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okay. It is life now. All right. Welcome, guys. Um, to my session. Can you guys see my screen? Okay. Can you just, like, type in the chat if you guys can actually see the screen? Can you guys hear me? Okay, as well. Nice. Okay, Good, good, good. Right. Um, I think, um, we're just gonna wait, maybe for, like, one or two more minutes, and then we're gonna start this off, right? When is your how many people is? Uh, second year here. I assume a lot of important to be a second year. Have you got lost? Second year here right now? What kind of year are you guys in? Come on. Okay. Nice. Nice. Nice. You guys feeling okay? I heard that you guys have, like, all ski s woe. Is that true? Like all ski all spin medicine. They changed it, apparently. Oh, my God. I'm really sorry to hear that. Guys have trusted you guys, but after after this session, it's gonna be a Okay, um, you're gonna be professional. G. I, um Consultant. Um, yeah. So right. How many people have got 23. So should we start? Okay, Weight, By the way, Raymond. Is there any way that maybe we can record this session or No, it is recorded. Right. Okay. Right. Okay. Right. So should I stop? Right? Are you ready, kids? Okay, right. Hello, everyone. Um, my name is Kerwin. I'm a third year medical student from Aberdeen. Um, sounds like introducing myself to a patient, but anyway, um, so today, we're going to do, um, g I block speed run. So it's kind of like, um, uh, already quick go through on the major topic. They love asking it. However, it's not like, you know everything. You know? Um, you know, you guys, um, I have noticed, like, I didn't include, like, some stuff in there, but, like, these are the presentation here are going to be, like, the major stuff. Okay, So if you learn, everything here is very likely is you know, you're going to get, like, at least be, um be one. Um, yeah, but hopefully you guys will enjoy this session. Um, so, yeah, let's get started. Right. So here are the learning outcomes. Um, so, as you can see, um, let me just put my points, and it's very important this year right now. And at the end of this session, hopefully it can be you right here. Okay. Right. Let's go. So I'm just gonna quickly go for a structure of this lecture, not lecture like this session. It's gonna be informal. So, you know, uh, esophagus disease, and I'm going to go to stomach. It has no pancreatic, um, liver disease and hepatobiliary. Okay. All right. So just a quick definition. There are, like, you know, um, a little bit, um, some words to sound very similar. Like, they have different meanings. Um, they love doing that. Like, oh, patient's come in, um, with DYSPHASIA Or like dyspepsia. They don't act. They don't. They never they would never say. Oh, they have difficulty difficulty swallowing food. Okay, so they love doing that shit, like, you know, um, just love doing that. So, dysphasia, um, is basically the difficulty when you know, swallowing the food or liquid. Uh, all the nerve age is basically the pain with swallowing and dyspepsia is, um the pain of this comfort around like the epigastric region. So, um, I just also put here the Greek this and pepcia. Okay, So, um, I hope you guys can understand that. Right? So, um, the first one got is, like, definitely some of the biggest, you know, disease that you're gonna learn in G eye. Um, So, um, so, basically, what happened is that, you know, the gastric acid reflux into esophagus. Um, that's gonna cause the thickening of squamous epithelium and also causing the ulceration of the esophageal epithelium. Um, why is that? Because the esophageal epithelium, it's not really built for, um, stomach acid. So, yeah, it's very likely that, um, the acid's gonna damage this of Julia. Okay. Right. The typical symptoms. Heartburn, Um, cough, um, sleep disturbance. Um, and also something called the water brushes. Well, um, does anybody know what water brushes just like to be in the chat? If you guys know. Right. OK, so water brushes. Basically, that's, like excessive, like, uh, saliva production. Um, when it's mixed with, like, a stomach acid, that's been refluxed. Um, so, yeah, it's, like, kind of like, common sign. Okay, so, um And also, um, there are some when you see some slides that I put in bold and also highlight. Um, these are the stuff you have to know. Like, you know, I don't care If you don't learn any other thing else, you have to learn. You have to learn by heart like I don't care what what you have. I don't care if you're if you have to learn by heart. Okay, So the treatment for God, you have to learn that originates, um, and the histamine blocker and the PPI, Um, and also is something that they love doing that as well. They just give you the drug name. Um, you know, they don't tell you like, oh, sometimes they will give you like, oh, which are following medication is good for God. Okay. Maybe do allergenic if they, you know, if they are feeling, you know, good. Um, were they making the question, But most of the time to give you, like, the drop lanes, like, you know, um, or which are following drugs are, um, useful for God. Okay, so I just ate, and then, uh, he's gonna be blocker, and then PPI. Okay, um, it's good to learn the, uh, the, uh uh the drug name as well. Okay. And if the drugs doesn't work, they don't if they don't work, Um, there's a surgery core fundoplications so basically they kind of, like, use the funders of the stomach to wrap around the esophagus to make it like it's kind of like, act like a like a spectre. Okay, to make this office is tight. Tighter. Okay. The upper, uh, Specter. Okay, um, there are so associating factors. Alcohol, nicotine. So, um, uh, you know, is very likely that you can ask that. Um, yes. Like, you know, um uh, patient alcohol abuse. Or, like, you know, they're long term, um, smoker, you know? Yeah, they they're gonna get like, these are like the hints you have to know. But like, these are other things you have to know. Okay. So, again, the things you have no other highlights it and the bald one. Okay, right. So, again, one of the main complication for God you have to have to know again is barrett esophagus. You have to know that. Like, if I say like God like complication for God, the first disease, you have to think of spare esophagus. So basically, um, it's time for me to place here. It's not really cancer yet, but it's more like, you know, medical in stage is kind of like transformation from the squamous epithelium. So that's normal. Uh, distal, uh, epithelium of esophagus, squamous epithelium. And then because of the chronic, um, long term, Um, uh, the damage, um, is going to lead to the change to Columbia Epithelium. Okay, so that's the change. Okay, so the Barrett's esophagus is the meta plastic columnar epithelium. Okay, they love asking that. So they say, Like, what's the histological pathology for Barry esophagus? Um, uh, so basically squamous epithelium to, uh, plastic columnar epithelium. Okay. And later on, the Barrett's esophagus is going to develop. Um, something called esophageal. I don't know carcinoma. Okay, so that is beyond the premalignant. That's the cancer. Okay. So, again, I don't know carcinoma and no means gland. And then So basically, it's like glandular epithelium. And it's cancer. It's, uh it's not good. It's not very, um, cash money for the patient. Okay, So the treatment for Barrett's esophagus, um, you know, these are two treatments, uh, usually radio frequency ablation as well. Um, or reception, Um, again, like, it's very unlikely that you're gonna ask that. So I didn't highlight them in both. Um, but this is good to like. Keep that in mind. as well. Okay, Right. So next one, um, motility disorders. Um, so they are generally hyper motility and hypomotility motility. Okay. Um, yeah. So, basically, let's just keep going. Right. So for both, you know, a multi hypo or hyper mobility motility, um, use, um uh, endoscope. Endoscopy is kind of like a You know, the gold standard is kind of like to see, actually, diagnostically find out exactly what kind of what what was happening. Okay. And barium swallow. Barrasso is usually the first line, uh, again, you know, it's like the generals or from in medicine. You know, um, we start the investigation with the least invasive. Okay, Well, from majority of the conditions, okay? And so we're gonna see like that. We would, uh, eat some barium food. Um, uh, you know, and then it's gonna do, like, you know, x ray and everything. Or, you know, it's like it's kind of like the barium acts like a contrast. Okay, It's kind of see lining of the esophagus and the the guts, not the guts, the stomach as well. And my mom a tree is basically it's kind of like measuring the pressure of this winter to see like Oh, it's It's the It's the winter working. Okay or