when it's got food around, it is to look that sort of color or feces. And there are conditions where, basically, as I said earlier, the compaction. Ultimately, if you've got a compaction, your digestive system and therefore your feces isn't able to continue along the tract and get out the normal way, it will back up and it will end up going out. Uh, you had the vomiting poop. It's quite bad sign. It means severe compaction because of the normally trying. Keep going the the normal route. Quite bad sign. Get patients with this on off. Simpatiaji bring up feces before, and it's not a very pleasant thing, especially for the poor patient. Ah, a big recommendation be after they finished vomiting. Give them something to wash their mouth out with because no one wants to be tasting that and, you know, help him get clean and things afterwards, even if it's not directly your role. If they're not, your patient is just really polite to sort of give them a better handle that one, because that's be honest. You'd want a hand. If you've just brought up feces, you're gonna want, you know, be calling to the can. Get those 90 nausea medications if you can, and you know checks along whatever is gonna happen to try and stop that happening again. It's a pretty unpleasant experience for them. Vomiting normally is not great, but when you're vomiting poo, look no fun for anyone. Um, especially not for the patient, just Pepsi. A heartburn dyspepsia and heart than know exactly the same. But generally the same asked the patient What they mean when they said they've got heartburn, they can have different things. Just Pepsi. Or is one thing that some reflux Is it stuff coming up? They could also medical bloating so often or me. Heartburn is sort of in the top part. The chest. If they've got lower heartburn in their abdomen, that again could be reflux. But it could also be bloating. Um, it could be that they're very, very full. Um, yeah. Uh, people are not very specific with terms. They use reflux for medical water brush. This is that That feeling acid or fluid coming up from the stomach into the mouth is a very bitter, very acidic taste. No, Very pleasant. Um, that sensation, some people say of throwing up in their mouth and swallow it back down. That could be reflux. Um, at the gastric pain is pain in the top part of the abdomen just below the rib cage in the middle. Um, and that could be related to the part of stomach. Like I said earlier, we talked about about bloating. I mentioned ascites and bowel obstruction. Ascites. Is that that buildup of fluid in the abdomen? Um, there are other problems that come with it as well. Uh, ulcers talk about that more in a bit. Gastritis is just information. The gut. This could be due to an infection or various reasons. And then I VSL talk about it more in a minute. Um, safety, safety and satiety ease. Uh, basic house 88. Did you all have fully? Well, it's just a fancy way of saying it. Not really worth knowing, Judy. More slowness. I mentioned earlier that the speed at which your stomach empties if your stomach emptying really slowly, it might just be the case that you're going to feel more comfortable because you're filling it up and it's not emptying quickly enough, and you got things like flash ones passing of wind. I'll mention that here, but I don't think I mentioned it later on. Generally, patients who say they really got problems were too much wind. It's not very diagnostic as a fact. If you're farting a lot, it doesn't normally mean you've got a problem. It's normal, something dietary as the most common reason you'll have problems with wind if it's particularly smelling, tasting the offensive. Normally that's diet based. Um, if you're fighting a lot and you're not able to pass stool, that could be a sign of obstruction. Generally, the gas is a lot easier to pass by an obstruction than solid. Um, but normally you sort of go down like a. There's a spectrum of things that we would expect for that. So so they stopped passing stool. They have abdominal pain. They might continue to pass liquids, just liquid feces. For a while. We call that overflow on. Then they might pass just gas for a while, and then they might not past anything. And that's a sort of normal progression of any of a bowel obstruction. Um, just frequently passing wind and passing stool. Really, it's not lapsed. It's not that diagnostic. It's just probably something that you've been eating. Nerves is another thing that can cause it. Sometimes you know, bacteria in the gut can affect how much you're digesting or how you're making gas. So if you've got particularly have normal bacteria ratio bacteria going on, that could be it. Really, there's no huge amount. It's gonna change certain food stuffs people will eat will make it worse. Certain food stuff people eat will make it better. There's a lot of people who swear by things like tumeric or garlic that that sort of help balance out what's going on in your