Super Simplified Pathology - General pathology, Hematology and Systemic pathology

So let me start the session. A very good morning to all of you. I am Dr. Priyanka Sachdev here, and today I am here to, you know, to take a crash course on the most important, high-yielding topics of General Pathology and Hematology. So let's start. Super simplified course of pathology. Can we go ahead? Are you people ready? Can I start? Okay.

So let's start with General Pathology. So let's finish General Pathology in, say, four or five hours. And after that, two to three hours of Hematology. Okay. So again, I'm repeating, I am taking the most important topics of each chapter. You can also understand, completing entire pathology is not possible in 15 hours. If we want to complete entire pathology, it requires 80 hours, 60 to 80 hours, not 15 hours. Then in 15 hours, what we can do? We can see the most high-yielding topics or most, uh, repeatedly asked topics from each chapter. Okay.

So let's start with chapter number one of General Pathology. Let's start with chapter number one: Cell Adaptation, Cell Injuries, Cell Death. Okay. So let's start with the topic cell adaptation. First, I will let you know what is cell adaptation, then cell injury, then cell death. In cell death, we will see two things: apoptosis as well as necrosis. I can challenge whatever exam you are targeting now, you will get one question from this topic. Okay.

So what is cell adaptation? Cell injury? Cell death? Are the three things related to each other? Are the three things related to each other? Listen, in the human body, from head to toe, we all are made up of cells. You know, cell is the structural and functional unit of human life. So we are completely made up of cells. Normally, all the cells are in homeostasis. Can you see a cell in this diagram? All the cells are in homeostasis. You can ask them, what is homeostasis? Homeostasis means a cell is performing a particular function with a particular structure. For example, God has assigned a particular function to particular cells. For example, the cells of the salivary gland, they do the function of secretion. The cells of the intestine, they do the function of absorption. The cells of the nervous system, they do the function of cognition and memory. So they all are cells, but they are assigned different functions because they have little bit structural differences between them. That is the meaning of homeostasis.

But whenever any stress acts on the cell, whenever any stress acts on the cell, whether physiological or whether pathological, three things happen back to back. Number one thing is cell adaptation, in which the cell will try to adapt and survive, uh, the unfavorable condition. It will, uh, it will, you know, try to survive the stress, overcome the stress. That is known as cell adaptation. But these are reversible. I mean to say, once you remove the stress, the cell will come to a homeostasis again. After that, if the stress is continued, continued, continued, the second thing takes place as cell injury. Again, cell injury. First, there is reversible cell injury, followed by there is a point of no return. After that, there is irreversible cell injury. Reversible cell injury, it is reversible. Irreversible cell injury is actually cell death. It is irreversible. Once the cell is dead, it is not again alive.

Right now, please understand with the help of an example. It was a theory part. Let me tell you, uh, the example. Okay. I'm coming, I'm coming on that. MD Islam, I'm coming. What is stress? Stress is anything which is not physiological. I mean to say, that is not normal. That is known as stress. Let me take an example. Okay. How many hours you study in a day? Can you tell me how many hours you study in a day? Normally, normally today, how many hours you will study? You will say, "Mom, four." Some students will say, "Mom, four." Or some will say, "Six hours." Okay. So four to six hours normally you study every day. That is your homeostasis. You are in homeostasis. But what about the day before the exam? How many hours you study a day? One day before the exam or on the day of the exam, how many hours you study? You will say, "Mom, 12 hours." Some will say, "18 hours." Maybe 16, 17 hours. Impressive, right? So what is this? What is this? So exam is acting as a stress, and to overcome the stress, your body is doing adaptation. So instead of doing normal, you are doing something, uh, extraordinary, you know? So instead of studying six hours, you are studying for 12 hours, 15 hours. So that is adaptation, right? So you will do so. What about once the exam is over? How many hours you will study? How many hours you will study once the exam is over? Don't say, "Ma'am, I will not study." Zero hours. So again, you will shift to the homeostasis. I mean to say, once you remove the stress, now the adaptations are reversible. I, I want to explain this. But imagine the exams are continued for one month or two months. So what will happen? Continuously you will study for 12 to 15 hours for one month or two months. You will have certain diseases in your body, right? That is injury. That is injury. Again, up to a certain point, injury is reversible. Once you remove the stress, the exams are over, it is removable. It is reversible. I mean, but if exam continues forever, forever, you cannot study for 15, 16 hours or 20 hours, you know? You will have many disorders. This is the irreversible cell injury. You can have. So this is just an example to understand. So I mean to say, I mean to say, there are three things happen back to back. The first thing is adaptation, followed by reversible cell injury, and followed by irreversible cell injury, which is known as cell death. So if the stress continued, continued, continued, these three things are the progressive one by one, they will happen. Okay.

