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Reproductive, Renal & GI Part 1 - PreClinEazy (Back to School Series)

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Summary

Today's session seeks to educate medical professionals on the benefits of joining Medical Protection Society, a leading medical defense organization which provides indemnity, legal advice, access to resources and support for healthcare professionals worldwide. Guest speaker MP will discuss indemnity, what Medical Protection Society offers and their unique international aspect. There will also be a 20% discount for those who join the session, as well as a lucky draw to win £183 - the average amount a medical student spends in a week. Attendees will also gain insight into different aspects of the gastrointestinal system, such as anatomy and digestion, absorption, hormones and more.
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Learning objectives

Learning Objectives: 1. Describe the roles and functions of saliva in the gastrointestinal tract 2. Explain the importance of the buffering properties of saliva 3. Recognize the digestive enzymes in saliva and their role in chemical digestion 4. Analyze the anatomy and physiology of the esophagus in relation to the gastrointestinal system 5. Summarize the benefits of Medical Protection services for healthcare professionals.
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Hello, everyone. Welcome to today's session. Um, before we start, we have a wonderful guest here, present with us our wonderful sponsors MPs and he's just going to give us a shot. Talk on what medical protection is and what do you guys can benefit from it, and I have definitely recommend it signing up for it. I'll hand it over to um Oh, thank you very much. So lovely to see so many of your hair. Hope you're having a lovely day. So I'm mobile tea from Medical Protection Society and BS uh, provide indemnity, which is a T M C. Requirements where we are medical protection. The world's leading leading medical defense organization. We've got over 125 years experience and expertise in our field. We are not known for profit organization established by doctors. Four daughters eso We know that that the member journey we know with the trials and tribulations doctors go through, we sport are members from the training years throughout their career, on beyond on, even after you retire. If a case happened historically, we would cover you for that as long as your membership was in place at the right time, so we protect the interests and livelihood off. Healthcare professionals worldwide were truly international, so I'll discuss more about that later on and talk. So what's included in your membership? You got 24 hour 24 7 access to our expert legal team or problems that arise from your work or placement. We give advice and guidance and patient safety, consent, confidentiality and much more. You'll have unlimited access to our sweet of online educational resource is including post podcast webinars and case studies. Some of these are like impossible importance of case now dealing with difficult patients. Resilience on burn out. We provide you with the protection you need if things go wrong now, you may think you covered within their NHS or by your Diener E, which you will be. That state called state Backed Indemnity. But that is only for clinical negligence. If you ever if you ever had any other problems like any GMC hearings, um, if you wanted a device and complaints, um, as a matter of fact, that's where you come to it. Because supplementary benefits they wouldn't be covered, uh, within the NHS so or their membership benefit. It's your membership. It's still free for all your students years right into your foundation year. So what will always a unique feature of our membership compared to any any medical defense organization which is occur in space, um, is that we were truly international. Like I said, All you're on. So if any of you wanted to work in Australia, Singapore, Malaysia, Hong Kong, just to name a few, you can take membership with a student for free and recover you abroad. Also, um, currently, we have a automatic price draw. So if you if it's our if, if I if I just go on when you get to the QR code, right? So basically, on each slide that there's a cure coats, you can scan that you are code on that that will allow you to get the membership page. What you do is you need to fill out the the address field there if you if you put in the old details for your email address as your personal email address, because obviously your student one will only laugh for while serious student eso we'll enter you into a price draw on the Little weekly went around 183 lbs. Now you may think, Where's that figure come from? Apparently see every student spend for a week. Although when abouts I was a student, I'm not sure it was a lot less than that. You also get up to 25% author wide range of medical textbooks. Uh, you've got the right to request assistance with. Like I said, with GNC with claims complaints, TMC issues disciplinary proceedings. So we we we protect you in your medical career. And also, like I said, all you're on, uh, protection, Good Samaritan naps. So what makes us different to other medical defense organizations? Well, we've got over 100 over 300,000 members worldwide. Worldwide is a critical aspect because we do operate internationally on. Like I said earlier on, if you want to work abroad, a student or years beyond, you can work in. Some of the locations have mentioned Australia, Singapore, Malaysia. Your membership is free. Like I said, right into your foundation years, we have a confidential counseling service ready to spot you should you ever need it. So he only takes about 60 seconds. And, you know, like I said, the memberships fit for free. Um, please enter. Enter into it and please register using a Q R coat or you convince it. Www dot medical protection protection. They're all forward slash UK force Like join forward slash medical hyphen student. I will put a a link off the QR code on the email address into the chat. If you've got any further questions, we've got dots. Lehman, who's our be just for students, and you can always reach out to hear him on Adam. Don't sleep. And at medical protection, they're all. Alternatively, we've also been on media platforms, Twitter MPs