gut. Um, but really individual. You know, some people will find one thing works and people will find something else works. And there's no sort of guaranteed solution for for things were starting, um, the last one. I know I won't ever want to remember this word because one of my favorite words in the world that's borborygmus or borborygmus is the singular, which is tummy rumbles. Eso that noise. When you hear your stomach moving, you hear that grumbling noise in your stomach. That's bull. Bring me some people, say borborygmus. Is that sort of Morgan recipe version. Actually, Barbary me, by definition, is any sort of noise your abdomen makes from Paracelsus. Person else is the rhythmic squeezing of food along your intestine. Um, so any noise that makes is bothering me. It's for my favorite favorite words. If you don't hear any borborygmus. So if you put stethoscope of someone's abdomen, you don't hear any movement going on. That could be a sign of obstruction. Um, but really, that's the main thing of all right, if the hearing their stomach rumbling is for is something going for it normally? If you here orderly, If I'm like sitting next to and I can hear your stomach rumbling, that's normally. Gas then only uses gas bubbles floating for your intestine, so it means probably in the next, sort of often out some of that your past wind and then your stomach will shut up again. Some people think it's because they're hungry. That can be the case if you'll intestine sort of empty and not go much food in it. What's in it, then? It's normally liquid on gas, and so you're more likely to hear it. But you'll hear the gas running for a liquid, but actually not necessarily get a good guarantee that you're hungry. It more likely is that in the next half, now you're gonna need to fart little bit about the language in these things. Whenever you talk about the gut, you've got to just get used to using this or language because ultimately this is what you got does it turns food into poop and you may thought, and these are things you just have to sort of get used to, um, abdominal pain. So I don't think in any of our previous sessions. So far, we've mentioned Socrates. Socrates is probably the best way of assessing pain, and it's just an acronym. That's okay. He's a great guy. We used the acronym. It doesn't really have anything to do with him, but it it just fits. And these effectively the ways in which you sort of assess someone's pain. That's that's all the questions you need to ask the site onset character character being like, What? What is the pain like? Radiation doesn't go anywhere. Or did it stay in one place? Where does it go? Associated symptoms. So anything that comes with the pain, the timing of it, has it been ages? Has it stayed? Does it come and go? Exacerbating relieving factors means anything you you do that makes it worse or better, and then severity. How bad is your pain? Normally, we talk about this out of 10, maybe have 100. Sometimes it's the little like faces that tell you things about you use little faces and say? Well, you know, there is your pain really happy? Is your pain really sad? The face is, uh, very rarely used there, any sort of used in pediatrics, but yes, Socrates, if you haven't come across Socrates, I would really probably more strong than anything else. Advise you to go look this up because the brilliant way to a set pain It's a very commonly used way to assess pain on, but certainly in medical school, we use it constantly. Anytime someone's got pain, you're expected to be able to get teeth. The Socrates to be able to, like, break down their pain into these sort of things. Um, so it tells you the abdomen house, different specific site of pain. We talked about nine quadrants. I'll I think I've got a slide with that in a second, but it's basically how you divide up the abdomen to understand what's where. Onset. When did it start? What was going on when it started what happened before it started? You know, if you say I ate food and then the pain happened or I've just been to the toilet and then the pain came on. These things are important character What's the pain like? Is it sharp? Is it burning? Is it dull? Is it achy? You know, whatever words the patient wants to use to describe it, And if they say I'm not really sure what it's like saying, you know, give them a couple of options. Is it sharp burning dull? You know, give them just a bit of a list of options. Be very vague in general. With them, they might try and be more specific afterwards. But just don't try and put words directly in their mouth. Let them tell you what it's like. Give him some hints. A sto What sort of words people should use Brady a Shin. Does it move anywhere, you know, if it starts in the sort of the lower right of the abdomen, does it radiate in the middle that start in the middle and radiate to the law of right? There's a few, um, a few particular things in the abdomen where radiation is