How many types? Let's talk about adaptation first, then we will come on injury, then cell death. Okay. The three things we have to cover. The first thing is the adaptation. How many, how many, uh, types of adaptations are there? There are five types of adaptations. What are the five types of adaptations? Hypertrophy, hyperplasia, atrophy, metaplasia, and dysplasia. Okay. What do you mean by that? Okay. First, understand the word hypertrophy and hyperplasia. Okay. Both are hyper. Hyper means more. Hypertrophy and hyperplasia. Okay. What is the difference between between them? Trophy means size. In pathology, the word trophy means size. And in pathology, the word plasia, the word plasia means number. Number. It's the number of the cell. Hyper means more or increase. So increase in size of the cell is hypertrophy, and increase in number of the cell is hyperplasia. You got it? So that is the meaning of hypertrophy. Trophy means increase in size of the cell. Plasia means increasing number of the cell. Can you see here? Can you tell me what is this? What is this? Can you see there? One cell. So normally, this cell was in homeostasis. Now the stress is acting on the cell. Because of the stress, the cell is doing certain adaptation. So what does it? So you can see the size of the cell here. You can see the exact same size of the cell here. But here, one cell. Here, multiple cells. So basically, the number is increased, not the size. So you can say it's hyperplasia. It's hyperplasia. Okay. Let me see. Okay. Can we go ahead? Okay. Okay. So that's that is hyperplasia, increase in number of the cell. And here you can see this cell is also in homeostasis. So when stress is acting on this cell as a part of adaptation, this cell is same here. It is also one. Here it is also one. Number is not increased. But you can notice the size is increased. So you can say this is hypertrophy. So one is hyperplasia, one is hypertrophy. See the third here. The cell is in homeostasis. Now the stress is acting. Because of the stress, it decreases in size. Appreciate the size here. Appreciate the size here. It is decreasing in size. That is known as atrophy. That is known as atrophy. Give me a thumbs up. Yes. I will provide the PDF after the session. Don't make the notes. I will provide the PDF on the Telegram group. Okay. You can find the PDF on the Telegram group of the Procium. Okay. So can we go ahead now? Give me a thumbs up. This is atrophy. Okay. Atrophy. Now I taught you three things: hypertrophy, hyperplasia, and atrophy. Can you tell me a common example of all three? Hypertrophy is increase in size. Hyperplasia is increase in number. Atrophy is decrease in size. Can you tell me a common example of all three? Can you people please tell me the common example of all three? Yes. So best example is the pregnant uterus, you know? So during pregnancy, can you see the size of the uterus? Normally, this is the size of the uterus normally. But during pregnancy, to accommodate the fetus inside that, the size of the uterus increases. We all know. But how does the size of the uterus increases? In the uterus, there are three layers: endometrium, myometrium, perimetrium. Let's talk about the middle layer, myometrium. These are the cells of the myometrium. Okay. You can see the cells of the myometrium. So basically, the hormones during the pregnancy, the estrogen and progesterone, they are acting as a stress. They are acting as a stress during pregnancy. The hormonal changes take place now. So they are acting as a stress. Because of this stress, the cells, you see the cells in the uterus, these cells will increase in size as well as number. So they increase in size, that is hypertrophy. They increase in number, that is hyperplasia. So basically, pregnant uterus is an example of both. So because of increase in size and number both of the cell, the uterus increases in size. The uterus increases in size because of increase in size as well as number of the cells in the myometrium. But what about after delivery? Now the delivery of the fetus already took place. The delivery of the child, the fetus, the newborn already took place. Now parturition, you know, during the next two, three months, uterus again becomes normal size. So how does it become again shrink in the size? Because of atrophy of the cell. Now these cells, under good reduction in size, whatever cells they were increased, now they undergo reduction in size. And because of which, there is parturition. So