and start medical on Facebook at medical protection. Go on on instagram and PS and start medical. Or again, you can email a student at medical protection. They're all thank you for listening to me. Is anybody getting questions? Thank you so much more. Um, if any questions, please put in a chat. More will stick around for a few more minutes after this presentation to listen to any questions. I've popped the link for medical protection. Um, in the in the checked uh, yeah, it's completely free for medical student, so I would definitely recommend that you can sign up fantastic Thank you very much. Thank you. I'm just going to share my screen now, so we just have a quick insurance and we'll get the sessions up. Scott. And sorry for the really high. We're all ski C today. We're doing a pretty easy section. Um, and today we have to present It's so hard and pap on their prepared really hard for this session. We're proud of responsibilities. People. A Z have heard medical protection service, MDU and metal metal. Help us with all our certificates. Um, and our feedback, all our wedding's are put on metal. A swell, uh, and so please check them out. Feeling the feedback from to receive the recordings and slides, Um, a quick shot it and ask the most. They help connect healthcare professionals from all of the place. Quest Med are an amazing happened like overuse. You provide good questions and very, very in depth explanations just following. Um, if you guys are interested in signing up, please use a ski Z 20 or 20% off your percent. We have a community, so I think one of them will post the community. Uh huh. Link in the chat. If you guys want to ask questions about literally anything. We're here for your reports. Daily questions once every two days. Also could very arrange eso Please. Please check out a community and Jonah community because we're just trying to facilitate an open discussion. Just a quick few rules. Least keep them. I can check. Um, I can camera on mute, ask questions and engaging in the polls. He's be respectful and a check. Just a quick reminder. Megan, Who was the host? I'm not sure if you're created the port, Uh, if they're gonna be any indicated in the session, uh, the section will be recorded and doing any, um, meeting yourself out. Turning on the camera would be captured in the recording. So by not disputing in this lecture, you're consenting. And if there's any objection, police message or email us and we'll be more than happy to edit it out, the feedback from will be sent out. The end of the session on the slides will be sent. All those are feeling the feedback from If you have any queries, please email off cuz it out dot com or or sneezy a gmail dot com. We have a free service and we hope to be a free service. So we work on social media presence. So please, please share. It's on all their social media stuff you enjoyed session on. We truly appreciate it, too, that it helps us fund hours, um, platform that we're able to go. And apart from that today, as I mentioned the Honda and Purple, are these the host for this session of the presenters for this session? But their medical students so have any guidelines Present. Please can tell. The official website says just nice guidelines and stuff. But this is based on our experience and our knowledge. I will let them take it away. Thank you, and just I don't If you have any questions to more, please put in Chateau Feel free to D m him or even email. Adam. But who's email address? That was. Who's the military's was president? He last night. Thanks. Hi, everyone. See the slides clearly? Yep. You're good. Okay. So Mr so hi. Everyone said today sessions going to be on the gastrointestinal system. So today we're going to be covering the anatomy of the GI tract. Digestion and absorption as well is looking at the hormones involved at in the, um, in the fasting and fed states. So shall we begin? Um, so first we'll be looking at the anatomy of the GI tract, starting with the mouth. So this is obviously where food enters the GI tract on guard. Two types of digestion that can occur here. There's mechanical due to mastication on that's basically just chewing on became ical due to the work of salary enzymes. Investigation basically helps increase the surface area terms of his area for enzymatic attack, so saliva in the mouth has four main roles. It has a lubrication role because saliva contains glycoprotein called Mucinex Andi. Basically, musicians produce mucus secrete are produced from mucous secreted glands on when nuisance come into contact with water, therefore mucus, and this helps to facilitate taste, speech and swallowing. It also has a defensive role because it contains lysozyme on like Differin and lysozyme zar antimicrobial enzymes, which break down the cell walls off certain gram positive bacteria lactoferrin on insulin. I've a it binds to at, um, iron within saliva by reducing available iron, which bacteria in need. Of course, on this makes it more difficult for the bacteria to grow. Saliva also contains antibodies as well, and saliva also has buffering roller bicarbonate ions. Raise the behavior of saliva from slightly acidic at basal secretion level to around Ph of eight during active secretion. There are a few reasons why I salute. Saliva needs to buffer acid. One of one is because why saliva needs to buffer acid is because when we eat, the same foods are Sediq, for example. Oranges are acidic on there. Also, bacteria that live in our teeth themselves on. Basically, the buffer helps protect her teeth from corrosion on saliva buffering properties. Also helpful in the missus, which basically means vomiting and finally, saliva also contained salary. And I'm a laser, which basically enzymes that break down starch into a legal saccharide. Saliva also contains something called hepatic or in which basically binds to be 12, which we probably heard last year. How important it is on it protects you from the stomach acid. Whitman B 12 is essential for life on Bear. Four. It means that the role of saliva is all the more important. So as you can see in this diagram, um, that shows the mouth all the way down to the stomach. Esophagus essentially is kind of like a conduit for the food to pass through. So when the food has been masticated in the oral cavity, the bolus travels down is pushed back by the tongue into the back of