All right, let's get started. All right, here we go. So these are going to be the questions and the information here. So let's go through them all together. Now, if you know the answer and you feel comfortable enough shouting it out, please do that. If not, and it's radio silence, faculty, shout out the answer. If nobody knows it, I'll just put up the answer. All right, here we go. You ready? All right. The esophagus moves food from the mouth to the stomach, begins digesting proteins and fats before the food arrives in the stomach, is normally lined by the same columnar mucosa similar to the rest of the GI tract, or ABNC. Boom. Nailed it. Good. 100%. All right. The esophagus is where Barrett's mucosa occurs, is lined by squamous mucosa that can be damaged by acid exposure, or has an inner, circular, and outer longitudinal muscle responsible for propelling food through peristalsis, or D, ABNC. You sure? Final answer? D. Boom. Good job. Walter, you got that one wrong. Sorry. All right. The stomach is the main location. Food and electrolyte absorption is the main location of nutrient absorption, is where food is ground down into small pieces to increase digestive and absorptive surface area, D, is where gluten causes inflammation in patients with celiac disease. Ooh, nice. All right, shall we try again? Shout it out. Loudest one wins. D. Boom. Good. Is where food is ground down into small pieces in the digestive tract so it absorbs things, right? So the stomach is just basically a bag that just grinds stuff down. And then the duodenum, where all the enzymes from the pancreas, et cetera, are, is where actually our absorption of nutrients occurs. So which of the following is a cause of bleeding peptic ulcers? Helicobacter pylori, A. B, acetaminophen. C, celiac disease. D, proton pump inhibitors. A. A. Perfect. H. pylori. Did you get it? Mm-hmm. All right. Crohn's disease is associated with inflammation limited to the colon, deep ulcerations and fistula formation anywhere in the GI tract, a normal appearing colonoscopy but inflammation seen under the microscope, or D, improvement on a gluten-free diet. B. B. Bravo. B is in Bravo. Perfect. So inflammation limited to the colon, deep ulcerations anywhere in the GI tract, a normal appearing colonoscopy but inflammation seen under the microscope, or D, improvement on in the GI tract. All right, liver, gallbladder, and pancreas. Here we go. The liver is important for all the following except storage of vitamins, metabolism of drugs, production of clotting factors, clearing toxins from the body, or production of insulin. E. E. Walt Coyle, do you agree? All right. You can go back to medical school. All right, E, production of insulin. Good. What produces insulin? Awesome. All right. Upward GI endoscopes and colonoscopies generally have the same dials to control the scope tip direction. True or false? True. True, yeah. They're just wires attached to two wheels. And for those of you who were in the skills lab, you saw that. There's a little wheel and a big wheel. They're controlled by wires. Those are called Bowden cables. And they deflect the end of the endoscope. And you'll see that tomorrow as well. In most GI endoscopes, optical fibers and electric signals from digital chips are used to carry both light to the scope tip and images to the image processor and then to the monitor. True or false? True. Yeah, absolutely. So digital chips are not the end, but they used to be fiber optic, which is why a lot of them were labeled PCF, CF, colonoscope fiber optics. And so there was a time back when Walt was training where you'd have to get up on the bed and actually get close to the bottom end and look because fiber optic cables are just essentially light sensors. And that's how you'd see. So you'd get real close to your patient. Now we can stand a little further back. Esophageal disorders can result in A, maldigestion, B, difficulty swallowing, C, chest pain, or D, both B and C? D, both B and C. Yeah, difficulty swallowing and chest pain. The initial treatment of bleeding peptic ulcers includes all the following except A, proton pump inhibitors, B, gastrectomy, C, upper GI endoscopy, or D, IV fluids? B. Yeah, B as in boy. Absolutely. I certainly hope that the initial treatment is not removal of somebody's stomach. That would not be ideal. Sorry. All right, what type of endoscope is used to view at least part of the small intestine? A gastroscope, also known as an EGD scope or an upper endoscope. An enteroscope, B. C, colonoscope, or D, all of the above? It's always D, right? If it's