can I say uterus is coming in all three examples? Say yes if you got it. So during pregnancy, it's hypertrophy and hyperplasia, which is which is leading to increase in size of uterus. And after pregnancy, during parturition, after delivery, the reduction in the size of the uterus is due to atrophy. I want each of you to give me a thumbs up on this point if you got it. So you can see three of the adaptation: hypertrophy, hyperplasia, and atrophy are coming in this, in this, the three, the three of them are coming in this. Can we go ahead? Okay. Yes, hypertrophy is the single best. You can say another, but all three are there. Okay. Can we go ahead? Okay. You can see here the gross and the microscopy of the uterus. You can see this is the normal uterus, non-pregnant uterus. And you can see this is the pregnant uterus. This is the pregnant uterus. See the appreciate the size. Appreciate the increase in the size grossly. Appreciate that. Now make the slide of this. Make the slide of this. See the histopathology of both of them. The non-pregnant uterus. See the cells of the myometrium. And during pregnancy, see the cells of the myometrium. I appreciate the size of the cell is increased. And if you count the total number also, the size as well as number, both is increased. Give me a thumbs up if you got it. Yes. I'm, I'm going to cover important topics of the entire syllabus. Adil, I'm going to cover entire syllabus today. So can we go ahead? So we are done with three: hypertrophy, hyperplasia, atrophy. Coming on the fourth one. The fourth adaptation. What is the fourth adaptation? The fourth adaptation is metaplasia. What is metaplasia? Now, can you tell me what is metaplasia? It is transformation of one type of cell to another one type of mature cell is transformed to another type of mature cell. I mean to say, either the squamous cell converted into columnar, or the columnar cell converted to squamous. So either squamous to columnar or vice versa, columnar to squamous. So it is known as metaplasia. Basically, there are two types of metaplasia. Whenever the squamous cell converted to columnar, so finally columnar is formed. Now this is known as columnar metaplasia. And whenever the columnar converted to squamous, it is known as squamous metaplasia. So basically, you have to see finally what is formed. Finally, what is formed? Can you see here? In columnar metaplasia, finally columnar is formed. In squamous metaplasia, finally squamous is formed. So yes, yes. Another, absolutely right. It is the transformation of one type of epithelium to another type of mature epithelium. It's not increase in size, increase in number, decrease in size. It is transformation or replacement of one type of epithelium by another. Either by squamous to columnar or columnar to squamous. If it is converted from squamous to columnar, it is known as columnar metaplasia. And if it is converted from columnar to squamous, it is known as squamous metaplasia. Okay. Can we give me a thumbs up? Yes. I'm coming, Osama. I'm coming on the examples also. Okay. Give me one example which is common for both types of metaplasia. I mean to say, the columnar and squamous. As I have given you an example of uterus. Uterus was a common example of hypertrophy, hyperplasia, and metaplasia. Right? Now I want you to give an example. Can you tell me the organ? The example which is common for columnar metaplasia as well as squamous metaplasia in one organ? Both of them takes place. Can you tell me the name of that organ? It's female cervix. The female cervix. Okay. Let me give you the basics. So this is the uterus of a female. This is the cervix of a female. And this is the vagina of a female. Okay. Tell me the lining of the cervix. Okay. The uterus is lined by columnar epithelium, I guess we all know that. The uterus is lined by columnar epithelium. Okay. And the vagina is lined by the squamous epithelium. We all know that. So this is the normal lining. Can you tell me the organ cervix, which is between them? What is the lining? What is the lining of the cervix? Can you tell me? So yes, the cervix is having two portions. The cervix is having two portions. Let me divide the cervix. This is endocervix and this is ectocervix. So can I say endocervix is a continuation of uterus? That's why it's columnar. Common sense. Yes. The endocervix is. And can I say the ectocervix is a continuation of the vagina? So it's the ectocervix is squamous. Yes. So use your common sense. There is nothing