the throat. On basically the touch receptors in the pharynx initiate something called the declaw, a tissue in reflex, which is the swallowing reflex. And this is a cord, and this is coordinated in the swallowing center in the medulla. And the lower part of the respiratory center of the medulla is directly inhibited by the swallowing center for the very brief time that it takes to swallow on. It's referred to as declined deglutition apnea. So basically the bolus of food will travel down these different parts of the esophagus all the way down into our stomach. Okay, so moving on the form moving on, I'm going to just talk briefly through the general histology off the GI tract. So therefore, main layers off the G I tracked on, but basically the diagram here shows the mucosa, which is the inner lining on it consists of the epithelium, the lamina propria, and the muscular is mucosa. Um, so next is the sudden you closer, as you can see in the diagram, it consists of collect a collection of blood vessels, nerves and glance. And it also contains a sub mucosal plexus, which is responsible for glandulous secretions. Next is the most glorious external, which consists of two layers of small muscle and in a circular on the outer longer to dinner layer on between the two layers doesn't, um, and our backs plexus, which forms part of the enteric nervous system. On the outside of the good tube, you'll find a layer of connected to shoot Costa Rosa, which is covered by simple squamous epithelium. So the epithelium found in the mucosa of the GI I try to hold very. But as a general rule of thumb, there are two types of two types of epithelium present. So, as you can see here, you have a Z line, Um, off those off a guess. And basically I hear the pectinate line of the anal canal here and the pectinate line of the anal canal. The epithelium is Columbia, But there are only three places where a deal, um, is not Columbia. And instead they're stratified, um, squamous and This is a the mouth esophagus, um, and below the pectinate line in the anal Canal. So the Z line of the off the esophagus is simply where the stratified squamous at the ceiling meets the Kelowna Epitol um, so moving onto the stomach. Now there are four basic functions off the stomach. One is that it acts as a reservoir for food and allows for controlled release of its contents at the pyloric sphincter. So also plays a role in facilitating digestion, especially instating protein digestion. Stomach acid produced can be used to destroy ingested microbes, and finally, the stomach plays a role in regulating appetite through various feedback and feed forward mechanisms. So basically, when food arrives in the stomach, it causes the stomach to distend, which makes sense, cause when something arrives, it needs to make more room. And this basically triggers the stomach receptors to relax via the vago-vagal reflects on. Just to clarify the vagal view, legal reflex is, um, is both Afrin on deferent, and they're both carried by the vagus nerve. So rather than two layers of muscle, the stomach tends to contain three with an additional oblique muscles layer present, so the antrum has a thicker muscular wall on performs more forceful contractions than the proximal stomach. Okay, so time for an SBA. So basically on an x ray when you might see three constrictions this off for this, what would you see? It the level of t three? Um, I don't know if the poll is up. Yeah, yeah, it's a Okay. Thank you. Um, I'll just give it a few more seconds, and then I'll stop it. That I think. Yeah, so? So the answer. Waas I can you see the slides? They artist, I think most of you got that right. So, as you can see, they ought is a t three. Or is, um, the Kirkwood cartilages about C six and the diaphragm down here is t 10. Um, you can always refer back to this diagram after when the slides have sent out to, um So now we're going to move onto the duodenum, so this is often said to be the first part of the small intestine and follows on from the pyloric sphincter off the stomach to form a c shaped loop around the head of the pancreas. Um, so basically, as you can see, in the diagram. It said to have four parts in the order in order of Superior um descending, inferior on ascending. So the 2nd and 3rd parts are retroperitoneal whilst the first and forth parts I said to lie on the mesentery. So there are two sources of arterial supply to the duodenum, proximal to the major duodenopathy supplied by the gastroduodenal artery and distal to the major Do deal duodenopathy A and it's supplied by the inferior pancreatic duodenal artery artery. Sorry, the veins of the duodenum follow the major arteries on drain into the hepatic portal vein. So basically it's always remembered that they all drain into the hepatic portal vein. The major duodenopathy, the major do A. Do you know Papilla is a rounded projection in the do dinner into which the common bile duct on the pancreatic filed a train in two. So this opening in the duodenum at the major duodenal papilla is referred to as the Ampulla Varta, where the sphincter of oddi it acts is a muscular valve responsible for controlling the flow of bile and pancreatic secretions, so you can see it here in the diet them if you can see my cursor. Uh um, So maybe one to the rest of the small intestine. Um, the other two parts following the duodenum are the judge in, um, and the ileum, which intraperitoneal in contrast to the duodenum, the differences between the judge in them and the ileum are summarized in the table on the right here. Um, so as you can see, the difference is ah, on the umbilical region, where as they have a super pubic region But I think just save on time. You guys can look at this after eso the ileum ends at the earliest. See cool junction, where the ileocecal valve, um is on the small intestine is roughly about 7 to 8 m long, which is like very long Do you think about in terms of like, the size of our body. So a very important anatomical adapt a shin of the small intestine is it's large surface area on that's present due to its brush board the surface so that so it'll surface area off The birth border is about 250 to 400 m squared. And just to put that in perspective, a tennis court would be 260 m squared and area roughly so. It's very, very large. So factors which increase the surface area, um four small intestine inclusion. Mucosal