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Do you want me to get it? Oh, it's still loading, it's still loading. IDA is gonna introduce right now. Perfect. So, hi, everyone. Welcome to um another one of our lectures. So today we have Adele, a final year student with us. He'll be going through main gastrorenal and urology conditions in Keith. There'll be lots of SBA S so keep your eyes peeled and I hope you enjoy. So I'll pass it over to Adele. Ok. Hi everyone. Um I can't see you but um I'm Adele, I'm one of the final years, so I've just done my MLA done my CPS A and I'm gonna be talking to you guys today about pediatrics. I um if you're watching this recorded or you're watching it live like I'm very into teaching, so I'm happy to help with anything. So you can just drop me an email. I also speak. I also speak quite fast sometimes. So if I'm speaking too fast can like um someone like shout out or let me know, I guess. Um Yeah, so basically we're gonna be going over gastro renal and urology. So pediatrics is a really big topic as you guys are probably aware. Um, so, yeah, like I said, I'm, I'm also really interested in PED S and I'm about to do my P SA, which is your progression to F one where you basically do five weeks of any specialty. Um, but usually you don't get to choose it, but they're trialing a PED S one. So I'm just about to start peds for another five weeks. So again, if you guys have any questions or you've done your peace of rotation or you haven't, um I'm in Mary. So just come find me if you guys want any like teaching or anything I can help with. Um I thought I'd start by giving you guys like a bit of advice about fifth year just because fifth year is by far the most daunting year. It's the worst year, but it's also like the year where you learn the most, probably feel closest to being a doctor. Um So I think, yeah, so like just quickly before and we'll go over this as I go over the topics as well. But basically work smart and hard, but mostly work smart. So basically, there's so much overlap in path. So I remember thinking like, I literally didn't have to do path path is like horrible. It makes no sense, but there's so much overlap, especially in pediatrics and pathology. So for example, like, um all the like hematological condi conditions that you need to know for peds. So like acute lymphoblastic leukemia and basically all the heme ones are done on your heme, um, heme topic with pathology. So you're kind of done with that, same with like, um, say, like Crohn's. And you see, I mean, you've done that already in like older years. But, um, that's just something again that you can, you can literally just do those, um, at one go and then you've like, kind of hit your beds with one stone and I think that's the key with fifth year is that's so much of it. You can do kind of at the same time. Um Yeah, I think the hardest part of fifth year isn't even the content. It's how long it is. And you guys are already like way more than halfway through. So just kind of hang in there and like take a break and every now and then because you won't um like the way the reason why people can struggle a lot is because they burn out. It's not because of content or stuff like that. So, um I also, I know about PS which I know this isn't a PS lecture, but I'll touch on some things that are common topics in cases, but all PS is all about being safe. So like, don't stress yourself out about PS because PS should kind of be your easier to exam because if you just, if you knew every single bit of content then, but you're a robot, you wouldn't pass. Whereas if you kind of literally knew like basics, but you were confident with it and you were safe, then you would definitely comfortably pass. So I think that's the key thing about patients to think about is being structured and we'll kind of go through the structure when I teach you about topics um that will hopefully help you and yeah, fake it to make it, which is the same thing for all finals as well. It's all of the like practical exams all about like smiling being like structured in what you say and also just being safe. So in the day, they don't want you to like know every single like nitpicky thing because that's not real life. Like you just need to know when you'd escalate it. And then I also, yeah, so any questions or anything my email is at the front. But yeah, just message me or anything. And for this whole um presentation, I use nice guidelines from like, I guess when I was putting together this was like a week ago. So it should all be up to date. If there's something that isn't up to date, I will let you know. And um basically you need to use nice guidelines from fifth year because that is what they base it on, especially with OG um and PS is because it can be really nitpicky. But if nice guidelines says something like this is first line, then you can confidently say that that can come up because ultimately, you're not doing the MLA yet and 50 you're doing these, um, doing these questions made by the course leads and, yeah, so obviously I'm so sick there. I survived fifth year. Um, but I apologies for my spelling mistakes. Cos I'm quite bad at spelling. Yeah. So just to get into it a bit. So I'm doing gastro and then I basically did renal and neurology together because I know about you guys, but I find that the gastro was quite confusing, impedes, but hopefully I've kind of put it into perspective a bit and hope you be a bit easier. I've also used stars at different points like and where they are on the slides is um kind of like high yield bits of what they ask you about that condition should make more sense when we go along. I also am like a colorful visual learner. So I've done like quite a few things like that. So um all the information and all the key points are on the slide. So if you're