rocket science in that. Nothing to learn. So if you have understood, so normally the endocervix is columnar, and normally the ectocervix is squamous. The cervix is an organ in which we find both the linings. Right? So basically, let's talk about the endocervix first. Imagine the uterus is connected with the pelvic cavity with the help of ligaments. Imagine if the tear, if there is a tear in the ligaments, what will happen? The uterus will prolapse. The uterus will prolapse. Like this. The uterus will prolapse. The uterus will prolapse like this. Now, this prolapse is acting as a stress for the endocervix. The prolapse is acting as a stress for the endocervix. Okay. Because of the stress, because of this stress, the endocervix, which was columnar, converted to squamous now. So this is an example of squamous metaplasia. Finally, squamous is formed. See what is finally formed. Okay. Now let's take the example of the ectocervix. In the ectocervix, during, during reproductive age or during pregnancy, whenever there is increased estrogen and progesterone in the blood, that is acting as a stress. So here, the stressor is the hormone. Whenever there is increased estrogen and progesterone in the female blood during pregnancy or during reproductive age, during puberty, at that time, at that time, the ectocervix convert that to cervix, which is normally squamous, from squamous it converted to columnar. So ectocervix is an example of columnar epithelium. Say yes. So the two things are in front of you. So have you got it? So the cervix is coming in both examples. So can I say the endocervix is an example of squamous metaplasia, in which columnar get converted to squamous? And can I say ectocervix is an example of columnar metaplasia, in which the squamous cell get converted to columnar? Everyone give me a thumbs up. It was complicated, but I tried my best to give you the concept. Learn the stressor is different in both of them. Please try to learn the stressor. In case of endocervix, the stressor is the uterine prolapse. The uterus prolapse. In case of ectocervix, the stressor is the estrogen present in the blood. Try to, uh, you know, give me the thumbs up. Have you got it? So please interact. It's an interactive session. It's a live session. It is not a recording you are watching. So if you have any doubt, please ask. If you don't have any doubt, give me your gesture that you got it. How you can see me, but I cannot see you in front of me. There is only one camera. So I can see your comments only. Okay. So the comment is the only way we can interact with each other. So give me a thumbs up. You got it. Can we go ahead? So that is regarding the metaplasia. So till now, we have seen four adaptations: hypertrophy, hyperplasia, atrophy, and metaplasia. The two types of the metaplasia we have seen. The example we have seen. One common example of these three, the uterus, you know, during pregnancy, it's hypertrophy and hyperplasia. During parturition, etc., in the uterus. And we have seen a common example of the two types of the metaplasia, that is cervix. In endocervix, takes place. And in ectocervix, its columnar. Am I right? Am I right? Yes, I guess I'm right. So that is what we have learned till now. Let's continue. The last one is the dysplasia, and most important and difficult to understand. Most of the students have trouble in understanding what is dysplasia. Okay. I will make it super easy for you. What is dysplasia? If you want to give the definition of dysplasia, it's disordered development. What is dysplasia? It's disordered development. It is a pre-malignification. You can ask me about what you mean by that. Okay. So I will tell you seven features. If these seven features are present in any cell, that cell is known as dysplastic cell. That is a pre-malignant cell. So let me explain you the seven features in a diagram instead of, you know, reading and learning, try to see them in the diagram. Try to see them in the diagram. The seven features. All seven, I will show you in one diagram. The one diagram is in front of you. Okay. Now see this one is the normal. Normal epithelium. And this one is the dysplastic epithelium. We will notice the changes between them. The seven changes which are absent in normal and which are present in dysplasia. So you will understand the definition of the dysplasia in this way. Okay. Listen. Normally, normally, you can see this is the cell. You can see these are the cells. Can you all see? Please have