Computer generated transcript

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

Hi guys. Um, we'll just give it two more minutes and then we'll stop. We'll give it one more minute and then I'll start. Ok. Um, I can start, um, good evening guys. Um, thank you for joining. So today we will be going through bili biliary and liver conditions. Um, so similar structure to the previous lectures. Um, we'll go through the, um, etiology history, um, that you might be listing presentations, signs and symptoms, uh, investigations you wanna carry out and how you would manage the condition. So there are a lot of conditions and presentations to cover today. So I'll just get straight into it. Um, and there will be questions throughout the powerpoint. So, um, if you feel comfort comfortable enough, please do type the answer into the chat. Otherwise, um, it's more than ok to just have an answer in your mind as well. Um, so to start off, uh, we'll start with SBA one. So I'll give you around 30 seconds to just think of an answer. Um, we'll type in the chat if you're happy to. Ok. Um, so we'll just go through this question now. Um, so the answer for this was C, um, so the presentation of this mean, um, makes it sound like the most likely diagnosis is biliary colic. Um, so you've got a fairly short history of abdominal pain. You've got colicky pain. Um, the location is right, upper quadrant and it's post, um, eating food. Um, in terms of biochemical markers, um, everything seems to be normal and there are no signs of fever or jaundice. Ah, hello, Yvonne in the chat. No, I don't have a po if you just type in the answers in the chat, if that's ok. Um, and all of these signs suggest that it's likely bilary colic, um, which is caused by a temporary obstruction of the cystic duct duct commonly by gallstones. Um, and like this woman has in the question, stem after eating a meal. Um, so the fact that she has, um, biliary colic means that the most definitive management is elective laparoscopic cholecystectomy, um, which removes the gallbladder and will prevent future attacks or progression to complications of biliary colic. Um, so we won't go through the other options. Um, because I think we'll go through them in the next few slides. Um, so talking about gallstone disease. So, um, there are main five risk factors to be aware of and we can remember this through the five Fs, um, so fat or better termed as obesity. Um, and that's because the obesity can increase your cholesterol saturation in your bile. And then that promotes gall stone formation. Um female because women are more prone to the effects of estrogen. Um and then estrogen itself increases cholesterol in bile and also reduces gallbladder motility, um being fertile. So, pregnancy in high estrogen states, um such as taking oral contraceptives, um can raise your risk via the effects on the bowel composition. Um being 40. So, the incidence of gallstone disease does increase with age and particularly increase after the age of 40. Um and finally, family history. So, genetics um can play a role uh in your predisposition to gallstones. Um So focusing on biliary colic first, um this is when the g there is the gallbladder neck is transiently blocked by gallstones as shown by this diagram. Um in terms of history, you'll get right upper quadrant pain, um which is described as sudden dull colicky, um and lasts, um, typically lasts longer than 30 minutes, but um not a few hours. Um And it may be precipitated by fatty foods, the pain will respond well to analgesia. So, if you give analgesia as um the first line, then the patient should normally, um say that the pain is reducing. Um and nausea and vomiting may be present. Um On examination, you may see right, upper quadrant or epigastric tenderness and differentials can be uh gourd, peptic ulcer disease, pancreatitis and IBD, um which I think are conditions that we've previously covered uh in previous lectures. Um The slides are a bit blurry. I can stop sharing and I'll we present and hopefully it's a bit better. Is that any better? Let me know. Um, in terms of investigations, um, you wanna be doing an FBC, um, particularly paying attention to the white cell count, um, which is normally usual in like normal and biliary colic, um, because there's no inflammation or infection. Um, but you wanna be checking that it is normal cause if it's raised, it could be suggesting like a more serious condition such as acute cholecystitis, cholangitis or pancreatitis. Um, glad the slides are much better. Um, in terms of investigations, um, um, imaging, you want to be doing a.