all the above, it's got to be just by definition. So what part of the small intestine does a gastroscope or upper GI scope visualize? The beginning of the small intestine? Perfect. What's the name of that area? Duodenum, perfect. What's an enteroscope? We didn't really go over that too much, a little bit. Yeah, I hear people shouting out small bowel. That's right, entero, like enterocyte, small bowel. So scope is a video camera, right? So a small bowel endoscope. It's a little bit longer, a little bit goes deeper. Sometimes they have balloons or other mechanisms on it, right? Because there's like 25 to 30 feet, like Dr. Calloway said there. So you see the small bowel with that. What part of the intestine do you see small intestine with a colonoscope? The ilium, perfect, the terminal ilium. Yeah, absolutely, which is important, like what we talked about with Crohn's disease. Look, you guys are learning. Do you feel it? I feel the aura. It's great. Yeah, boom, perfect. All right, diverticulosis is associated with an increased risk of lower GI bleeding, colon cancer, ulcerative colitis, or appendicitis. A. A, absolutely. Diverticulosis, those outpouchings there, right? As the outpouchings get bigger, there's blood vessels that go through them. The wall is thin. It gets thinner and thinner and thinner. And eventually, that blood vessel sort of pops through, and it bleeds. And then it's low pressure. So that when that blood loss goes down, it stops bleeding, which is why they can be pretty challenging for us, because it's bleeding, bleeding, bleeding. And then it just stops when the pressure lowers down. And you're like, what blood? You have a million diverticulosis. I can't find it, right? So perfect, good answer. Gastroenterologists commonly perform all the following services except A, appendectomy, B, colonoscopy, C, prescribed biologic medications for IBD, D, upper endoscopy, or E, esophageal motility testing. A. Now, if you ask some of my colleagues like Chris Thompson, he would say that we should be able to pull out an appendix through the colon with an endoscope. Some have tried. Hasn't always been successful, but sometimes it is. So, but this is a correct answer overall. Most will not do an appendectomy as a gastroenterologist. Crohn's disease can result in ulcers or fistulas in the colon, small intestine, colon and small intestine, colon, small intestine, and perianal area. D, perfect. Yeah, absolutely. And these are those things that we talked about earlier with seton placement that Dr. Parekh said with those perianal fistulas, right? You have a perianal tract that leaks. IBS can cause ulcers in the colon, A. B can cause abdominal pain. C, have ulcers in the small intestine. Or D, all of the above. Ooh. B as in boy. All right, here we go. Absolutely, B as in boy. Remember the difference between IBD, inflammatory bowel disease, that's ulcers, inflammation, et cetera there, and IBS, irritable bowel syndrome. Irritable bowel syndrome, normal structure, normal labs, normal endoscopy, but symptoms, right? Abdominal pain, bloating, et cetera. And that is our slides for here. Good. All right. Now, we are gonna do our prize scenario, right, Ed? We got it? We're tabulating feverishly. Ah, here we go, all right. Are we ready? So for the winners for this segment, and before I go through this, just note, this just came in. Those Post-it notes over there, you did a great job filling out a bunch of them, but here's the deal, we're gonna up the ante with these. If you put your name on the back of them, and you submit a whole bunch, there's prizes for these as well. So if you submit the most number of things that you learned, now don't go overboard, we got prizes as well for this also. So at the end here, before we get drinks and stuff, if you put a couple more on there, you just upped your thing for more prizes, all right? All right, so here we go. The winners for this segment are Lyle. You ready? Let's do it. Oh, I get to click it. Oh, I feel special. Here we go. Number six, Chad. Where's Chad? Come on down, Chad. You wanna say some words of encouragement to everyone, or a prize at acceptance speech? Thank your mom. I didn't think that was gonna be a very good score, to be honest, I got a few wrong. Six, that's not that great. I'll take it. Amen, good job. Let's give a hand for Chad. All right, awesome. All right, anybody gonna take a guess who number five is? No. Not Chad. All right, here we go. Skylar, where is Skylar? All right, way to go, Skylar. Congratulations, that's for you. You wanna say a few words? Thank you