a look. These all are cells. Okay. This is the normal cell lining. You can see actually it is a cell lining of the endocervix of the female. It's a columnar lining. Now see during dysplasia, what is happening? The first thing you can see, the number of the layers is increased. Here we can see one layer. Here we can see multiple layers. So the first thing you can see, the number of layers is increased in dysplasia. On every point, please appreciate that. You got it? The first point is increase in number of layers. I guess everyone can notice here is one layer and here is multiple layers. We all can see. Number two. Here you can see normally it's orderly arrangement. They are back to back, beautifully orderly with a pattern, like orderly arrangement. But here you, you can see haphazard. They all are like half is it? Half is it? So you can see the second point is disordered arrangement or haphazard arrangement. So normally it's I'm sorry, normally it's orderly arrangement, and here it's disorderly arrangement. That is the second point. Everyone can see in the same diagram. The third point, which is very important to understand, is the loss of basal polarity. What do you mean by basal polarity? Let me explain you. Let me explain the normal epithelium here. Normally, this is the epithelium lining. This is the basement membrane. You can see this is normal. I am drawing, not dysplastic. And this is the basement membrane. This is the basement membrane. Where is the nucleus? Where is the nucleus of these cells? The nucleus is not in the center. Normally, the normally the nucleus is towards the basement membrane. I'm saying towards the basement membrane. Mind my words. I am saying it is present towards the basement membrane. It is known as basal polarity. Basal means basement membrane. Polarity means, you know, North Pole, South Pole. So it is pole, base, couple, basal polarity. It is present towards the basement membrane, right? Basal polarity is present normally. Normally. But see what is happening here. Um, in dysplasia, let me draw this plastic lining. And this plastic lining. It's haphazard. Let me draw multiple layers, not one layer. Let me draw. They all are haphazard. They all are disorderly arrangement. This is just plastic. Now here is the nucleus. Here is the nucleus. It is away from the basement membrane. It is not towards the basement membrane. Number one, nucleus is enlarged in size. And it is away. It is dark. It is condensed. And it is away from the basement membrane. So can I say here the basal polarity is absent? Basal polarity is absent here. So basically, I want to say the loss of basal polarity takes place in dysplasia. Say yes. Loss of basal polarity. Basal polarity presence of basal polarity is a normal thing. We all have this basal polarity in all our columnar epithelia. It's normal. But the loss of basal polarity is dysplasia. So learn the third finding. It's loss of basal polarity. You can appreciate in this diagram also. See the normal diagram. All the nucleus towards the basement membrane. But in the second diagram, the nucleus is not towards the basement membrane. It's away or haphazardly arranged. Got it? The third point. Coming on the fourth point. Fourth point is pleomorphism. Pleomorphism. You can see all the cells. Normally, they all are same size, same shape. Normally, they all are same size, same shape. That is they all are uniform. But in dysplasia, some are small, some are moderate, some are large. So it is known as pleomorphism. Pleomorphism means variation in size of the cell. All the cells are of different size. So normally pleomorphism is absent. But in dysplasia, the pleomorphism is present. Can I say it? Yes. The pleomorphism. The next is we will talk about three things of the nucleus. Okay. See the size of the nucleus, color of the nucleus, and mitosis in the nucleus. Compared to three things in the nucleus, back to back. Normally also, in dysplasia also. See the size of the nucleus in both the diagram. Can you appreciate? Your nucleus is small, small. Okay. We will talk about the ratio known as N:C ratio. Nucleus in the numerator and cytoplasm in the denominator. The size of the nucleus in the numerator, the size of the cytoplasm in the denominator. This is known as N:C ratio. Okay. Okay. See the N:C ratio here and see the N:C ratio here. Can you please appreciate? What is increasing? Numerator, denominator, what is happening? So see, normally nucleus is small, cytoplasm is large. Appreciate. Nucleus