very Coleman, you're expecting radiation is certain way for it to be a certain condition. It is important to ask it. Associated symptoms. The main ones. You'll get a nausea, vomiting, diarrhea. You might get constipation, these other things. So I've got a lot of pain and I have diarrhea or I have a lot of I have diarrhea and then I have pain. Figure out which way around. They sort of go. But knowing they go together, how long has it been on four? Does it come and go when it does come? How long is it? Therefore, how long does that go away for? Um, that's basically relieving factors. One of the main ones here is when you eat or when you go to the toilet. Is it worse when you eat? Is it better when you eat? Is it worse when you go to the toilet? Is it better when you go to the toilet? Um, and if it's not related to eating or going to the toilet, that's important as well. Um, it's the other one is also Is it worse if you if you pass wind, if the patient is I haven't passed? Win for a while have really, really sharp, really bad abdominal pain. It feels like it's everywhere. Potentially is. They just have a really they've got trapped wind and they really need to thought that is no uncommon presentation. Um, anus. Verity after 10 and 110 is the worst pain ever. You weren't paying you ever experienced in your life. Zero is nothing. Uh, but be prepared that patients do vary their scale quite a lot because that patient may never have had bad pain before. This could well be the worst pain that ever had in their life. So 10, 10 pain to them, but actually, comparatively, if they if you took that patient that this current experience the patient is having and gave it a different patient has had a lot of pain in the past, it might only be a five out of 10. The severity is what it is to that particular patient. You can try and put that into perspective of people if it's the worst pain they've ever had, But they're a person who's never experienced any pain before. You still have to say that it's the worst pain I've ever had. It's a 10 out of 10 pain. Yeah, um, just in particularly interesting things that come with parts, stomach pain, a stomach cold so so and also high up in the stomach or esophagus tends to be worse with food goes in the intestine. It tends to be better with food in the duodenum, a test it better with food, colic or crampy pain. Call. It has to be paying. That sort of comes and goes. It sort of comes in waves and goes away in waves on cramp. If it's a constant versus it not constant. There's a of variants in there colicky painters we quite common with, like kidney stones. Um, but we're not really covering the kidney so much in this. Um, yeah, cause she endo decrescendo does it still get? Get worse and worse and worse and worse, and then go away. Go away, Go away, Go away. Worse, Worse. Worse. We're sort of building up going away. Or does it appear? Disappear? Um, pancreatitis. This is very specific ones. Pancreatitis is inflammation of the pancreas. This is quite common with certain infections, but it's also very related to alcohol to patients with chronic alcohol users, or have had a real binge of alcohol might get pancreatitis is mentally one of most incredibly painful things that human could go through. There's not very pleasant, but if they're having incredible pain in the upper part of your abdomen. It's going to rule out, um, if you've got pain in the top middle of your abdomen after you've had quite fatty meals or lots of cheese, is not to meet this kind of stuff. That could be biliary colic, which basically bile stones. Stones in the gallbladder, stopping the passing of bile salts into the intestine, which are what's needed to digest fat. Um, burning could be reflux if you lean forward and the pain goes away. It's normally upper abdominal thing because that move your upper abdominal organs about, um, and if they've been taking a lot of opioid painkillers, opiate pain killers that can cause constipation. So if they've been in pain and now they're constipated, is it because of the medication they've taken? Um, you can check for questions and also share the feedback Lincoln this point. So anyone who does want to get away your able to, um, both Si, as I said, with all the other sessions, we do really appreciate feedback. Sound, restructure what we do, so please do give feedback if you have it. It's also how you get hold of the stiffness of attendance. If you want to start building a portfolio of things that you've attended besides school or science. You need whatever it is you're doing. They're quite useful to have this difficult. So I would recommend doing the feedback for me getting anyway, moving on her. Mapped him Apoptosis on Molina some Actos. This is the vomiting of blood. Melena is the past in you digested, blood installed. Um, there's a couple of different sorts of blood, and we'll talk about them in a minute. But basically, the Baptist could be vomiting of fresh