not. Okay, right. So, again, hyper. Uh, motility. My apologies. So one of the main presentation in barium swallow, you will see a corkscrew appearance. Okay, so if you whenever you see like, oh, barium, swallow corkscrew, the first thing you think of is hypermobile motility. You don't even have to read the entire questions. You just go. Oh, Costco appearance. Hyper motility. That's it. That's it. Okay. You don't have to think about anything. You just press hyper motility. I don't care about what other things is. Okay, so there are the presentations as well. Um, Sophia, uh, episode of chest pain. Um and you know, usually for how burn as well. A lot of people get confused with angina, but Yeah, I'm just, uh keep that in mind. Okay? Um, and yeah, and then, um uh, other, um, presentations as well. And the treatment. Nine trade and calcium blockers. Okay. Um, these are like the smooth muscle relaxants. Also, uh, I don't I don't think they might ask her, but it's also, you know, Yeah, keep that in mind as well is, um, they can't ask that. You know, they can those, you know, people can ask anything. So, you know, right, Anyway, And then, um, next one, um, hyper motility. Um, achalasia is really, like some of the most common hypermotility. There are other hypermotility, um, conditions as well, but this is, like the most common one. Okay, so for presentation, um, the main one is like, you know, the, uh, the, uh the signs that is basically progressive dysphagia for solid liquids and, well, especially liquids. Um, weight loss, um, usually weight loss. Because, you know, they are, uh, you know, the digestion is not very good, so it's causing the weight loss. Okay. And again, it's a little bit weird. You know, the treatment, the medical medication for hypo and hyper, um, utilities. It's kind of it's it's the same. You know, we use the nitrate and the CCB, but yeah, it's just I mean, it's easier to remember, I guess, and also, um, the main complication for hypermotility. You have to remember as well. It's, um, the squamous cell, uh, video carcinoma. Um, so it's actually much high risk of getting that as well. Okay, right. So first it's offered to your cancer. So there are two main types. This one you have to have to know as well. They love fucking asking that. I'm sorry. My apologies. My language. Um, squamous, um, carcinoma. Can someone tell me? Put it in the chat. Um, where does it occur? In the esophagus? Where does it occur in the esophagus? There for squamous cell carcinoma. Where does it occur? Usually in the esophagus. Okay, right. Very nice. Very good. Very good. So usually, um, proximal middle third. Well done, Hannah. Um, so yeah. Also, esophagus. Um, the main, uh, risk factor of tobacco and alcohol. Okay. How about for adenocarcinoma? For adenocarcinoma? Where does occur in esophagus. Nice. Very good. And very nice. Okay, Right. So this still esophagus. Um, the way I remember is like, you know, usually, like, you know, they're like, you know, the esophagus. You know, uh, you know, the, uh, the possible part of, like, you know, um, kind of squamous and I don't know, you know, it's, like, really bottom part because, like, you know, I don't know again, glandular tissue. So they are like, you know, um, more for digestive esophagus. You know, hopefully you guys know but it's time. It's not really for digestive. Okay, Um, so, you know, um, digestive. More like, you know, the bottom of the of the, you know, of the, um of the track of the GI tract. So, like, you know, the stomach. So, you know, So you know, which is, you know, the distal part of the esophagus, you know, closer to the distal part of the esophagus. So, you know, this is so part. So I don't know carcinoma because, you know, it's like the gland closer to the stomach, okay. And the squamous cell carcinoma. Because, like, you know, like, non digestive, um, function. So, you know, it's like a proximal and or, you know, more specifically, the middle there as well. Okay. Right. So presentation of esophageal cancer? Um, there are. These are two main ones, Major. Major one, um, anorexia, weight loss, kind of systemic. I mean, by this time, hopefully, you guys should know like cancer. You know, um, flags are, you know, um, these kind of things, Um, yeah, basically, um, it's kind of similar, but like, you know, it's very Yeah, so it's very unlikely. Like they're gonna ask. You like to differentiate without telling you the result of the investigations. Okay, right. So they love us. Love doing that. Like for GPS? Well, um, so when do we where we're going to go for, um, endoscopy, Usually in the pneumonic alarms. Um, so in your excel, when there's, like, loss of weight and then anemia. Especially when there's like, um, my iron deficiency. Um, So, um, and then recent onset. Um uh, Melania. So you know. Yeah, GI bleed. And then I'll go further into that, um, solving problems. So these are, like the flags, like cancer. So, like, you know, whenever you see these flags, always straight Urgent. Reflow, um, re referral for endoscopy. Okay. Right. So we're gonna move on to stomach. Um, yeah, I just found a picture. Really cool. So I felt like I have to put their right, so definition, Um yeah. Again. Just, uh if you guys just in case you guys forgotten, you have dysphagia and then, you know, blah, blah, blah. Right. Okay. So can you guys tell me, um, write for alter immune gastritis? Um, can someone tell me, like, the pathology, like, what is like, what kind of cell? And then are. They is affected in the guts. Like what kind of cell? Usually in the in the in the stomach. Does anybody know what kind of cells? Nice. Very nice. Very nice parietal and intrinsic factors. You know, they have been, uh, they basically make the immune cells making antibodies against towards the priority cells. Produce cells of the of the stomach and also, you know, towards the intrinsic factor as well. How about the bacteria was the most common. The cost of a causative agent. Bacteria, causative agent, Um, gastritis. Very nice. This h pylori. I don't care. You know, um, about what you think you have to remember H pylori is like, just call scarce writers, okay? And And states, um I'm sorry. Passed a little bit too quickly. Um, yeah. And so it's alcohol. Um, And it was like some of the big one. Okay. Again? Uh, yeah, for peptic ulcers. Um, so because it's the main one is hitch pylori, you have to have to learn that. Okay. They love asking that which of the like, which of the following agent are the most common causative agent for the peptic ulcer? You have to learn that by heart, inside out, outside and inside out again. I don't care. You have to learn that. Okay, So basically, it's just like it causes the increase of the gastric answered in, uh, production. Okay. And there are some investigations for h. Pylori infection. You know, the most common one. Kind of like your your breath test. It's kind of, you know, it's not very invasive, so it's kind of like the first line, and then it's kind of a G G as well. Um, just test out, you know, if that's like, you know, anti antibody for h pylori. So confirm the infection, and then the stool antigen tests. They also do that as well. Um, and then there are some more invasive, you know, to confirm with more. You know, um, diagnosis usually, um, rapid, um, slide us test. Um, it's nice to keep in mind, but again, like the definitive one. You know, it's always going to be the autopsy, you know, culture and histology. But, you know, they're going to take a while so that they're not really like, you know, the gold standard. Okay, Okay. Right. Peptic ulcers. There are two main types. Um, gastric ulcers and then Georgino else is How can we differentiate that? I'm gonna give you guys a hint Is something to do with having food. Okay, how do you differentiate that? Like, you know, gastric ulcers. What is it known for? Like if I have food, How How is the how is it gonna affect the symptoms for gastric or Georgino Alsa? How is it going to affect it? The main major major difference show. Yeah. Nice. So that is get gets better with eating. Which one is that, right? Worse. Something gastro. Exactly. Nice. Good, good, good. So gastric ulcers. It gets worse when eating Julian Tulsa. Um, you know it released by eating. Okay, so, um, the way I think of that, I mean, it's not the way I think of it. It's like it's literally the reason. I think, um, so, you know, um, whatever it is, a food you know comes in. So basically, why? What What causes the pain is the gastric acid have is contacting with the ulcer. Okay, that's causing the pain. So whenever you know, that's a when whenever you're eating food. Okay. So you know the stomach is going to produce a lot more stomach acid. Okay, so it's going to trigger the ulcer, the stomach ulcer. However, in the when, when we're eating the food. Okay. The the politic entrance of the