is small, cytoplasm is abundant. Normally. So numerator is small, denominator is more. Normally. But see dysplasia, reverse is happening. Can you appreciate the nucleus is big, cytoplasm is small? You know? So nucleus is increasing as compared to cytoplasm. So basically, can I say in dysplasia, in dysplasia, N:C ratio increases because numerator is increasing and denominator is decreasing? Can I say so? Overall N:C ratio increases in dysplasia. So here N:C ratio is normal. But here N:C ratio increases because of increase in size of nucleus. Say yes if you got it. Do you have any problem in understanding or you got it? The meaning of the N:C ratio. N:C ratio. The numerator is the size of the nucleus, and the denominator is the size of the cytoplasm. Normally, nucleus is small, cytoplasm is more. But during dysplasia, the nucleus increases in size as compared to cytoplasm. So if you compare, you can say N:C ratio increases during dysplasia. Say yes. Yes, very good. Shalini. Very good. Everyone. Can we go ahead? So this is the N:C ratio. The next is the color of the nucleus. You have seen the size. Now let's appreciate the color of the nucleus. Here, nucleus is light color. And here, the chromatin inside the nucleus becomes condensed. Because of condensation, the nucleus becomes dark color. What is color in pathology known as? The color, in pathology, known as chroma. The meaning, the dictionary meaning of chroma's color. The color is increased in dysplasia now. So say hyperchromatism. Hyper. Split the term. The meaning is in front of you. Hyper means more. Chroma means color. More color. Dark color because the nucleus is condensed. So say hyperchromatism is not a normal picture. Hyperchromatism is present in dysplasia. Okay. And last is mitotic activity. Normally, we cannot see the mitosis. Normally. But here, if you can appreciate, you can see the spindle formation in some of the cells. Some of the cells are dividing. Mitosis is a common feature of dysplasia. Can you appreciate the seven features? We are done with dysplasia. What are the seven features? Please everyone with me. What are the seven features? See normalcy, dysplasia. I appreciate the seven features. Yes. Here the number of layers are normal. Here the number of layers are increased. Say yes. The second. Here, see the arrangement. It's orderly arrangement. Here they are disorderly arrangement. The figures are in front of you. Please appreciate the changes. Don't learn. See in the image. The third is the basal polarity. Normally basal polarity is present. In dysplasia, it is absent. In dysplasia, it is absent. Right? Pleomorphism. Normally it is absent. Hyperchromatism. Normally it is absent. But in dysplasia, pleomorphism present. Hyperchromatism present. And the ratio. Normally it's normal. But in dysplasia, it is increased. Mitosis. Normally it's normal. But in dysplasia, mitosis also increased. So you learn the seven points. It's the definition of dysplasia. We are done with topic number one, cell adaptation. Everyone give me a thumbs up. We will solve some questions now. If you got the topic, I want you to answer the MCQs. Can we start? Are you people ready? I will give it 20 seconds to answer each. You have to write your answer from A, B, C, D in the comment. Fast and accurate. You have to be fast. You have to be accurate. The first question is in front of you. Give the answer. Both hypertrophy and hyperplasia are seen in four examples: A) Breast enlargement during lactation, B) Uterus during pregnancy, C) Skeletal muscle during exercise, and D) Left ventricular hypertrophy during heart failure. So what is the correct answer? A, B, C, D, may say, what is the correct answer here? Can you please give me the correct answer? Very good. Arthur is first to give me the correct answer. And rest all are also right. Very good. Very good. Yes, very good. Osama. Very good. Absolutely right. You have enumerated the seven features. I appreciate it. Very good, everyone. Please, everyone give me the answer. It's the easiest question I have asked you. Pregnant uterus is an example of both hypertrophy and hyperplasia. And instead of pregnant uterus, if I say the parturating uterus, parturating uterus, it is an example of atrophy. So mind the words. Okay. So yes, the correct answer is B. And you all are right. Very good. The next question. Transformation of one epithelium to another type of epithelium. What is it known as? Is it dysplasia? Is it hypertrophy? Is it