red blood so that normal musical blood a bleed somewhere in your esophagus or maybe in your stomach diversities. Older blood blood that looks like coffee grounds is partially digested and broken down or plotted. That tends to be a bleed further down. Sort of passed the stomach in the Judean, Um, maybe in there in the small intestine. And that's just blood Had to travel past the stomach. Basically, it has been broken down. It's no bright red, fresh, just come out of the secretary system. Likewise, have the same the other end. So you got Molina, which is dark, very sticky. There's a very distinct smell to Melena once you smelt it once, you'll know it forever. Um, it's pretty foul, and that's basically blood that's traveled a long way through the digestive system, basically become digested and then been passed. That's normally a bleed from the upper part of the gastrointestinal system, maybe in a soft agio believe that's gone all the way down or a stomach bleed or intestinal bleeds. Um, past a long way, been broken down a lot, clotted a lot on been passed. Something else that really worth saying with that is actually blood in the digestive system is a very it is dehydrating you. Blood is a very, um, it's for good, matey substances very good drawing fluid into it. So if you've got blood in your digestive system, that will often pull liquid from your circulating blood into the digestive system and so that basically could give diarrhea get very liquid blood that can get very sticky with this sticky, smelly, nasty, uh, stool alongside. The fact is, actual blood already in it is that something to be aware off. It's just a nasty cause of diarrhea. Um, comparatively, you can have red blood in stools of fresher blood and again There's two questions of this one is. Is the blood separate from the stool, or is it mixed together? So if you have a bleed, normally it's off the in the large intestine. You will still have red blood in the stool. But if it's near that start the large intestine, it might be mixed together, whereas if it's right at the end of it's a bleed in the rectum or bleeding the Anis like a hemorrhoid, for example, um, this could this normally we separate. So it could be that you pass stool and then blood. Or maybe even just you passed all. And then when you're cleaning yourself this blood on the tissue paper, um, and that that that's differentiate what? It's important to get that differentiation from the patient. When was the blood Where was the blood? If it's Melena, that's higher up to that small intestine stomach, duodenum, esophagus still bleeding. If it's mixed with the blood, that's normally the first sort of couple of parts of the large intestines us the ascending transverse descending normally, Uh, but then, if it's separate from the it's separate from the stool, it can be from the sigmoid or the rectum on. Then, if it's completely separate, like you, you pass stool. And then we were cleaning yourself this blood on the tissue paper that's normally the anus or the finals inch or so of the rectum. Um, and that that would be more likely, something like a hemorrhoid or a fistula. It is very near the end of the digestive system. On Getting that differentiation is really useful could tell you the difference between sort of a stomach untested cancer or ah, crone's disease or ulcerative colitis on if inflammatory bowel disorder. If I'm good about disease, this is something quite un offensive, quite common but quite straightforward, which is a hemorrhoid or the fistula in some cases. Oh, a Mallory Weiss tear. Just just something this's really that important to know that for interest, this is a very long, very thin tear on the esophagus, which causes quite a lot of fresh bleeding into the it's often gets you vomit up clear, fresh blood. This could be also this could be due to like projectile vomiting, causing the tear. Or it could be due to a lot gagging for some it first reasons. If you're choking or something for a prolong period on the reason I put it here and the reason why it's got its own special name of sort of tears. They're very difficult to fix. It was very long, and it's very thin is quite hard to close that off as quite difficult for it to heal itself. So quite difficult to repair. Possible You could have, like small, small tear. Small damage is which will repair themselves. They could be quite uncomfortable, but they could repair themselves. The Mallory Weiss tear being quite long, quite thin, is very difficult to repair. Um, the other one that's worth mentioning here is a thing called of viruses, which is basically do two liver failure that increases the BP inside your liver, which in turn increases the pressure in the systems next to the liver. The arteries around it, um, and that, in turn, causes them to protruding into the esophagus. This is quite common, not common, but most commonly occurs with, um, chronic alcohol use. Patients have been an alcoholic for