stomach. Closest the closest. Okay, so the acid can no longer get into the Geo Dino part. Okay. Toujeo Denham. So, um, it's gonna, you know, So it's just gonna, you know, relief by eating Ingenio Georgino, Elsa, And, you know, it's the opposite in the gastric ulcer. And again, this one, um, it's nice to keep in mind that Georgina also is a lot a lot more common and yeah. And also nausea, vomiting, um, weight loss. And then, um, paternal hunger. Hunger pain issue More common in them. Um, did you as well? Okay. And also, keep in mind one of the main main major complication in captain ulcer, um is preparation, um, so just just be careful, okay? And also, we can bleed as well right again. This I would say this is the major one. You have to learn treatment for peptic ulcer. Um, you just have to learn it by heart. Um, you know, again, um, triple triple therapy. So, basically, you know, eradication therapy for H pylori, clarithromycin amoxicillin and omeprazole PPI. Okay, And again, um, if a patient is penicillin allergic, you can give tetracycline. Okay? You have to have to learn for seven days as well for seven days. Okay, It's not 14 days, seven days, seven days. Free drops. Okay, You have to learn it. I know where you live. I'm gonna come in and find you, and I'm going to shave your shave Your pets head like that. Okay? So, yeah, just keep that in mind if you don't learn that, I'm gonna come find you, OK? Okay. Right. And and be the the BD means, like, twice a day, by the way, But you don't have to learn that. Okay? Right. I b d Okay, everyone's flight favorite. So, um, also with colitis and Crohns. Okay, so there are general presentations for IBD. Blood diarrhea and pain fatigue. Weight loss is kind of similar to cancer. Um, yeah, I'm just gonna Yeah, we'll go through it like, how can we differentiate that? Okay. Of the major one? Um, if I say like, oh, what's the investigation for IBD? The first one that pops in your head. You have to think about is fecal calprotectin Okay? This is, like, you know, kind of like, um, first one, you do like, you know, a fecal calprotectin. It's like a inflammatory bowel marker protein. Okay. Basically, is released in the guts whenever. That's like inflammation happening in the guts. Okay, so you have to You have to learn that. Okay, um, you don't really have to note. Um, you know, I really have to know the values. Um, but the thing is that I Yeah, I'll recommend it. I mean, um, just just learn 50 and then 200. Like these two numbers. That's it. You know, um, yeah, I guess. But, you know, it'd be nice if you can learn, because you you never know what they're going to do, so, you know, let's be prepared. Okay. Right. So, um, also low albumin and also endoscopy bell, see, is these are, like, you know, definitive diagnosis investigation as well. And then p Anca p anca is kind of a like a gene protein. And then, you know, for, um, you can confirm in the, uh, IBD, which I will further go into okay. Rights for also, um, for ulcerative colitis. Um, this is my dog, Jeff. Right. Um, anyway, also with the colitis, Um, the know Monix No, it's close up, you know? You see, um, close up. Yeah. I mean, there's some really mix, but it is what it is. Look. Okay, right. Um so, see, you know, continuous inflammation, so you don't see, there's there's no skip lesion is continuous the entire track. Okay, the entire lesion is continuous. There's no skip. There's no, like, skipping of lesions, you know, Just keep going, okay? And you see, lonely Lim limited to the colon and rectum. There's no, um it doesn't really have, like, a small about involvement in there. Okay. And also the it only occurs in the the only in the superficial mucosa. Okay, so, you know, if you cut it in half and transfers section, okay? It's only like the superficial Okay? Smoking protective. And then, you know, usually they're like, bloody and mucus. Um uh, stool. Okay. One of the main thing as well is you have to have to use, like, you know, um, aminosalicylate, um that is like, you know, that's how we differentiate. There's not normal, differentiates it, but like, that's the main difference. You know, um, in treatment in, uh, comparing to, um, Crohn's disease. Okay. And also it if you we use aminosalicylate. Okay. Amino. So I said I've done that. Um, and also, they love asking that as well. You know, it is also difficult. Itis has a strong link with primary sclerosing cholangitis. Okay, Um, yeah. So, um, which Crohn's doesn't really have, right. And also HLA Genes, Um, uh, it's kind of strong. It's really strongly linked to also a typical isis as well. And also, um, you see, does not have, um, granulomas. Okay, if it does, like in the histology wise, there's no granulomas, All right? And for classifications, for ulcerative colitis. They love doing that. Especially, like, you know, patient comes in with, like, oh, um, five stools a day. Um, you know, what is the management or like, What's the severity? Um, you know, they love doing that. So remember, like, um, these, like you just You just have to learn, Um uh, the criteria. Um, but the thing is, it's not too difficult. Just remember, the number four and six. You know, less than four is gonna be miles four and six. It's gonna moderate more than six blood stool or stools. It's gonna be Sophia, Okay? And yeah, just that's that's it. And also, you know, Sophia, if they have, like, any other symptoms as well, so that's a nice way to learn it as well. Okay, um, there are, like, you know, um, to kind of treatments for also typical lightest one is inducing remission also maintain remission. So right now we're talking about inducing okay, remission as well. First. So mild and moderate so again, you know, mild moderate. So between 4 to 6 stools a day, mild moderate, we're going to use first line aminosalicylate. Okay. And a lot of the time they don't use the word administrators today to use the word massaging. This masala scene is kind of, uh, the most common they use. Um, uh, I'm gonna start to sell it. Okay, Um, the other ones that so far as, um, service so, so far seen, I think. Yeah. So, um, but like, you know, massaging, they're probably just going to keep using it, but like you have led by heart and sadder seen. Okay, second line. If, like, you know, if they If it doesn't work. We're gonna go for cortical steroids, mainly prednisolone. Okay, if it's a fear. So there are more than six. Or, like, you know, 10. Yeah. Yeah, More than six. And also, like any other symptoms of these symptoms. First Line IV, You know, a lot of the conditions. You know, when you see like, Oh, it's a severe disease. You know, always go for IV. Okay. So, IV critical steroids again? You know, the general rules of thumb for critical steroids. Just pressure immune system. Okay? Because like, you say, it's can't. It's basically like autoimmune. So, like, we just kind of, like, suppress it, you know, and anti inflammatory. And then if it doesn't work, second line, um, super sporin again, like, you know, um, learn the highlighted stuff by heart. I need you guys to know it, like, instantly. These are things you know it. Like instantly when you hear, like, treatment for U. C. S. But, you know, they rarely ask you like, second line for severe, um, treatment for you see, like, you know, Yeah, like, you just remember cortical steroids and and also, you know, I'm gonna started sitting as well. Okay, right. And, um, if they don't work, um, of these don't work. You know, we're going to go for, um, you know, just surgery. Um, there's something called J pouch. So basically, I call on the rectum, go by by, you know, we just, like, remove the colon, the rectum. Um, yeah, it's just kind of like, um ileostomy. Okay, Right. And for maintaining remission, Like after this. Like so, you know, this this one is called, You know, when a patient comes in with, like, acute flares of you say Okay, but right now, okay, we have settled down. Um, the flares is gone. The patient's no longer suffering, like, you know, acute conditions like the symptoms, uh, which is gonna keep it, you know, stable. Okay. So what we use again, I mean, the Sinus silly. Um, and also, it's a thioprine. It's an immunosuppressant. Okay. Right again. Yeah. I'm not sad to say, like, you know, you see it everywhere, and you say Okay, you just have to remember that crones, right? So how differentiate from crones to also the colitis? Um, the way around, like crows nest. You know, crows sounds so much of crows. You know. Yeah. No. Okay, um, so nest okay with no nest. So, no, there's no blood. Or, uh, my apology? Um, yes. Kind. Yeah, it'll be. It'll be really nice if you Yeah, to know them as well, because, like, they kind of asking that, um, these kind of conditions You have to know the treatment by heart. Um, there are other conditions. You know, You don't really need to know the