falls of the Kirk ring, which the character in which give the small intestine the appearance of having circular folds on the villa on the microbial I. The lining of the small intestine is constantly against wear and tear during digestion. So the Crips of Levaquin, between the village secrete of fluid backs is lubrication and also contains themselves for the replacement off discriminated epithelium Selves. So finally, been a touch on the large intestine, which consists off the cake, Um, the ascending and transfers dis undescended and sigmoid colon on, and also the rectum and anal canal. So it's roughly about 1.5 m in length, so it's much shorter in comparison to the small intestine, but it's still long distinguishable of future off this large intestine. Is there pendency ease of EpiPen? Okay, you might have heard about it before. Basically, they're small tags of fat you can kind of see here. Um so the the different parts of this large intestine do slightly different roles, So the proximal part absorbs most of water and I owns while the transfers colon predominantly stores feces, um, the functions of the large intestine include to start, mix and process. It's contents to expose the contents to microbes on, to absorb nutrients from microbial fermentation on to expel a species in a controlled manner. Okay, so now we're going to be moving on to digestion and absorption in the upper GI I. So Upper GI I refers to the mouth, esophagus, stomach and the duodenum. We also already discussed about the mouth's role in digestion and that how this offer grass axis a conduit, um, for food to pass throat through into the stomach from the mouth on a large portion of the upper GI I digestion comes from the gastric secretions in the stomach and also the pancreatic secretions, which also released into the duodenum. So we'll be again by, um, begin with gastric secretions. So they're three main glands off stomach mucosa. So says the cardiac plans the oxygen oxyntic glands on the pyloric glands. So, as you can see in the diagram on the right hand, shows the contents what's released from each of the glance. As you can see all of the glands Mr Create mucus to protect the stomach from the really acidic environment from all the hydrocodone Casodex present. So the table on the so the table on the bottom right shows which cells within the gastric glands secrete what substances. For example, parietal cells secrete hydroponic casted on intrinsic factor. Chief cells are also known to release pepsinogen on one of the ways which pepsin engine is converted to pepsin. His virus breakdown from hydrochloric acid on drummer hydrochloric acid is all is to provide a pH of less than three, which is optimum for enzymes like Pepcid in to work in on. Remember on a quick note is that the only one, the the only one thing that the stomach does that's actually essential for for life is the release of instruments ick factor, because intrinsic factor plays a really important role in the absorption of B 12, which is essential for human life. So this the a cool fact would be patients have survived without a stomach as long as we supply them with vitamin B 12 intravenously, which has always really cool. Um, so we're now going to touch on some gastric acid specifically on what the roles of gastric I said are so um, gastric acid can be used to delay gastric emptying if acid is getting into the duodenum at too high rate. There's a feed feedback mechanism, which reduces the rate of stomach emptying so the acid itself is involved in the feedback control on the rate of emptying too. So the gastric acid also plays a role in improving calcium and iron absorption. As I mentioned before, as it could be used active, it pepsinogen and also killed the microbes too. So, basically, gastric eyes acid is really important in our digestion. So how do we control the acid secretion? So it's basically a dictated by a variety of different and crying paracrine on new newer crime signals, so so summarized Ah gastrin histamine and a C H promote acid secretion, while secretin and somatostatin on prostaglandins inhibits secretion. So many of these signals have a combination of direct and indirect signaling involved. For example, looking at the diagram here, Come on, the right. The vagus nerve not only stimulates the parietal cells to be directly to directly release, see, tell colon it also stimulates, um, de cells, too. So vagal stimulation on ECL cells enhances gastric acid secretion via increased histamine release vagal stimulation of the D cells also promote gastric acid secretion By inhibiting the release of somatostatin which were discussed is inhibit tree on hormone, which would other which would basically stop it inhibiting the power crying mechanism. So the release of histamine from the S L cells on the secretion off acid biparietal cells basically controls the gastric gastric acid. Um, so I just couldn't move on. So now we're going to touch on the three phases off digestion known as this phallic gastric on intestinal phase. So the cephalic phase is the anticipation of food, including chewing the smell of food on the taste of food. So food has yet to enter the stomach. This point on basically, um, there's a feed forward mechanism, um, mediated by the vagus nerve to increase at a secretion in the stomach. So basically, the vagus nerve prepares the stomach for food to enter by increasing that secretion when the food actually arrives within the stomach, you get the gastric phrase on here you have nerves saying, basically, let's get ready for some food to come. So we're gonna screw even more acid on. But we also have the hormone gastrin activated here, and gastrin is released in response to que such a pet peptides an amino acids in the stomach itself. So basically, after after you've actually eaten the meal, this happens Finally, when the stomach content drains into the duodenum, Um, you have the intestinal phase that'll be a reduction in acid secretion during this face because you don't actually want to overwhelm the duodenum with this acidity. So there might be still a little bit of acid, um, secretion here, but it's being wound down on the part of the mechanism for switching awful involved the home and secretin, which will come to a little bit later when we talk about the hormones off the digestive system. But it basically inhibits the