quite a long time or other reasons why the liver might not work. Certain hepatitis infections, this kind of stuff, um, and basically that causes that to be large out pouchings of the vascular system in the esophagus. And if one of those ruptures, the patient will bleed a lot and they will vomit. A lot of blood on this is a medical emergency. They are basically having a major bleed into their Sophocles on. They need to have that repaired and the best way to repair that. Probably only real rip. It's repaired that design of it surgically, or is viral endoscopy, which is sticking a tube down the throat to find the bleed. And then you can basically cauterizes it with heat or cold, actually can cry cryo treatment on. Then you do a thing called banding, which is basically you expand the expand something around it and push it back into place and sometimes leave the band in place, but more often, or you just push it back and try and get it out of the esophagus itself causes a place where it could come across a lot of potential irritants. A lot potential, further damage. They go just mentioned this. It didn't realize that a slide on it, um yeah, liver disease leading to the distending of these vessels into the esophagus on then something. You know, if you swallow something really sharp, actually, alcohol itself. Some patients, when they drink alcohol that causes to bleed on, then that needs in. He's repairing. Basically, it's quite dangerous, and it's not a very good sign. I mean, so it's had a lot of normally prolonged exposure to alcohol if they had quite late stage alcohol and dependency or they've got some infections in the liver, some things like hepatitis. Yeah, uh, onto the lower gut. This is more. Ah, yeah. So this is gonna be the large intestine and maybe the last bit of the small intestine, and I think we finish after this. So I mentioned a lot about toileting diarrhea versus constipation. Diarrhea doesn't mean liquid feces, and I think it's important to get across diarrhea just means an increase in consistency. Uh, an increase in frequency or a ah, softening. A frequent of consistencies is getting maurico idi than normal. Well, a tip toe what the patient normally has if the patient normally only goes only opens their bowels four times a week, which can be normal. Um, there abouts four times a week in a sudden the opening their bowels twice a day that is, technically still diarrhea, even if it's not liquid that can be diarrhea and likewise the other way around. If the patient normally opens their bowels twice a day and it's now only doing it four times a week, that's still a normal amount of bowel opening. But that can be. But that is constipation for that person that's important to know what someone's toileting habits so like normally, how often do they go? Well, it's normally like on then to know what was changed, something that consultant told me in my second year on it. So I never really thought about in the past. If every individual for you there at home watching the series, it's important to look at your stool. So when you go to the toilet is important to have a look before you flush. Know everyone does. And I found that really weird because I think I've been doing this most of my life. But it's important to look at your still have an idea of roughly about you know how much you've been to the toilet, make sure there's no blood, and it's important to know what's normal for you. Because if you don't know what's normal for you, it's very hard to judge when something's changed. And so you need to know your normal. So then, if something goes wrong or something has changed, you can say this is what I'm normally like. This is what I'm like now, Therefore, that's my symptom and every patient Consejo that to you when they've got problems with their toileting. That's really, really useful, because you've now got a much better picture of what's going on. Um, something really good. Bit of advice. Everyone at home in your own life, even outside of being a healthcare worker or healthcare student, whatever it is you're planning to be, um, just just haven't idea of what's normal for you and not just went opening your bowels, but also in urinating. How often do I normally weigh? What's my We normally looking like what's going on that, um, just be aware of some, uh, you shouldn't need to open your bowels that night. If you wake up in the night and you need a poo, that is weird. Um, if you don't wake up in the night and you do poop So you saw yourself a night. That's also really weird. Probably more. Obviously, that's weird. So you should be. That's an important thing to ask the patient. If they're saying I'm going to the toilet five times a day. This is really bad. Ask them. Is it just when you are awake or when you go to bed? If you're still having to do it, Um, and if they're going to the toilet in the middle of night, is probably because there is a genuine reason they have to certainly like