treatment. Just need to know how to recognize it, you know? Yeah. I'm really sorry, but yeah, it's really, um Yeah. All right. Oh, shit. I'm sorry. Do you use both treatment at the same time? What, you mean both three minutes in time. Like, um, you know, usually, um, inducing. We induce remission first. And then once the remission acute flares has been, like, you know, uh, you know, toned down like, uh, patient is no longer suffering from remission. Um, we're going to maintain that. We're gonna maintain it. So, like, we're gonna we're gonna keep suppressing. Because, like, if we don't give the maintaining remission treatment for U. C. Patient's, it's very likely that it's gonna acute. Flare is going to flare up again. You know all these symptoms here. We're gonna start coming up again, okay? It's not at the same time. It's kind of like, you know, we make, um we get rid of the acute flares at first. So right here and then once we get it off the acute flares, we're gonna maintain it with here. Okay? Use the remission. Okay. Right. I hope that makes sense. Right. OK, so, um, Crohn's again the entire track. Okay. Then try the entire, um um GI track. Okay. So from mouth, esophagus and then to like, um, stomach and into, like, small intestine to the large intestine and rectum. Okay. And also escaped. There's, like, something called a skip lesion. So again, you know, in, uh, the thing is, uh, in the, uh You see, um, there's, like, continue a continuation of the lesion, you know, remember like, from wrecked, uh, from here to, like, direct. Um um, for Crohns disease, you can see like it skips. Okay, It skips. Um, it's not continuation. Okay for And also, um, yeah, terminal ileum is most effective. Okay. And also, transmitter transmitter is like the full thickness. Okay. Again for ulcerative colitis is only like a superficial layer. Okay, for this one is the entire thickness. Okay. Um yeah. And also, um, not not too genes. Um, it's kind of like it's associated with the chronic disease. Okay, Um, so again, you know, Crohn's C D. So, like, you know, has a d. So, um, not to again, Uh, HLA is for, you know, also to colitis. Um, you see, Doesn't have a d. That's how I remember. Um, I'm sorry. Yeah, OK, right. Anyway, nonsense. 18 granulomas. You know, um uh, so, yeah, Bones has grown enormous, but they're like, non sensation Grandmama's and you see, does not have an enormous. Okay, so there's some something to keep in mind as well. Um, yeah. Okay. Right. So treatment for Chrome's okay again. When there's, like, patient comes in with, like, acute flares, we're gonna cause we're gonna start the remission first. Okay, first line steroids. Okay, Usually oral prednisolone. Or it's like razor fear. We used to give IV called hydrocortisone. So, um, and for second line, you know, if steroid doesn't work, we give methotrexate. So methotrexate, you know, it's kind of like, you know, we love using methotrexate for Crohn's. Okay? And we we use, um I mean, a status update for you. See? Okay, I'm sorry. So, pouch, You know, um, are you know, um, unusually not recommended for Crohn's? Because, like, you know, they can re occur, So yeah, it's kind of sad. So for me to maintain remission first line. Um, it's a thioprine. Um, it doesn't work. Methotrexate. Okay, right. So how do you attend Fight? Um, IBD. There are quite a lot of, like, extra intestinal manifestations. So, like, they are, like, you know, a lot of, like, other symptoms. Um, other than you know, um uh, gi the main one, like, uh, mouth ulcers is very common. Um, muscular scalito and eyes as well. Um uh, you can also see, like, you know, um, you colitis, uh, and then, uh, and also like a primary closing cholangitis again in you see and rashes sort of rashes also, like, you know, when it says like, yes, skin rash. And then it's like my body's in terms. It's very likely to be, uh, IBD. Okay, so these are like the common ones, um, skin rashes. And these are like, you know, the general. Um, you know, they don't have to learn all of them. There's no way I'm not gonna learn of them. Thank you so much. There's no way I'm going to learn that. Um, these are just, like, for our own sake. Um you know, um, if you guys gonna have this, um, power point, um, for vision. And here is, like, the more, uh, detailed one. Okay. Again, You don't have to learn all of these, like, please, don't acute GI bleed. Okay. Right. So, um, for upper gi bleed, you know, it's like the proximal. Also, like, kind of like above the ligament of Treitz. Okay, so, like, this one is here. Okay. Ligament here. So, basically, um, esophagus stomach, a little part of the geo Denham, like the proximal part and lower GI be bleed. It's basically, like, you know, distal to that. Okay, So, basically anything below that, it's just like, you know, Judy numb, and then anything below that is the consider, uh, defined, but as a lower gi bleed. Okay, So presentation for GI bleed Main one came to Moses blood format. Um, because, like, you know, it's still kind of like proximal supper giants is still kind of proximal so the patient can still be able to throw up the blood if the blood is like GI bleed, um, occurs in, like here. There's no way that, you know, the body is going to push the blood all the way back, you know, to the, uh, ascending colon and back to this blood test. And in fact, right now, there's no way. So you know, um, so, yeah, so this upper gi bleed, you know, you should have, like, you know, more like formatting related. Um, yeah. Covid ground format. Um, and then it's like black tarry stool is very common and an elevated urea as well in the blood. So what happened is that, you know, there's a GI bleed, and then the blood get digested and they get reabsorbed back. And then, like, you know, the heat, the digest the blood turned to him, and then the him turn to the urea. That's how you know. That's like, can see that they increase, um, area in the blood in GI bleed. Okay, so this is the coffee ground format. I'm really sorry. Um, Yep. You just have to have to You just you have to deal with coffee ground format. And then there's the black toss to okay, right? Lower gi bleed again. You know, it's very, you know, they they're not going to throw up the blood because, like, it's traveled way too far. And it's also extremely disgusting. Um, and, you know, fresh blood, um, began to stew. It's kind of purple. Red, purple stool. Um, so, yeah, it's just like, you know, coming out from your anus. It's not from your mouth. Thank God. Um, and then usually it has a normal urea. Interestingly, and then it's also typically painless. Okay, Right. So, um, there are a lot of causes for GI bleed. Um, especially for upper GI. Peptic ulcer is most most important one. You know, this is very it's very important. Um, you you guys know it, And also, these are the cost of a lower GI bleed. You don't have to learn all of these, but it's nice to keep that in mind. Swell. And the glass if occassions that you have No, um, there's no. Yeah, but it's very important for you guys to know they enjoy, Like, asking like, oh, what's which of the following calcifications offer a G I bleed. Black folk score, and it's for it's most common use, Rocco. They don't use it anymore. Apparently. Um so here are the criteria. You don't have to learn it by heart. Please don't. Um these are just like, you know, I'm just here to give you guys an idea. Like what they take into the account with with the scores. Um, yeah. Please don't learn it. I beg, um, Project management, Um, again, you know, like general, um, because, like, um, is pretty acute. It's quite, um, quite an emergency. So a b c D e and then raise us. Okay. If the patient is on, like, you know, warfarin use vitamin K to reverse it and a specific met here just like that. Okay. Right. Trimming for peptic ulcer. This that induced bleeding? Um, end of therapy. Um, it depends on you know what? Like the severity of the bleed. Um, if it's not, like, really severe. I mean, I don't think you can't go into You don't have to go into that. I'm kind of, um uh, invasive, um, treatment, but, you know, but it kind of depends. Like you don't have to know, like, oh, When do you decide? You want to use what to use? Okay, so I keep in mind. These are treatment, okay? And we also like to give, like, you know, omeprazole as well as, like, you know, kind of like yeast down symptoms as well. Okay, for the Pepto also, And if the bleeding is like uncontrollable is, just keep going. You know, we just we just use embolization and geography and laparotomy, okay? And for first is induced bleeding. Um, we use, um this of your band ligation and also a tele present. Okay, um, these two, these are the main ones I want you guys to remember, Um, especially for first season. Just gi bleed. Yeah. So, telepresence using the drug, Um, it basically acts as a facial