acid secretion in the stomach. So finally had like to mention the roll off the pancreas in releasing exocrine secretions. Mainly, uh, mainly because, um hasn't basically, it releases under crying and exocrine secretions, so that's very important in digestion. So the endocrine secretions of the pancreas also play a very important role in the Fed and fasting state. So as you can see the endocrine secretions are insulin, glucagon and so much statin on the exocrine secretions of bicarbonate. Um, malaise is like paises proteases ribonuclease is and deoxyribonuclease is, um so so in the fed and fast state, the smiling in the small intestine, you'll fact so in the federal estate, you'll find, um oh, it has it frozen. Sorry, has this side version I think you're okay after. Okay, um, so in the federal estate within the small intestine, you'll have basically the breakdown off products present, like mainly the breakdown of glucose, amino acids and fatty acids. So glucose will be absorbed into the blood and cause an increase in blood glucose, triggering the release of insulin and from the beta cells in the pancreas. So let's look at the effects of insulin. So the effects of incident of really widespread and they promote a number of biochemical process is so by increased in glucose uptake by certain tissues, including her. Patrick add opposed on muscle tissue. The liver blue coast is stored as collection, or it can be used to make ATP four off, for it could be converted into triglyceride and stored into adipose tissue. Vialli, progenitor cells, Canosa, uptake, glucose for uses many immediate energy sources or store as glycogen. Similarly, the brain uses glucose as an immediate energy source. Incident not only affects glucose but also increases amino acid absorption from the blood into the liver, promoting proteins and assist. And finally, fatty acids are absorbed into the lymphatics in the form of chylomicron, which rain into the thoracic duct and entered the Venus um, circulation here too. So in the summary, you concede that the metallic metabolic process is the incident in the Fed state. Promotes is glycogenesis glycolysis ISS like a genesis on protein that synthesis so in the fasting state instead of insulin and glucagon is released from alpha cells in the pancreas, and it promotes the breakdown of glycogen in deliver on promotes the formation of glucose and deliver to be distributed in the blood. So Glucagon also promotes like policies which causes the breakdown off triglyceride in either post tissue to be released as free fatty acids, which is actually the main, and you saw us off the heart. So due to an increase in fatty acids to do to an increase in fact, the acids on their four high amounts of this do telco. A key to Genesis will basically occur here on the at forms Keytones Onda Main three, which are listed here. I see tone as a C two acetate and beta hydroxybutyrate on a shown in the slide here, and this basically go act after weeks of starvation. Key tones basically act to become the primary source of energy to the brain, as part is basically a last result during fast in. So I'm just going to go to the next slide. So I mean, I said we'll also be sent to deliver to produce Blue Coast viably progenity cyst. I also want to, uh, briefly mentioned the effects of the Fed and fasting states on gastric motility. So during the Fed state, and from of the stomach is called is responsible what's called the antral mil. So this is where food is ground up into really small pieces on the antrum. Basically, contracts to, um, release the basically the antrum contract, uh, in the presence off interstitial cells of cradle, which present, which is present in the walls of the stomach on These are basically specialized move muscle cells containing only a few contract. I'll elements on days a basically are longer to dinner and circular in layers. On the act is a pacemaker cells allowing for the slow wave of contraction in the stomach to basically allow the food to pass through. So in the Fed stay, acetylcholinesterase are released on. Basically, they they increase the chance of action potentials on DCAA tractions to occur. So the antrum So the antrum milken basically let the food to pass by by a wave of contraction. So as the wave of contraction, um, approaches the pyloric sphincter, it basically prevents the passage of ingestion. So the stomach contents are forced backwards towards the middle of the stomach to basically make sure they're fully, um, digested. And it basically prevents is a process called retro pull shin. During this milling process, the pilot, the pylorus, is closed, but and it does not allow the passage of any ingest it. But after the way the contraction has ended, the parents went to region, relaxes on, allows the food to empty, uh, from the stomach, um, and, like pits actually passed through the powers really easily. But solid particles need to be grown down even further to below about two millimeters in diameter. in order to pass to the tougher the food and the larger is particles, the longer it takes to remain in the stomach. So over a course of the left and they'll be foods ingested, which are hard and cannot be made any smaller for this ingested that migrating. My electric complex, initiated by a release of motilin, is used to sweep the remaining food out of the stomach through the pyloric sphincter into the duodenum on the M C is a wave off contraction with stomach from the to the all the way to the end of the ilium. On it occurs when you were in a fasting state, so approximately every 90 minutes, it because so now we're going to be looking at the heart murmurs involved in digestion. So previously I think I mentioned about secret in before in relation to its role in him inhibiting acid secretion. So basically it's released from um s cells in the mucosa off the duodenum and then judging, um and as you can see in response to the acid in the duodenum, it stimulates bicarbonate secretion by pancreatic ducts, and it basically inhibits the secretion from the stomach. Therefore, secretin is the most important humeral regulator off the doctor bicarbonate secretion. Next, we'll look at Cholecystectomy in in which is released in response to the presence on the which is released in response to the presence on the products of fat digestion in the duodenum. So basically it's