an infection. Oh, they've got yes, I'm going wrong. Uh, and it's a really good way to differentiate between patients who have physical problem and a mental health problems. I bs irritable Bowel syndrome is effectively a mental health issue of the gut. It's what's called somatic symptoms. It's a physical symptom. Do two or mental health cause, uh, it affects a lot of people. There's no shame in it. If you got IBSC Guy Bs, that's fine. Don't don't be. There's no point hiding. It's just a fact. Um, basic ideas. Patients shouldn't need to go to the loo at night at all. So if you're saying I've got diarrhea away, but then I get eight hours of sleep and there's nothing happening then, and then I go back to having diarrhea five times a day. That's fairly that that's a fairly I be espresso it a shin. If you say that I've got diarrhea five times in the day and one of those will be while I'm asleep, I'll have to get up to go to the toilet or sol myself in the night. That that means more likely it's something like an infection or in inflammatory condition on a healthy person person who's not got anything going wrong in their gut. Tall shouldn't have to get up in the night to go to the toilet. Um, certainly not open that bounce waiting in the nights a whole different game that could be affected by how much you're drunk. Your bladder's not great. Waiting your digestive tract is much better waiting for you to have to go to the toilet. Um, yeah. Useful symptom. To be aware of how often do you need to open your bowels? Anything from so twice a week, about three or four times a day? Is is a normal range, a person should know what's normal for them. And that's why I said to you guys be aware of what is your normal amount of time going to the toilet? Normal. At times you go to the toilet in a day in a week, Whatever. If you become dehydrated, you might go less often. Um, but also, if you're going to the toilet so often that you become dehydrated, that's not great on the of it is that is you comfortable? You know, you're going to often what works. What is your normal? What's happening now, Um, that, yeah, I b s often first thing in the morning or before something happens. And then in the middle of the day, not so much in the evening, maybe Mawr and then no, during the night. Um, I don't know why I put not during the day. It should be. Not during the night on that, Um yes. And also I guess patients, when they're doing something else when they're distracted, don't tend to need the toilet. So these are quite useful things, too. To know, to rule out ideas the idea is doing a lot of patients suffer from, but it's not particularly dangerous. They're having gastro symptoms because of a mental health cause it's not something doing wrong with their gut. Plus I, um, and ask patients about diarrhea. What do they mean? The diarrhea? As I said a minute ago, it can just be you having increased frequency of going to the toilet. It can be that it's more liquidy than normal. So that could be anything from normally have quite firm stools. And now that it's like soft to I'm now, you know, passing liquid. What do they mean by diarrhea? Is it just liquid? Is it mucus? Is it thicker porridge Like I know this is quite gross thing to think about it. Actually, once you get past that barrier on talk to a patient about this still generally assaults asking you about it and they sound confident and they know what they're on about, you feel a lot more comfortable discussing it. So if you get to that point of confidence, it makes everything that little bit easier. Um, like I said, I said most of these consistency blood shouldn't You shouldn't have blood in your stool. Bright red is lower, got dark red is up a gut Is it mixed? Is it separate? What's going on with that? Um, mucus? Some patients will pass mucus. Some people just do. It's normal. That's mucous that's being secreted by your digestive tract just to help the passage of stool just to stop it from irritating the lining. Um, lots of mucus convenient or a tumor or a pull it? Well, we'll send you to an IBD inflammatory bowel disease, like ulcerative colitis or crone's disease, because where it's inflamed, your body is going to make more and more mucus to try and protect the inflammation. And stop that from being a problem. Some IV espacio will just passed mucus. Sometimes they'll go to the toilet and just past mucus. That's no big problem, but it is worth checking out because there is that risk of it being cancerous or a polyp or some of this further up in the intestine. Um, Steatorrhea is pale stool, um, sometimes describes clay like or greasy, and this is just a very fatty stool. There's a lot of fact in whenever you've just past, so it could be due to a blocked bile duct due to a ball. Got a Goldstone could be due to a thing like pancreatitis or celiac disease because you're not absorbing your fats or because you're not producing the things you need to break down your