constructor. Splanchnic blood vessel. If it's still keep going, um, you know, use these two. Okay. Black. I doubt they're going to ask you that. Like, you know, it's nice to keep in mind like there are these two, um, treatment. Okay, right. I b s okay. Right. I b s is kind of like a functional disorder of neurology, but it's kind of we just don't know what the hell is, um, the main one, You know, the main cause. Um, stress and anxiety. Um, yeah. So and then, um, the presentation there are kind of like to type too many types of like, uh, the the types of I B s, one of them with diarrhea. The other one is constipation. Um, yeah. IBSD and IBSC. Okay. And then, um, the main one is like, you know, is is improved by opening bowels. And then there's, like bloating, bloating It occurs so common in I b s, like, you know, when When they put, like when in in the question when it's put, like bloating, improved by it improved by opening bowels. And it's like it's just I don't know, man. I don't think they're They're not very creatively, always, like, see these two together. And, like also maybe like diarrhea and constipation, Um, you can just straight going to straight to i b s. To be honest, or maybe like they would say, like, alone cost you just have to put I p s. And that's like the third, um, type. Um, it's like a I b S m. You know, it's like a combination of both diarrhea and constipation. Okay. And that almost the criteria. So, yeah, basically, like, you know, there are quite a lot, but, like, you know, the the only thing you remember is like all the tests are normal. It comes back negative. Okay? And that's like a Rome criteria. Okay, so basically, um, you don't really have to, like, learn it by heart, but, like, just remember that, um, you know, um, Rome criteria, You know, for I b s okay. They love doing that as well. Which of foreign criterias for I b s blah, blah, blah, You know, wrong criteria. Okay, um and also, it's also it's nice to keep in mind as well because, like, you know, it helps you with, like, oh, the presentations as well. It's kind of related. Okay. And also for treatment. Um, FODMAP diet is the main one. I don't care about what you learn. What you you know, get off from the I b. S this lecture, or like the slides, um, FODMAP diet. You have learned format format format. Okay. Promide for you know, um, for, um, diarrhea. Um uh, Bs and, uh, yeah, the other one. It's basically just like that, um, again, you don't really need to load these. To be honest, they I'm pretty sure they're not let you know. Let me ask you guys about third line, second line, um, let alone like these. Like, uh, for for the, uh, the symptoms. Okay. The main ones. The fall map. Okay. Celiac disease. Okay. Right. Is the autoimmune condition. Okay, when it's just gluten. Okay, um, we see gluten. Celiac disease. Okay. It's just bread and everything. Okay? It's an autoimmune. It causes the inflam inflammation of small bio. Okay, usually, like, you know, um, if it's celiac disease still usually, like, you know, uh, the question. Oh, yeah. It's like a It's like a kid, like, you know, five year old, like 10 year old, you know, and like, uh, kids starting himself. I'm sorry. Pooping himself. Um um, after eating gluten, um, it's very like it's gonna go. It's just have to go straight to celiac. Okay? And again, they'll be of pathophysiology here. It's kind of big disease as well. So they like to ask you that. You know, um, so, antibodies, you know, they target the, um, intestinal epithelial cells, especially. Did you, um do you know? Okay, so they attack the epithelial cells, causing inflammation, causing atrophy. So, um, the atrophy of the feline and then causing malabsorption. Okay, The grip of amount. Um, yeah. So, um, the main major major, um, antibodies, um is anti ttg okay, You have to learn it by heart. I don't care. Okay, You have to learn it. But this one you don't really have, I mean, I don't know. Um I mean, just learn it. I mean, why not? I mean, but the thing is, like, this one is the main one. Anti ttg you have to know is the celiac disease. Okay, you have to know that, um, for associated genes. Um HLA d q um, to it's like the main one. The main genes. Okay, that's responsible for the disease again. I really hope you guys noted, like, you know, the queue. Um, a queue to Jeanne. Um, yeah, they're like asking that as well. But the main one, uh, the main thing you see, I guess, is like, you know, gluten inflammation. And then, um uh, the antibody responsible is just one anti ttg. Okay, right. So presentation. You know, failure to thrive and diarrhea Fatigue. You know, all kind is like this kind of like the most very common, um, GI symptoms. Okay. And the major, major one. Okay, this is the number one thing, okay. For celiac disease, Um, dermatitis herpetiformis. So basically, just like I g h i j um, deposit in the skin. So they're, like, really itchy, extremely itchy. Actually, this kind of rash should happen. Like whenever. Like, you know, it's like the key word. Whenever the question has like, Oh, there's a Russian abdomen for itchy. And then Or maybe they just say that, uh, dermatitis type of performance. I don't care like what other thing is I would just go straight to celiac disease. Okay, that's yeah. I mean, it's the key word. You have to know them have dermatitis. Herpetiformis When I say that, you just know celiac disease. Okay, um, for celiac disease investigation. Um, you know, uh, endoscopy, um, you know, it's Yeah. Again. It's diagnostic. Um, gold standard diagnostic, uh, differently. Definitive diagnostic investigation. And also, but like usually, um, you know, first choice. Um, you know, they love asking that. Oh, what's the next best step? If you say that was the next best of investigation. You have to say anti ttg. Okay, but if you say that, uh, what's the definitive diagnosis for investigation for CRTC as you go for that. Okay. You got to go for an endoscopy. Okay? Um, yeah. Again, like, you know, um, they love like you have to do. Um, you know, these kind of blood tests again? Um, and, uh, there are quite a lot of, like, associated conditions for celiac. Um, these are like, you know, you can see a lot of them, like, basically, like, you know, um uh, autoimmune as well, because, like, Yeah, because if you go, uh, you know, further going to study more in the second year, you're gonna learn like gi No, no, I'm sorry, uh, endocrine and then m s k and then blah, blah, blah. Um, you know, you're gonna learn a lot more, uh, some a lot more autoimmune condition. A lot of them. It's kind of related to the one HLA genes. So yeah, So there's a lot of them, um, linked and treatment. Um, that's it really gluten free, you know, um, just like, you know, uh, if you eat gluten and you have symptoms. Just don't eat gluten. It's like, you know, if you wake up in the morning, you have a back pain. Just don't wake up in the morning, wake up in the afternoon. Something like that. Um, you know. Okay, I'm just joking. But, you know, anyway, like, you know, you have long term good and free diet for celiac disease. Okay? This is really have, uh, treatment. That's kind of sad. Okay, for large Colon also has a big guts. The guts, you know, you can use the professionally peaceful free. I'm joking. Please don't use that. Okay, right anyway, for colorectal cancer. Okay. Um, well, at enormous, it's not really cancer. It's more like a It's, like, more like a polyps. It's like pre malignant stage. Okay, It's not really like cancer, but like the most common polyps at enemas and the most common in enormous tubular. Okay, it's the main one. Tubular adenomas. Okay. And, um, and then, you know, it can further, you know, um uh, worsen and develop into adenocarcinoma. It's the most common, uh, colorectal carcinoma they love. Asking that which are following is the most common colorectal carcinoma, which is for adenocarcinoma. Okay. And these are like limbs. It's quite bad again. First line, you know, uh, fit, test fit. Test is kind of, like, you know, they're gonna they're gonna take your thesis, and they're going to test for blood. They're gonna take your feces and then, like, Oh, there's any blood in there. If there's any blood in there, it's right. Like you have cancer. I'm sorry. Um, yeah. So, um, fit test is like the number one thing that they do is kind of like the first line. It's like non invasive as well. And colonoscopy, biopsy again, the definitive, um, investigation. Um uh, diagnostic investigation. Okay, but it's not really the first line. Okay? And CTS will CT is good. And again, colorectal cancer. Um, there is like, classification. Um, this criteria. Okay, I just I don't know. I feel the way I remember is like duke's. They're rich, so they eat love meat, so they're very likely to get colorectal cancer. So Duke's cancer? I don't know. I don't