triggered. It triggers two things. One. It triggers the gallbladder to contract which causes the release of bile on. And second is it relaxes the sphincter of oddi, which we said earlier allows the bile to end to the duodenum. So by releasing the bile into the duodenum, it basically helps to, um also if I the facts and therefore it allows for a negative feedback loop to form because fat is broken down of unabsorbed more efficiently. Basically, a multiplier basically means increase its surface area and basically allows it to be digested faster later on on basically closest. Once that happens, once the fact is broken down and absorbed cola, Sister Cailin will no longer be released. So basically, here we have a quick summary of the mechanisms off secreted and CCK, as we already discussed. So you start off with acidic time and then you have the eye cells which released a cretin. And then you have bicarbonate released from ductal cells in the pancreas. And then you have fatty acids with the low pH oh, does it work which basically trigger I cells to release CCK. This triggers two things. So triggers go buddy to contract on day, As you mentioned earlier, it basically means that bile enters the do dinner. But it also allows digestive enzymes to be released from the pancreatic, a sinner cells on. Also, that means that, um malaise is like paises and trypsinogen could be released. And this basically allows the sphincter of oddi. This basically all pastored the sphincter of oddi into the duodenum. So I've just been a quick summary of digestion here as a flow chart. Hopefully, it helps to break it down a bit easier. So basically food comes and then you get stomach distention. So as you mentioned earlier, you have a vago-vagal response so basically the same, it relaxes for the food entering on the local stretch reflex occurs, fire the action of his little colon, and then you have vagal stimulation Viagra, aspirin released in peptide. So this all stimulates your cells to release gastrin. So Basically this then causes an increase in calcium. I owns concentration in the parietal cells, so basically him, there's an increase in pertains by the proton pump. Now this all works also on the entire criminal thin like cells to release histamine via the hatred Septus, which increased, I click MP and increase the proton pump activity, hence increasing proton concentration. And then you also have the local structural flex viaduct shin of acetylcholine. So vagal stimulation via the gastrin released in peptide Jap. It also happens when this all collectively similar it's per prior to our cells to release hard colic acid, which we'll said earlier was essential far, um, pepsin for the low pH. The other action of parietal cells is that it releases intrinsic factor, and this obviously binds to be 12, protecting it from the stomach acid on later on. After this protective protection happens, it's absorbed in small intestine. So, meanwhile, is this happening? Um, the stomach distension also triggers on the college. The college cholinergics Kalinic's, the Cholinergics cholinergics activity from Vegas never on acidics the any triggers. Acidic stomach conditions on gasoline is secreted, and the presence of gastro and secreted in means that chief cells release pepsinogen and they release is I mentions. Well, pepsin engine is a sign mention. So combination of these two means that the heart colic acid from the parietal cells activates the pepsinogen from the chief cells on that creates pepsom. So, what did anyone know? What inhibits gastrin relief from GI cells? Ah, if you can put it in the tap. Yeah. So, um, I can't see the chat right now that I'm just gonna put it here. So? So if anyone said CCK in secretin, you got it s o. They inhibit the gastrin relief from GI cells. So now does anyone know what increase it? What? What inhibits? Hard to call it acid secretion from parietal cells. So I was going to say it now somatostatin on which is released from diesels in the fund us of the stomach and also prostaglandin. So this is just a quick summary of it that you can look after the slides of sent out. So So finally, I would like to touch on the hormone ghrelin on basically it, as it's one of the three homeruns that provide the peripheral peripheral signals about the It's one of the three hormones that provide the perfect peripheral signals about the energy stores on nutritional status. Grandal grennan is released from the tube, it from two places, so it's released from PD one cells in the fund. It's of the stomach on Exelon cells in the pancreas. Ghrelin is essentially your hunger signal. I remember it because sounds like grumble or like ghrelin, so basically makes your stomach grumble, and it actually is the only home, and that causes hunger. So when you have so when you've been on having an empty stomach for a long time, your bread and levels become high on the opposite will be true for your insulin levels were. So when you eat well and goes down whilst incident goes up, so when they haven't invest, so they have an inverse relationship, as shown in the graph on the side there, so outside of meals, grilling does not change much besides increasing gradually over the night because you'll be sleeping and you'll be fasting. So so that's the presentation on G I tracked. I think I'm gonna pass it off of it to Savannah. Now Think you have. That was a really, really good session Thank you so much. I'm going to shortly Just be putting in the chart. I I know some people won't break from these sessions, so I'm just gonna be putting in our mailing list. We've got this said that if anyone wants to receive emails about our latest sessions, they're coming up. Um, you can get it through this mailing this, so I'll just put that in the chart. Now, feel free to take a couple of minutes break on, then Sana will go into some reproductive teaching. But give that I fill in on day will contact you whenever we have a session. And and feedback, things will be given out shortly. And when we're into the next session, um, should I go back to the slide on Fed state? Because I think somebody asked. Yeah. Go for it. Um, I was going to try it. I am. Probably lose the slide. That that was on, um, one movement. Can you see this yet? More. On your feet. Back slide. Okay. Someone's gonna go back my my exit. And then who? Oops. Out as the window. Has it