fats. It could also, just because you've eaten a huge amount of fact. If you've gone and eaten, you know a lot of margarine. For example, margarine is not very well digested, so you could end up with a lot of you can end up with steatorrhea because of things like that, and sometimes you get it in patients who are on the Keto diet because the Keto diet 70% your calories should be from fat. 20. It's extensive set from fat 25 cent protein, 5% carbohydrate. Um, so if you wanna, if you're new to that sort of diet, maybe a body is not used digesting the fats yet. It's not necessarily a problem, but if you're having pain with it, if you're really having trouble with it, it could be something like a gallstone or pancreatitis. Both of those are quite painful, and celiac could be very painful and very unpleasant. Um, comfortable slides do I have left on his double? Check that one. Uh, because I don't want to overrun dramatically. Okay, I'm gonna go couples, which is fine. So it'll symptoms don't see. Do you need to go to the loo urgently or can you wait? And it shouldn't be normal if you need to go to the toilet urgently, isn't that isn't normal? You should be able to sort of know when you're when you're going to need to have the flu, have a fair bit of warning and go to the loo in your own time. It can be normal, but it's no always no, in constant is definitely not normal. You should never open your bowels about intending to on this committee just of the colon issues or sensation issues. There are some things, but yes, it's suddenness can be normal, but shouldn't be. But there are certain reasons why would be normal. Ask patient if it is normal for them in constant should never be normal. 10 is Mohs, which is, um, feeling like you need to go to the toilet even when you don't. This shouldn't be normal. That's the symptom. Tenesmus is that sensation that you you need to open your barrels and actually, if you go to open your bowels. Nothing happens. Um, cavity to information committed to various things. But it's worth checking out if you have it. Incomplete evacuation. So you go to the toilet, you open your bowels on. You don't feel like you've emptied entirely. This is quite common with I be s, um other reasons as well. So again, if you're getting that regularly, probably worth seeing a doctor over it, um, and then straining, straining is normally sign of constipation. Um, what is normal? What is not normal for the patient if they're straining a lot and they haven't been before and nothing has changed, this could be a problem if they are not. If they strain a lot often it could be dietary. Remember, fiber and water of the two main things to prevent constipation, lots of dietary fiber and lots of water that makes off still softer and easier to pass and prevents constipation and therefore prevents straining. And actually, if you're not straining your unlike to get things like hemorrhoids, very useful information. Um, yeah, this is no one is self digitate. So basically, if you're having a blockage right near the India digestive system, so in your final bill your rectum. Some patients will have actually stick a finger up there bottom and break it up on. Then they'll pass. That's not a great thing. Um, yes, really not great if they tell you you're doing that and sometimes you get older patients who say they do this or younger patients as well. Um, it's not good, and you need to sort of intervene in that one. Fiber and water two most important things in your diet to improve symptoms of constipation. They have one that people sometimes my use laxatives. Actually, laxatives should be the last option after you've gone through increase fiber and increased water. The last couple of slides now, I think, prior to say, and I literally means ichybum itchiness. Normally, it could be due to a parasitic infection or due to poor personal hygiene. So poor cleaning of the anus after you pass stool. That's more common in Children. If they see not cleaning it properly in adults or people who are looking off themselves better, it could be a sign of some sort of parasitic infections, worms, something like this. Uh, is this the last going for I think I'm getting close to my end. Me just double check I can up to most. Let's this and one more. Uh, I still got people. That's good. I'm not bored. You a little death yet? So all ST Colitis colitis on crone's disease of the two main inflammatory bowel diseases IBDs, as opposed to I. B s IBDs. There are differences between ulcerative colitis and crone's. Also, colitis is just in the colon. Crone's is everywhere, from anus to mouth, so it could be all of the intestinal. A logistic system might have ulcers for crone's only the colon for all surgical itis. Weirdly, also, colitis can improve with pregnancy of the patient becomes pregnant office. You know, every patient can. Roughly a third of these patients will go back to how they were. Um, but yes, basically, a third of