know if that makes sense, but anyway, um, associate the genes, so you have to learn. Um, please learn it. Um, I don't care what you feel, but I please learn it. Um, f a p m A p um, these are like the genes for colorectal cancer. Okay. And the treatment, you know, surgery is not going to be paracetamol. Anything like, Yeah, it's gonna be surgery. And here's a dupe staging. Um, I'm just putting here, Um, you know, just for your own sake, um, you know, for information if you were curious, the police don't learn it. They're not gonna ask that. Like, you know, I'm just gonna give you giving you an idea of, like, how do we, uh, how to this stage? You know, it's about so basically just about invasiveness of the the Lumen And then like, if it's like a lymph node involvement as well. Okay, but personal letter, OK? Presentation for colorectal cancer. Let me just drink apologies. Okay. Right. So colorectal cancer, rectal bleed. Um, abdominal pain, it's called. It's usually described as colicky pain if this colicky pain is very likely to be colorectal cancer, But again, there are a lot of conditions. Can be colicky pain. Okay. Colicky pain. What does it mean? Sharp, sudden, intense wave. Okay. It's like waves. Okay. It just comes uh, no. Okay, right. Um, yes. It's very nice. It's a professional description of the pain. Um, and then palpable Mass. I mean, I mean, obviously, um, if I have to explain that I don't know what to tell you that, um systemic symptoms again. Cancer. It's just systemic. Like, you know, you just have to think about that. Why? I lost blood. Um, f fatigue? Um, yeah. Just like these are the main ones. Probably the mass Systemic. Um, a pain and rectal bleed. Okay. Very nice. Alright. Pancreatic disease. So acute pancreas. Um, pancreatitis. Okay, there's a Mao. And as Sophia Sophia, basically just organ failure. Okay. And with like or like, you know, local complications. Um, And presentations. The main one major one again. Increased serum amylase by four folds. Like, you know, you don't have to learn all by four folds like there's like, a massive massive increase in serum emulates. You're not supposed to find emulation serum, you know? So, um, if there's, uh, amylase in your serum, I'm sorry. Yeah, you're You're done by guy. Um, usually, yeah, basically. Just like you know, the way I remember it. Just like amylase. Um, acute pancreatitis. they get blocked into the duct that you just definitely to go. They just like, you know, just go to the blood. I guess, Um, that's how you end up in the blood. Um, yeah. So whenever you see, like, increase massive increase, Normally they just increase instead of amylase. You just go straight to acute pancreatitis. You don't have to look at anything. Increase serum serum. Amylase ap. Okay, that's it. They're like, um, the most common causes for AP gallbladder gallstones, alcohol. Okay. And treatment, usually ercp. Okay. And so basically, just like a endoscopic retrograde cholangiopancreatography, I think, um, so basically, like, you know, they just insert like a like a like a scope endoscope. And then, like, you know, they go into, like, your with your stomach and then go into a Judean. Um, and then, you know, it goes like, uh, the the sphincter of oddi like employees of fader. And then you just, like, have a look. Okay, right for antibody, we do use like we use antibody, but only only when there's a sepsis or Sophia ap. Usually, you know, we don't use antibiotics. Okay? We just use, uh, ercp. Okay, So anti antibiotics only in sepsis and severe AP. Okay, right. Chronic pancreatitis. Okay. The Remeron always tiger. You don't have to learn your math. And usually the main one is just like obstruction, toxic toxin and idiopathic. These are, like the main ones. Okay. And and then, yeah, investigation. You know, um, we use some, like we we look at, like, CT and then the ercp. And they also use, like, the the enzyme replacement. The reason why we do that. Because, like, you know, pancreas, pancreas, You know, it's like something the the organ that produce, like, you know, a lot of like, uh, body and, like, you know, food, digestive enzymes. So, like, you know, if we if we put, like, you know, let's say, like, the enzymes replacement into patient and the symptoms involved that we know that. Oh, shit. Okay, so pancreas is the problem. Um, so, yeah, it's like so the Creon is like, both investigation and also treatment. Okay. For pancreatitis again, Um, red, like, you know, the major major, um, you know, thing you see in chronic pancreatitis. Um, if you were ab Agni, I don't have to pronounce that. I'm sorry. Um, and pancreatic. Pancreatic calcifications. Okay, if you see these two together, um, you just go straight again. Straight into chronic pancreatitis. Okay, join this app. Pain like these are like, Yeah. Again. Like you can. Kind of, like, you know, it makes sense, because obviously, pancreas is not, like, functioning well, but if you see these two, um, you just go straight into chronic pancreatitis. You don't need it. Okay, so this is what it looks like. Um, so for X ray, you can see the white white dot So these are, like the calcified, um, calcifications of the pancreas. And it's like the CT scan. Um, you can see that. It's like to things. Pancreas. You can just see the pancreas is a calcified. Okay, so you see these two, um, like these, like, you know, these kind of, um, rashes like they don't just happen in the abdomen. They all can also happen in the leg or anywhere. Anybody anywhere else. Okay, we'll see this to just go straight. Please. Just go straight. Don't even look at other things. Um, chronic pancreatitis. Okay. Pancreatic cancer. Okay. Usually like carcinoma. Um, it's kind of sad, but, you know, upper upper pain usually pain this obstructive jaundice. So what's obstructive jaundice? So basically the duct, um, a blocked. Um, you know, when they're trying to get rid of the Billy Ruben, but they get blocked. Um, you know, so they cannot usually normal. Way to excrete Billy Ruben is to take them and then, like, put them into, like, you know, excrete them through the feces. But they're blocked, OK? The ducts are blocked. They can't get up through the feces with the feces, so they're going to go into the blood. That's how you know the John. These are obstructive jaundice. So they're gonna so you know, as you you will see, like, pale stool. Because, like, you know, obviously the bilirubin is not in the in the in the species and also, um, dark urine because, like, they're in the blood so they get futile as urine and you know, jaundice as well. So these are called obstructive jaundice. Okay, a weight loss. Okay. Obviously the cancer size cancer signs, okay? Treatment, You know, again, um, reception's, um, like, you know, these are, like, really just common cancer treatment. You know, again, you're not gonna give drugs for cancer. to cancer. Uh, reception or radio frequency ablation. Okay. Or ercp. You see, the ERCP everywhere is usually like ercp. Um, they are, like the main treatment for pancreatic. Um, bigger hepatic biliary conduction. Um, um, diseases. Okay. Right. Liver. Okay. My burning Christ. Let's get the spread. Um, yeah, And before going to live, I really want to go through the liver function test first. Um, they love asking you that. Um and also, it's very nice. Like, give you, like, a nice summery Like what? What? What? What? What it means? Because, like, a lot of the time, you know, were taught by, like, oh, each, um, conditions. And then, like, what are signs like the investigation results, But a lot of the time, we don't even know what they mean. But the thing is, like, you know, again like to learn medicine. It's very nice to understand it first, and then once you learn it, it's a lot easier to learn because you understand it all of the time. You don't even have to learn because you understand it. You just see, and you just figure it out. And just by yourself. Okay, Right. I mean, acid aminotransferase they are hepatocyte, uh, like, basically, just liver enzymes. If the amino transfer rates is raised, it means, uh, liver, uh, inflammation. Okay, so there are two main aminotransferase S t. And a l t. Okay, if they're both increase is basically just, uh, it's pointing towards. Not necessarily. It must be like, you know, it's basically very likely to be alcoholic liver disease. They're both increase. Okay, It's a hepatic picture. Okay, So if they're both s t and l t increase, um, it's basically means like, Oh, there's a kind of a bad liver cell damage. Okay, The second one is very commonly used as well. Liver function test is alkaline phosphatase a LP, so don't try to get confused about S t a L T l P. Okay, so a l p Can I foster taste? So they basically ensigns percent in bio duct bone, placenta, intestine if they innovated. So a l p uh, elevated to mean cholestatic