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Hello, everyone. Thank you for joining us today. Uh My name is Luke. I'm one of the education director and this week we're focusing on bilary and hepatic conditions and we're excited to have you all with us. Uh, today I'm joined by, uh Gabriel who will guide you through biliary and hepatic conditions. Uh, he is 1/4 year medical student from Brighton Sussex Medical School. So make the sessions as engaging as possible. We'll be releasing polls throughout these are completely anonymous. Uh, so we encourage you to participate actively. If you do have any questions during the session, please put them in the chat and we'll do our best to address them at the end of the session. We'll share a feedback form and if you complete this, you'll receive a certificate of attendance and exclusive discount codes to teach me surgery and pass the MRC S. Additionally, the session is being recorded, the recording and slides will be shared on our meal page a couple of hours after the session. So be sure to keep an eye off of that. We're also excited to share that an exclusive question bank and other resources will be made available on our learning portal. Um So be sure to check out our website to access them. If you create a free membership account with us, you'll automatically receive a discount code for 10% off the geeky medics, anatomy flashcards, surgery flashcards, and knowledge bundle. We also have an exciting opportunity for all our attendees. Two lucky people will win free access to the geeky medics surgical flashcards and the GKI medics ay stations to enter simply complete your Google form at the end of the session and enter the unique code that we'll provide the more sessions you attend the higher chances of winning, so be sure to stand until the end um and attend as many of our other sessions as well. Um And just before we begin, we'd like to thank our partners, uh the Royal College Surgeons England, GKI medics, the MDU more than Skin Deep Medal, teach me surgery and pass the MRC S. So without further ado, I will hand over to Gabriel. Um Hi. Yeah, I'm G on the fourth year medical student at Bright in Sussex. Um I'll be teaching the second session of upper gi and let's go through the biliary tree, gallbladder and liver and all the like related conditions that you'll see. So again, thank you to our partners and uh you are a few of the learning objectives that I will describe what we'll go through. So we'll go through like the basic anatomy of the gallbladder biliary tree and liver and then we'll relate these to the conditions that, um, upper gi surgeon, see, and look at some of the procedures that they do. Um, so, yeah, uh, with our first section, we'll be going through, uh, biliary colic and cholecystitis. So, we're looking at the anatomy of the gallbladder and here's like a little like diagram of, um, where it is and, um, its relations. So, you know, um, the gallbladder stores and concentrates the bowel from the liver. And then when it's needed for release, like after eating, um it will release the bowel in its, in its location. It is on the right hypochondrial region of the abdomen and it's like it's an intraperitoneal organ and it's like pear shaped, um with three parts. Um They have the fundus which is the rounded part that projects into the liver. The largest part which is the, um which is the body. Um You can kind of see it here and then the neck, the infundibulum which contains the Hartmans pouch. And um so in terms of the relations, there's a few relations on top of the anterior and superior relations, you have the anterior abdominal wall and the inferior surface of the liver. And then posteriorly, you have the transverse colon and the duodenum duodenum, sorry and inferiorly, you have the biliary tree and also other other parts of the duodenum. And these relations will be important in terms of uh conditions such as gallstones and cholecystitis. Uh So you have also the biliary tree, which is the inferior relation to the gallbladder. And what this is is like the pathway this like tract where the bile travels between the liver and gallbladder and eventually into the duodenum. And so from the liver, um you have the hepatic ducts, the left and the right one, they combine to form the com common hepatic duct and that'll eventually go to the common bile duct, which also connects from the neck of the gallbladder, which branches out into the cystic duct. And then they create that common bile duct with that hepatic duct. And then that common bile duct goes in, combines with the pancreatic duct and it goes into the opening into the duodenum, which is called the ampulla vata. And um this movement of all the bowel um is controlled by a muscle called the sphincter of oddi. And as you can see, you can see the right hepatic dot left hepatic duct and all the all the ducts that combine to eventually go into ul vata, which is around here and that's the entrance into the duodenum. So, the ana anatomical significance of the B tree in the gallbladder is uh the formation of gallstones. And also sometimes there's inflammation called, um which leads to cholecystitis. And um when there's cholecystitis, it can lead to obstruction on adjacent structures, which could mean the adjacent ducts, uh maybe some um may, maybe impeding on the, uh, peritoneum or also on the liver. And then that causes like symptoms such as pain jaundice with the destruction of bilary, uh, bowel flow and then it can lead to systemic upset, which is kind of the presentations you'll see in these conditions such as cholecystitis. So, um, you'll see a lot, a few types of imaging when looking at the gallbladder. So you have a few types. You have MRC V, the CT and the uh abdominal ultrasound. So with the CT, you can kind of see the gallbladder here. And then, um it's, it's in the same with the hand and the ultrasound, you can see the presence of gallstones within it as well. That is that pear shape and then there's little stones and then M RCP, you can see like that pear shape there again with the presence of gallstones and going and the presence of some of the um biliary tree ducts. And here are some other images. There's a uh IV. Uh this is a CT actual CT and also um M RCP of the instead of the gallbladder is M RCP looking at the biliary tree and you can kind of see the clear um contrast to display the um biliary tract going into the duo eventually down here. Um So with that, there's uh we have our first pole and um if you have a medical student who's asked to describe the pathway bowel, uh the pathway that bal kind of takes from that liver and then go into the duodenum and you have a few options. I think you've seen in the chats, uh, on the poll. And I'll just give you a minute to, um, look at the options and kind of, um, find, uh, which answer? Which one do you think the answer is? Yeah, I'll read out the answers. Give it like 15 seconds, don't? Ok. Uh, le is, uh, how's the pole looking? Uh I think because of the, the answers are kind of long. So they just take a while to redo it. I'll give it another minute or two. By the way, guys, I know the uh pole answers are slightly different to the um answers on the slide. So go by the pole answers when, when choosing uh OK, so we've got 46% for the bottom 1 30% for c um and then us all on for Amy. OK. Um I know the answers are slightly different, apologies for that, but um the bottom one is the right answer. So you do have the two hepatic ducts joining and that kind of forms the hepatic dart, but we'll talk about how it goes from the liver to the duodenum. So it goes through them to the common bile duct and then it goes into that opening, which is the vata um which is an important structure when you start opening into the duodenum. And yeah, so I hope that clarifies, uh, why it's d and not the other answers. And so now we look at gallstones, which I've talked about before, which is kind of like a significance in, um, in terms of the gallbladder and its anatomy. So gallstones, um, there's different types, you have cholesterol pigment and, um, mixed and they kind of form from different, uh, different ways. Cholesterol is more from like diet and what that build up of cholesterol inside your bo body. And the, the larger ones that can cause like, um cause obstruction within your biliary tree and the bile ducts and also at the neck of the gallbladder. Um, pigment is made from uh bowel pigment, calcium salts and bilirubin and it's like, it's small enough, but it can be produced in large numbers to kind of cause that obstruction to you. And then you can also get um mixed, which um I've seen as the most common, although, um this is made of cholesterol and salt, which develop in batches and can cause that obstruction too. So again, the cause is too much cholesterol like such as in your diet, these crystals in your bowel, they kind of form into stones and that's why they're large enough to like block the biliary tree or the neck of the gallbladder and kind of cause those symptoms of like jaundice and uh also pain and also in terms of pigment, um, stones, you have those components of Balda, uh