a bit confused by anything, a all the information is there, so you can just go back towards it um either looking at slides or rewatching this or whatever you want to do. So, getting straight into it is um we're gonna start with necrotizing enterocolitis. So I don't know if any of you guys have heard about this, but this is sometimes called neck and what it is it's a really important condition to understand and know because it's a cause of really high um mortality amongst um young Children and um or premature babies mostly. And the key with this in like SBA LA questions is that this happens with premature Children. So if you see in the question stem that it's like a 28 week old um child and like things like this and you wanna start thinking about neck because neck is not gonna really show up for a baby who's born at term and no one really knows what causes it, which is almost why it's so, um, hard to treat. Sometimes people think that it's because of ischemic injury or like to do with the micro, but also it's to do with like how fragile, um, these premature neonates bowels are at the time. So, um, the way I think about it is history, what you'll see in the stem is, um, prematurity, some sort of feeding intolerance. So either they like, reduce their feeds. Um, obviously the whole point with pds and gastro is you're not gonna have like a one year old saying my tummy hurts in this part. So a lot of it can be quite vague symptoms. So what you, a lot of the information you get is how they're feeding, which usually the parents can tell you in a pa context or in a real life context as well. Yeah, they'll also sometimes have bloody stools. Um, and if it was really late stage and they can pass away from it, they'll also just have a distended abdomen. So, what they'll say in the question stem, is that a premature baby has come in their feelings or they sometimes, well, in ICU, when this happens, um, their feelings have stopped and they've also been having like a distended abdomen that can be quite hard on palpations sometimes. And so the key thing is with investigations, you'll hear this a lot today, but it's bedside bloods and imaging. That's how you do every s especially, but for this majority of things is an abdominal X ray. And for this, um, you'll see an abdominal, um, so you'll see dilated bowel loops of bowel, which there are actually a lot of other signs as well to do with, um, the Aboral X ray. But I put a few pictures here. I don't know if you guys can see my cursor, but if you look at basically all of them have arrows on it. But if you see these kind of like kind of like gas bubbles, it's the best way to think about it. They might give you a picture like that as well with the history in your, um, exam. So that would be like a spot diagnosis, necrotizing enterocolitis if they said it was a premature baby feeling intolerance and they gave you this sort of abdominal X ray. Yeah, for this, it's mostly a spot diagnosis it's not necessarily about how you treat it, but I pop the treatment in here anyway because it's always good to know completion. It's quite cyst. But, um, the gist of it is you stop feeding because you basically don't want the, um, I mean, you stop enteral feeding, um, for usually set 24 hours to seven days and then you use a TPM and it's quite, it's a, it's an emergency and what happens is, um, and you also get antibiotics and usually they'll have to have surgery if they don't respond to this and this is all done in specialist centers. So, my, um, specialty choice placement was neonatal ICU. And if any of the babies had this sort of, um, condition, they would immediately go to a complete specialist center where they have specialist surgery. So that's just something to like, bear in mind. But if a question is like, how do you treat this or what's a different of treatment? Um, it's usually surgery but sometimes they can just be managed by stopping feeds and managed conservatively. But they're not really gonna ask you about treatment for neck. Ok. Next condition hash's disease. So the way I think about conditions is you want to think, what is it like if someone asks you to explain it and then you think about history and exam and then any sort of associations or risk factors which are kind of like buzzwords because that's what they'll tell you in the questions stem. So hash BRS, I don't know if you guys have heard about this is basically when um near the rectum, there's just a lack of ganglion cells. So basically just Ronal cells. And um what happens is the key thing with this is a delayed passage of meconium. So I don't know if you guys know any of the other causes of delayed passage of meconium. We'll touch on that in a second, but that's like a really key like buzzwords to look out for. They also tend to have abdominal distention. They can have like other things like chronic constipation if it's kind of found in older Children, but it's really unlikely. And usually this is found like within the first like 48 hours, basically, um 10 to 2 hours because that's when they haven't passed out meconium and they're all thinking, why is this happening? And classically on a question, you'll hear that when you try and examine the rectum and you withdraw your finger, you're kind of getting this explosive um explosive liquid stool and risk factors for this is Down Syndrome. And you'll see actually quite a lot um through these conditions that Down Syndrome is associated with a lot of them. So I think it's worth just like going through that a bit as well because that can give you a clue in the question. And um so about like 75% of them are kind of confined to the rectosigmoid. So it's kind of like, well, this picture shows and again, um bedside bloods and imaging, but gold standard is a full thickness rectal biopsy. They will, they can ask you.