pictures. So, like, you know, um, just like, um, liver or biliary? Um, courses. Okay. Just like primary sclerosing cholangitis. Primary primary. Biliary cholangitis. Okay. So, yeah. Uh, yeah, that's it. So, uh, l p raise um cause static aminotransferase both race hepatic. Okay, Remember that, please. Um, Gamma GT Gamma GT. They're kind of nonspecific, the like, then liver enzymes. Usually the main cause of the increases. The races alco and then in say, it's okay if both gamma gt and a LP increase is definitely the problem. Okay, Right. And another one creating creatinine. I'm sorry. Um, kidney function, um, is also very important assessment. Um, when we're deciding who should receive, receive the liver transplant. Okay. Um, just like that, it also tells the survival rate of the liver disease prothrombin time, you know, um, extremely important test for liver function. If the proform proform been time, I guess, like a lot. A lot higher. A lot longer. It means, like liver is kind of messed up. OK, like it's kind of just gonna go. Bye. Bye. Okay. Um right. So yeah, basically again. Yeah. It's just used for if transplant platelet count as well. Play account. You know, as you can see, it's kind of related to prothrombin time. Um, you know, platelet count is also like because, like, you know, um, from from a poet poet in is is just basically made in the liver. It's like it's not only maybe liver. I think it's made of bone, so I'm not sure, but yeah, it's made the liver mainly, Um uh, I think, Yeah. So, basically, yeah. If it increases if it drops, If it drops, then it usually means like, Oh, there's a split dramatically or there's something wrong to liver. So yeah, so the main one is pleased to learn aminotransferase, um airplane foster taste. Please. Please. I beg Hey, So, hepatitis. There are a lot of hepatitis A B, C d e. But mainly they love asking the hepatitis B, especially the foreign markers, because, um, the symptoms for hepatitis all the hepatitis is very similar. So they're not gonna ask you to differentiate that? Um, so first one, you know, there are two main foreign markets, antigens and antibodies. Okay, so first antigens, we look at the surface antigens first, so these are, like, obviously no on surface, Basically, Yeah, if if we are detect. If there's like a, uh, get your blood. And then we find, um, surface antigen in your blood. It means there's a positive infection. Okay, but at the same time, it can also mean vaccines as well, because, like, um, the hepatitis vaccine are basically just like surface antigen of the hepatitis. Okay, Just like that, we just inject service antigen to your blood. And for e antigen e antigen they released during replication. The only releasing replication. So, you know, during replication, it means they're in their active form, most active form. So, you know, because they're replicating. So it's gonna be if it's positive, it's gonna be acute phase. Um, so yeah. Again. So it means, like, you know, obviously the higher level is going to be higher than infectivity. Okay? Because, like, it's like the most active state for court antigen. We don't find it in the blood. We only find it in the middle of the core of the virus. Okay, so, yeah, basically, just, uh, let you know, get the idea. Antibody surface antibody. So respond to, uh, surface antigen. If it is positive, it means, like, you know, obviously, antibody, because, like ourselves made the activity our our immune system make, um, the the antibody. So if it is positive, then it means that we have been vaccinated. Or, you know, um, there's been a previous infection and we have kind of developed the immunity for. That's how you know, antibodies are made. So eat antibodies. Um, you know, it's just again. Yeah, like, um, corresponding to, like, going against with the the antigen. Um, so if they're positive, it means that they have been through the active phase. Okay, Right. So it's kind of like immune response as well. All right, So, um, the core antibody, Yeah. Again, it's kind of like just just yeah, just kind of binds, like with the the the quarantine okay of the virus. And these are some of the main, most important thing of what you guys know as well. These two i g m. So either way I remember it. I g m m immediate. So it means, like, you know, it's like acute infection. I g m the high, the high GM. It means that more is like acute infection. The so low, it means chronic. Start the other way around. So I g g kind of looks like, see Sounds like C as well. So it's kind of chronic. So I so I g means positive. I g means the best. Being a past infection. So it's kind of like chronic. Okay, right. We're gonna move on to join this. So basically, jaundice was joined us just Hi, Billy. Ruben. Okay, so, um, so Billy Ruben again is a bear in mind Is a breakdown product of the heme. Okay, so the team group of the blood and the definition joined us for the course. Just basically, it means the total plasma ability. The plasma bilirubin level is greater than, uh, for a free, uh, micro mall earlier blood. Okay, so there are two free courses Freeman courses. Uh, stages, of course, is for jaundice, one of them prehepatic. So it means, like, you know, something like before the blood gets too. Like, um, the deliver. So something like the spleen know, because it can be, um there's like means, like nothing to do with the liver. So it can be like, um, there's, like, over product over breakdown of the heme. You know, the heme metabolism it can be It can be like something like that is the Spain splenic problem. Okay, hepatic cause of jaundice. So there's something wrong with the Billy Billy Ruben metabolism because the Billy Ruben are metabolized in the liver. So if there's something wrong with the liver, Um uh, Billy Ruben cannot be broken down, so it means, Yeah, there's something wrong. The liver. And then there's, like a pulsing particles of jaundice. So basically, you know, the pathic there deliver or the spleen is doing their job. However, um, that's not like, you know, good removal for the Billy Ruben. Something like duct obstruction. Okay, as I said, the obstruction jaundice, as I mentioned, you know, they're they're doing the job, but the things like they can't get it out. It's kind of like factory. That's like, you know, maybe, like, you know, the people are like, um, the truck driver are like, you know, um, going on strike, you know, they can't deliver out there jaundice. It's kind of like that, right? So, classifications, you know the examples, Of course, of Jonas Prehepatic. You know, it's kind of Yeah, humanizes, uh, hepatic. It can be like close Stasis, uh, biliary ducts. You know, obstruction and post hepatic. You know, Goldstone blockage of, uh, extra hepatic duct. Okay, okay. Write. These two are the major major conditions as well. I hope you guys learn, um, everything on the slides as well, right? So primary biliary cholangitis is organ specifics. It's just just auto immune. I need you guys to need you guys to learn it. Anti mitochondria antibodies. Okay. I g m like you just have to learn. It is it is just like associated with primary biliary cholangitis like you just have These are things like just instantly link. Okay? Like, you know, they just love asking you, like you know, which are following antibodies is responsible for primary biliary cholangitis to just say, Oh, anti Michael mitochondrial. And that's another one as well. Anti nuclear antibodies. But they're not as common there around like, I don't know, like, 15 or like, 20% of patient with primary biliary cholangitis. So basically, what happened in Paris, PBS PBC is that the immune cells just attacks more bio duct in the liver. That's it. And it mainly mainly affects, uh, female and usually, like, kind of like older female as well. And for primary growth and cholangitis. I'm sorry. Um yeah. So presentation. Um res. Uh, SERM alkaline phosphatase. So a l p. Okay. This is like again like rice alkaline phosphatase. This means, like call a static picture so Yeah, it's just, like, instantly know, like, if there's like rice, Seremaia Okay, LP just instantly link with, like, these two conditions, okay. Or other, um, hepatic biliary conditions. Right. So primary schools and Collinge itis um, it's chronic information, so basically, it's different to PBC. So basically, it's like the the the colon. So the bile ducts kind of like fibrotic. So it's kind of like, just like, you know, get get fibrosis. And then, um yeah, it can be, um, anywhere. Also, it has, like, a massive increased risk risk of, um, cholangio carcinoma development as well. Please keep that in mind. Did of asking you that. And also again, just to, like, you know, um, reinforced, like, you know, as I said, mentioned in, um and you see, and it's strongly related to all sorts of colitis. Okay. And also p anca positive. Okay. And