to my fans, thank you. Thank you to the Academy. All right, perfect. Here we go, number four. Adrian, where is Adrian? We got your prize bag here. Congratulations. You gonna thank the Academy or anybody? All right, perfect. All right, here we go. Number three, Megan. Great job. Do you wanna say your name? Here, you can do that. It's just Megan. The B is pronounced with an N, just letting everybody know. All right, next one. All right. There we go. Congratulations. Here's your prize pack. Good work. Do you wanna say anything? I'd like to dedicate this to my boss who's given me the opportunity to be here. Very good, yeah. Like it. All right, and the last one. You ready? If I see Rishi's name at the top here, I'm gonna be really upset. The ringer. All right, here we go. Laura. Congratulations, you get the big bag. You wanna say anything? Thanks guys for paying attention to training. Excellent. All right. So with that said, anybody have any questions? Silence. Everybody's like, I just want my cocktails. We've been good today. All right, please remember on the posted notes there to put there a couple words here, just last minute things. Again, you guys did an awesome job. It's been really fun participating with you guys, teaching, learning from you, learning with you. Thanks to everybody at the ASGE again. Thanks to you and your team as well. Couple things, learning points go. Any faculty wanna have any key learning points remaining? I think the one thing that I'm gonna say here on this front would be just as far as things go, I think the couple things that we learned today, we learned the basics of the GI track we went through and we reprocessed it by doing this game here while it was fun. Going through it again, I think showed everybody how much they've learned and accelerated there. These are very similar to the ones on the post-test as well. Two, for those of you who are in here, we heard in-depth talks about EOE and the questions that you asked were fantastic. That will certainly be helpful in that regard. For those of you in the bioskills labs, I hope you learned as well what we do on a daily basis. That's a big part of our practice. And three, I like to just make sure, say it again, that we really look at you guys as part of the healthcare team and taking care of the patients. So the better trained participating in these sessions there that you are, the higher education advancement that you get in these domains here, not only helps you, it helps us, it helps take care of the patient and that's the main thing that we really appreciate. So thank you for your time. Thank you for being here today. Thanks for all the Regeneron people. Tomorrow morning, we're gonna get restarted again. It's another early session. We'll have breakfast and everything as well. And then it's basically a similar schedule, just sort of in reverse or opposite. So we'll do a day in the life session. We have our pathology team here. We'll do some Q and A. And then we have our small group breakouts and those are those things on the back of your badges with the A, B, and C. And you'll get to go to all of them, right? So we'll just rotate through and you'll hear from one of our patients and we'll do a case discussion there. And then one of everybody's favorite thing, we'll do a group photo. It's supposed to be nice out, so we'll probably do that out on the deck. Is that right, Ed? Perfect. And then we'll do our shared session. We got the second part of our quizzes and we'll move on. For the reception that's out there, faculty will be there. You guys will all be there. It's really a time to have fun, mingle, et cetera. Ask us any questions that you want. We love hearing from you guys and sharing information. But these are a couple pictures here. So from our animal lab from day one. And then here is from the other side. Ooh, I like the black and white. Whoever took this one, it's very artistic. It's very noir. More bio skill assessments. So if you're in these picture here, call it out. There's Dr. Coyle looking very enthusiastically at the therapeutic channel of the endoscope. Good. He's paying attention. Yay. What a day. Yeah. That was awesome. Yeah, I was just speaking with everybody. You guys are a fantastic group. I mean, the energy, the questions that you ask are at a really super intelligent level. I mean, insightful, thoughtful. It's been a pleasure. The faculty have all said it. You guys are awesome to work with. So kudos to you. So thank you so much. You got a great team. Thank you.

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