stopped? Sharing? Yeah. You've stopped sharing now. Oh, sorry. I'm just going to go to, um you just talk to it? Yeah. Hey, I'll just so I'm going to go. So basically, in the Fed, stay the small intestine. You have the breakdown off products like glucose and amino acids on batty acids, so glucose will then get absorbed into the blood on because your, um, eating, you'll have lots present. So basically, this triggers the release of insulin because I think I think we will head that if you have an increasing clickers to have insulin to lower the glucose on insulin is released from beta cells in the pancreas. Um, so that's basically kind of what happens in the Fed state and in the fasting state. A. I think I mentioned ghrelin, So ghrelin kind of happens when you're not eating. So it basically, um, makes your stomach grumbling, and it kind of does the opposite of insulin, and that kind of makes you hungry, if that makes sense, Um, is that what they ask? Like the action of that? Um, I think so. They just said, Could you explain the feds state again? But if you like, if there's a couple of other questions for you, maybe want to read through them in the chat while so hard is talking and just type out and answers. I'm sure people find that really useful. Yeah. Okay. Yeah. Brennan asana. You ready to go? Yeah. Pretty. And second possibility. And you. Great. Can you see my sides yet? Oh, good. Okay, Perfect. Okay. Hi, everyone. Uh, my name's Sana on do today. I'm going to be going over just a bit of pre clinical reproduction. You're productive stuff. So hormones, bit of reproductive anatomy, um, had some common conditions and things like that. So, um, any questions at all, Please put them on the chart and I try to answer them as we go, but if I can't, then I put them a lot. So back on the child later. So we start with some, basically knocks me to kind of get ourselves a good base. Um, this pelvic bone is the base off everything and doing practices, and it's where everything builds on. So if you have the pelvic bone and you have all your obvious effort around it and I got blood vessels and the muscles and your nerves that run through them and fit around this is really important to know and have a brief idea of what the public bone looks like and the most important point part of it. So if we just do the basic labeling, that there is a sacred the sacred born and the bottom is the coccyx, which is the very end of your on bottle column, the sacred in the coccyx at around these you have your illion bones is your iliac crest this bit over here on both sides and the part of naming today are mainly important because either muscles attach it to them or ligament attached to them and therefore the court anatomically important landmarks. You have the anterior superior iliac spines, where a bunch of muscles attach as well as the anterior inferior, really expiring, which is just below it over here. And then you also have this whole year, which called the object of for a minute, so more important parts included the issues you brought City, which is a notch at the bottom here, along just above the inferior pubic Ramus. It's not here. I disappear, people grimace. But I'm going to spend more time, do more significant part of the pelvic bone, which is the back the posterior bit off the parrot bone, and this is because we have two important nerves that run through the whole year. But first it's important to know what forms the holes at the posterior bit of the pelvic bone. So you have the sacred tourist ligament, and it's called the Sacred Tourist Ligament because it runs from the sacrum, which is this bone all the way down to the issue to urology, which is at the bottom here. And you have the sacred spinous ligament, which is called so because it runs from the sacrum to the issue of spine, which is here for the sake of is here, and the issue is fine, is there, and these are important because their position kind of creates two holes. If you have the greater sciatic for Ayman, which is a bigger hole, which is on top over here on both sides, and you have similarly a lesser sciatic for him, in which is a smaller hole, and it's just below, um, I'm the reason I'm bringing this up today is because I said earlier we have two important nerves that run through these hold. Can anyone put in a chat. Which nose run through, which for a man, you know. Okay, don't worry. So basically, um, you can see that the sciatic nerves run through the greatest attic for him. And as you can see here, and the pudendus of runs through the necessary X, that's the surgical room and as well as the greatest as it for even as you can see here, the sciatic nerve is really important in terms of nervous supply to your lower leg muscles. And your present illness is important in terms of sensation to your perineum and your reproductive system. So the reason you can feel around the genitalia and sensation there, it's because of pretending they provide sensation for those. If you really move on to external female genitalia, these are the basic labels you find. So the bits on top here is your mom's pubis. On the outsides off your, um, female genital area is the labia majora, which is the skin part outside. The most external flap off the genitalia is called the Labia minora, which is over here on D. We moved to the inside, but then you got the clitoris that sits on top and If you move further down, you have to hold. Hold on top is, um for your urethra, which is where you urinate from on the whole below. That is your vagina, your vaginal canal. And if you move further back posteriorly two words your back passage. You have you, which is your main issue in the canal on that entire area between your vaginal area and you're gaining area is called the perineum, which is this area here. If we now go inside the female reproductive tract and we look at what it looks like on the inside the main structures involved three Eylea we see here. Firstly is the vagina. This is the vaginal canal, then have the uterus on the endometrium is theme most external ear off the tress and is where, um, embryos, usually implants, then have the cervix. That is the opening between the vagina And you, Tris, the old reduction, the over in the memory A. So the ovary connects when relation occurs. And a new size is, um, you know ovulated into the reduct. It makes its way through the