for treatment. Um uh, these are, like, you know, kind of like, um, these These drugs are, like, kind of prevent the reabsorption of, um, or absorption of the cholesterol or, uh, how, Okay. And yeah, just please learn the drug as well. These drugs, like, um, they love asking you that as well. Um, And for liver transplant is just for end stage. PBS PBC for PSC, you know, um, investigation MRC, PS two, gold standard. Okay, Um uh, it's not really ercp like m r c p. It's a gold standard. Um, and yeah. So, um, usually we treat the liver course, um and then, um, liver transplant again. You know, it's the it's the it's secure. It's the only cure. Um, however, we can also treat with, like, ercp, uh, we we just put, like, a billary stance. It's kind of similar to, like, You know, how we treat, um um, coronary artery? Um, you know, um, disease as well. Okay. We just put a stent. Um, co star. I mean, you know, it's kind of like a be like, uh, sequestrant, so Yeah, right. So, definition, um, called Stasis accumulation of, uh, yeah. Again like these are just, like their own sake. Um, because, like, this do sound kind Similar? Um, yeah. So, like, you know, Stasis have been stopped. Accumulation, um, devices, you know, it's just kind of like stones and stuff. Um, and then these are like, these two kind of similar like they're like more of a different location of the blockade. Okay, right. Gallbladder stone again. Jaundice. Acute cholecystitis status is and yeah, these two. If you see these two, it's very likely to be a color with Isis. It's just like, um, it's just the gallbladder stones here, Um, colelithiasis, um, presentation. Um, yeah. Again. It's kind of that their region regional pain, um, and then, like, painful again obstructive jaundice as well, Because the, um yeah, again, Um, they can't The doctors blocked. So bilirubin, um, bio, you know, they get, um, resolve back into the blood because like, they can't they can't be excreted with the feces. So, you know, you're going to be a dark urine because, you know, in the blood and get future out as urine pills, too, because they're not in the in the in the stool and parameters as well, because of the, you know, deputy Reuben causing the, uh, your whole body to go itchy like it's really itch. Okay. It's not nice. Um, and then it's like basically just like, you know, a lot of fat in your feces. Okay, Right. So, um, for yeah, for Colorado. Um colelithiasis Jesus Christ. Um, yeah, acute pancreatitis. Um, it's common. And also ascending cholangitis as well. Please learn that ascending cholangitis, uh, painful obstructive draw tissue just linked to this. Okay, so there's a triad. It's called Charcot's Triad. Ascending, Ascending cholangitis, jaundice, fever, right Upper quadrant pain. You have to learn it. Please learn it. Okay. These are, like, two keywords for, um, corridor colelithiasis. Um, so yeah, for for treatment for these, um, they're basically just like, you know, it can be, um, the gold standard. The gold standard is, um, the Proscar pick. Um, cholecystectomy. But the thing is that, you know, sometimes Goldstone can be like, you know, they're not as severe to the point where we need surgery. We can just give, um um you know, some, um, oxy colic asset to dissolve, um, the Goldstone. Okay. Again, if it's like, uh, you know, a symptomatic symptomatic. You know, sometimes the Goldstone, you know, just hang in there, You know where they're not causing any symptoms. There's no point treating them. Okay, Right. So how do we prioritize the failure? Um, these are two. These are free main scores. Um, again, like, you know, you don't have to know everything what is calculated in these 23 scores. But please know that, you know, childhood scores meld, score. And then, um h a, uh you know the scores. Okay, um, these are the scores. We we we also, you know, take into account calculate when we, um, deciding who should receive, um, the, uh, liver transplant or to calculate, you know, the liver failure. Okay. Right. Test time. Okay, You guys, are you guys ready for test? Just to see use length are hearing and listening to me or sleeping? I don't know. This is just means you. It's you right now. Uh, funny. Um, right. Can someone tell me to put it in the chat? Um, for ulcerative colitis. Um, it's likely to link with which hepatobiliary disease to have it in the chat, please. Very nice. Oh, my God. You guys are so smart. Jesus Christ. Yes, it is very nice. Okay, right. Second question. You guys ready? Turn it to your mail. Comes in five. The history of history epigastric pain so epigastric pain. So occasional nausea, formatting pain is relief by eating. What is it gonna be? What do you guys think? Very good. Oh, my God, You guys are so good. I'm so proud of you. I want to cry. Um, okay, right. Very good. Very good, guys. Right. What does race outlined? Phosphatase indicate. What does it indicate? Like which kind of organs like, Yeah, system. Does it indicate this is a tricky one? This is sticky one stool, anyone? How can I? False with taste. So come Kinda? Yes. Yep. It's more like a call. A static picture. So it's something to do with, like, uh, the liver Or, you know, um, pancreas or, uh, the the, uh, the gallbladder. Okay, so something like the primary scores and cholangitis or primary biliary cholangitis. Okay, so yeah, usually obstructive call it static picture. Okay. Right. So what is the treatment for, um, for H pylori? Eradication therapy? You have to know it. This is like the most important one. I need you guys to know it. Um, please tell me the duration. Yep. Good. What? Yep. Nice. Seven days. What is it? What drug do we use? What drug do we use? What medications do we use? Triples? Let's say amoxicillin. Careful. Clarithromycin. Nice. PPI. Very nice. Okay. What if, um, patient is a penicillin. Uh, allergic to penicillin. What? What do I use to stop amoxicillin? Not really much. And also, um, Yep. Tetracycline. Nice. We used to try cycling to use to stop it with amoxicillin. Yeah, but not the metro. So I think. Yeah, but usually, um, if it's, like penicillin allergic, we just stop it with tetracycline. Okay. Very nice. Right? Patient percent with these are the following. What do we think? Nice. Very nice. Very nice. Good, good, good. Very good. Very good. Yes, it lays chronic pancreatitis. Right. What's the most common causative agent for gastric? Also, bacteria wise. I mean, it is bacteria. I don't think there's any virus. Cols H pylori. Nice. Always extra pylori. They love asking that shit. Okay. 32 female. Uh, not not not 32 females. 32 year old females also be hectic. Um, comes into any with preexisting, um, ulcerative colitis with for this history of bloody diarrhea five times a day. Okay, five. My guys shooting five times a day. Okay. What is the severity and what classification do we use? Remember, please. What classifications do we use? Also, remember like to remember which to number. Nice. Nice Okay. Okay, Good. Good, good. Nice. Very, very nice. Very nice. It's moderate. Yep. Um, so what is the name of the classification? It's quite cute. It's got quite a cute name to it. Anyone nice? Very nice. Oh, my God. Yep, exactly. Tulips and wits. Right. So Okay, so we now know that it is mount and moderate. Okay, So what is the treatment? What drugs do we give? Um, let's assume this one is, uh, so it's acute flares. Okay, We're acute flares. So we have to, um, induce remission first. Not maintain it. We have to. Nice. Nice. Good. Good, good. Very good. Very good. Again. Throw up some wits. Aminosalicylic. Very nice. Okay. What is the main biochemical protein markers? It's raised in, um IBD inflammatory bowel disease. Nice. Very good. Very good. Good, good, good, good, good. This right. Um, that's it. Guys, Um, thank you so much. Thank you. Thank you very much for attending this session. Um, yeah. Please, uh, please. Uh, you know, that's like a feedback form if you guys can, uh, like, you know, uh, you know, give me some feedback. It's very important because, like, I haven't done too much. Um, these kind of teaching sessions, and I'll be doing more in the future. And tomorrow as well. Tomorrow I'll be doing a neuro. Um, it's gonna be nice. Um, yeah. So please come. Um, it's gonna be very useful. And And also, yeah, please fill in the feedback form, so I know what to improve. Um, you're welcome for B B. Um, you're very welcome. Um, yeah. Also, I hope this this is useful for you guys. Um, yes. No race. Yeah. No race. I'm sorry. It's a little bit over time. Thank you so much for being patient. Thank you so much. Yeah. Okay. Yeah. Please don't forget to fill in the feedback form, guys. No worries. No worries. Yeah. Thank you so much for joining guys as well. Thank you so much for joining. Okay. Right. All right. Good job, man. Thanks, man. Alright. See you tomorrow. Bye. Bye, guys.