patients will get better. A third of patients will improve to the level they were at war. That pregnant, and a third will go back to how they were before they were pregnant. So generally people get better with pregnancy if they have also have colitis, politician hormones, fluid buildup. This was that and smoking weirdly, this is like the only time where it's sort of okay, there's a couple of times, maybe where smoking is slightly acceptable. One of the main known benefits off smoking is also a colitis. Patients. It's sort of believed to be linked to the nicotine. Um, there's previously been this idea of using nicotine Emma animals to improve flare ups. Also, colitis that not use these days the things like nicotine patches might be like some people do use nicotine patches, and that's when they're having a flare of the ulcerative colitis having diarrhea and lots of discomfort. Some people take up smoking in that period, or some people use nicotine patches and it can help alleviate the symptoms. Um, they're just to kind of hard facts, I thought, Well worth knowing because they've lost knowing, Really, Um, this is the last talk about his biliary blockage. So your bile ducts, basically your ability to just fats is due to your, um, bile acids. These are produced in your liver. They're past and stored in your your bladder, your gallbladder contracts to excrete them into duodenum. To mix with food mix of China's is at that point that helps break down fats to be absorbed. If you have pales stools, diarrhea, floating stools, these things, it could mean this fat that's under jested in your poop. Um, this is not always due to fat intake. It can be due to excessive fat intake, but more often it's due to insufficient biliary acids in the digestive system. Normally, I would do to a blockage or insufficient production, the most common cause of the bile stones. So that's Ah, basically the the acids solidifying to form crystals inside the bile ducts inside the bile duct or the goal bladder and eventually forming together to make a stone similar to a kidney stone on that can then block the bile duct and stop you being up to pass the digestive enzymes into the intestine, where you can break it down where you could break down fat Normally. This compared with very dark urine, Um, basically because of the fact that we also use those bile acids to breakdown elements from the urine, Uh, on also because the fact is because a buildup of problems in the liver and stop the liver working as well. Um, and it's also because certain things from the certain things from the blood of filtered by the liver and broken down and put into the boil assets to them into the stool and be excreted via the digestive system. If that's not working because you can't know excrete in that way, they then have to be filtered by. The kidney is excreted in the urine, causing dark urine, sometimes brown urine. Um, this isn't great is the one which is a word I'm not gonna go to pronounce, which is Colon Geo are so no more, uh, basically cancer of the common bile duct. So that can cause the same blockage, but without the stones and that is the end. So I'm going to leave with this lovely little seal. This is me adding the secret six F six f to the to the mix. So you're five, As I said earlier, that feces flatus fetus fluid and now fluff because fluff is adorable. Who doesn't love a fluffy seal? So that is the end of the session. Thank you. For those of you who have stuck around for it, there's a lot of information that I'm sorry it was a bit too much the this whole series. We're trying to do different styles of teaching to give you sort of exposure to what you're normally see it university, because no, to lecturers air exactly alike. Um, we will give different styles. And so, with the serious, we try to do a bit of variety just to give you a bit of exposure. If you have any questions, please do you pop them in the queue and a Morgan happy to answer them. Or you can email me them. Otherwise, you're more than free to go. Um, please, do you fill out the feedback formed by a medal? We are really, really interested in your feedback so that we can actually shaped these to be better sessions for you. Um, and if you're interested, do please go and take the get the certificate. Oh, because you can add it to your, uh, you can add it to portfolio if you're interested in building a portfolio for applications and like otherwise, I won't give you another 60 seconds just to check to see if there was any more questions. If not, yeah, you know, it's 40 more seconds. Um, if not, we'll finish their thank you, everybody. Um and what was actually said he was going to be. It's going to get back over. I can, but I'm seeing nothing in the queue and a so go. Just let the 40 seconds run out. 10 more, A little in recession. That's about the end of time. So thank you, everyone. Uh, feel free to email me. You have any queries anyway? Thank you very much. Good, right?