all the ducks on once it's fertilizing. The only doctor where's usually fertilization occurs It's an implanted in the uterus in the endometrium on so basically, um, maturation of your sights occur in the ovary, and then operation occurs and they get to the obedience and then transported either to the uterus when it's on fertilized or it weeks in your deductible fertilized. If you look at it from a transfer's point of view, we can see to make an anatomical landmarks, which is the best. It'll you try and pouch, which is a poacher sleeve between your bladder, which is your testicle. Or the nutrition, which is your uterus. And you also have a pouch between rectum on usually. Well, these important because these are part of your abdominal cavity. And, for example, if there's lots of fluids inside a woman on, but she's standing completely upright, then all the fluid is going to go and collect in these pouches. And usually, yeah, all the fluid goes and collects in. The director you trying out for is quite clinically important if we don't move the histology because it's already has a lot about the function's off these organs. So, um, I'm going to address the full main parts off the female reproductive system and we start with the uterus, which is this bit over here. So you tried histology. It's quite important because it consists of many layers, so you just you have your myometrium on your endometrium, so the myometrium consists of muscle layers, and they undergo You train contraction, especially during labor, and your endometrium responds to hold more changes and changes in sickness and changes in glands. Andi arteries, um, occur in response to hormones during the menstrual cycle. On essentially, what happens is that in response to home, once it is FSH or progesterone on Easter gyn on the endometrium, thicken on connective tissue is renewed and grows. You got the growth of these really thin fine arteries, and you also get the growth and maturation of these plans that eventually will feel with you trying milk that contained the glycogen and these on preparation for the implantation of an embryo in the future. Because even embryo is implanted, you need to make sure that the uterus is providing hospital hospitable environment so that the embryo could be viable, and therefore, along the menstrual cycle, you'll see that there's changes in histology the tress so you could see this diagram here. The uterus here is currently it's proliferative or secrete am secretive phase, where you can see that the glands these round blobs here are developed and matured glands that contraindicaitons glycogen and you try and milk and you can also see this is the myometrium here as well on do we then go to the cervix? The service is important in the context off ovarian cancer, for example, because basically, you have endocervix and and exercise six. So the end of cervix is the bit on the inside over here, and you're active. Service is the based on the outside. Now. The reason you have different types of epithelium in the endo and exercise Vicks is because they're explosive. Different environments, as you can see, the end of cervix kind of facing the uterus. Where is the excess of it's is facing the vagina and therefore Dex, they're exposed to different chemicals and different ph and therefore they have different adaptations and have different epithelia. So if you look at the end of service, which is on the inside, you have simple columna attic ileum, which on this diagram is on the left. And if you look at the X o cervical John outside. It has stratified, squamous nonkeratinized everything media, which is here now. They don't usually sir very specific functions. But the reason is it's so important is because the part where they transition from one type to another type and it's called the Transformation Zone on this part off the cervix on me, susceptible to metaplasia metaplasia is where a certain when one cell type changes to another cell type, and if this becomes malignant, it can be a source of cancers. For example, cervical cancer. Sorry, I think it's over in council, you know I'm in cervical cancer, and therefore this transformation zone is the most common site of development of cervical cancers because of the transformation zone under change in cell type. If we then look at the ovary doctor, which is the fallopian tube, you could see that it's lined with silly, ated, simple columnar epithelium, and the reason it has. This is because the celiac your reduction of two types you have secretary Epithelia and you have ciliated epithelia, so you need them to secrete. Can icals that will help to keep the old um alive when it is in the overdose and sell your help to move the site of the Obama long on the reduction in the ovary. You then have the ovary itself on. The appetite I'm looking at here is in the outside membrane, which is called the Germinal Epithelium off the ovary. And the journal epithelium of the ovary gives rise to follicular cells on these particular cells or later invaded by primary germ cells that then become a primordial follicle. So it's just the follicular cells and not the over in itself that arises from the German Levaquin of that make sense. So before we continue, here's the so sp a I wait for about another 10 seconds. Maybe. Here. I still good there. Okay, so most of you go to right? That's really good. Sorry. Yeah, I was going right. So it is the Ampyra of the you trying to you. I can see once question will be tricky, cause the same is a bit more clinical and complicated. But I try to break it down for you. Basically, here we have a 29 year old woman who presents with lower abdominal pain and some bleeding from your vagina. It's been about five weeks since the last period, and she's complaining of some tenderness in the breasts and also feeling nauseous on. But when you touch when you feel with the air but your hip, But she complains of pain, it's a bit tender. So in terms, the most likely diagnosis I was thinking more something like an extra pick pregnancy because it's been quite a while since the last period. Some vaginal bleeding, which is quite common as well. It's an abdominal pain. Um, these quiet is quite typical presentation. Open topic, pregnancy on what I was trying to he take, You got to fight. She is, in fact, pregnant. And so I'm trying to him. I'm asking you where.