neoplasia? Or is it metaplasia? What does it known as? Can you give me the answer? So this is the definition of what? Yes, you all are right. Very good. Yes, yes. Very good. So it is the definition of metaplasia. Very good. The transformation of one type of cell to another type of cell. It is a definition of metaplasia. It is of two types. Either squamous to columnar or columnar to squamous. Okay. So I have given you an example that is cervix. It is an example coming in both. The next question is in front of you. All are true about metaplasia except. Don't miss the word except. Is it slow growing? Yes or no? Reversible back to normal with appropriate treatment? Yes or no? Is it irreversible? Yes or no? If persistent, it can convert into cancer? Yes or no? Tell me the correct answer. I mean, tell me what is there in the except. All are true regarding metaplasia except. Yes, what is the correct answer? You all are right. I told you all five adaptations are reversible. The definition of adaptation is reversible. Metaplasia is a type of adaptation. So it has to be reversible. It cannot be irreversible. So correct answer is C. The next question is in front of you. About hyperplasia, which of the following statement is false? Which of the following statement is false for hyperplasia? Is it increase in number of cell? Is it true or false? Increase in size of cell? Is it true or false? Endometrial response to estrogen is an example? Or all of the above? What is the correct answer? It's a tricky question. Don't get confused in the option. It's very easy but tricky. What is the correct answer? Hyperplasia. Plasia means number of the cell. It's increasing number of the cell, but not the size. And the endometrial response to estrogen is an example. The incorrect among them is B. They are asking the false statement, not the true. And they are asking about hyperplasia. I told you, don't get confused with the trick. Okay. Coming on the next question. It's very easy. All of them are cellular adaptation except. I told you there are five types of adaptation now. So which of the following is not an adaptation? Hypertrophy, hyperplasia, necrosis, metaplasia. Which of the following is not an example of cell adaptation? Can you tell me the answer? Can you please tell me the answer? Please. Yes. What's the correct answer? Can you please tell me? Yes. You all are right. Necrosis is not an example of adaptation. It's a type of cell death. Rest all are the examples. Decrease in cell size is known as. Is it atrophy? Metaplasia? Hyperplasia? Or hypertrophy? Can you please give me the answer? I guess super execution. Decrease in size of the cell. Yes. So there is a little bit lag. If I ask and you give me the answer, there is a 10-second lag. So I have to wait here. So you all are right. The correct answer here is, of course, A. Atrophy. Atrophy is decrease in size. You all are right. The correct answer is. Let me change the question. Increase is the correct answer here is atrophy. Instead of decrease, if I ask increase in size of the cell, what is your answer now? What is your answer now? Increase in size of the cell. Yes. What is the correct answer now? If I change the question a little bit. Yes, I'm waiting. Yes, very good. The correct answer here is D. Yes, hypertrophy. And if I change the size to number, increase the number of the cell, what is the answer now? In that case, your answer will become C, hyperplasia. So that is the thing. So let's come on the next topic. The two types of the cell death. So I am going to cover two types of cell death now. One is apoptosis. One is necrosis. So we will be covering two types of cell death one by one: apoptosis and necrosis. So why there are two types of cell death? These two types of cell death, the cell die by one of the method. So you can compare apoptosis with suicide and necrosis with murder. Yes, I will prove that in the annual. I will convince you. Apoptosis is a suicide, and the necrosis like murder, you know? The two ways. In both of them, the person will die. So here also, the cell is dead. But there are two ways. The first point is that you may be thinking, "Ma'am, why there are two ways of the cell death?" I mean, if there is a choice given to the cell, you want to do suicide or you want to do the murder? I mean, why? No one wants to die now. The cell also does not want to die. So why there are two different types of the cell death? I will explain you. Okay. So let's start first with apoptosis. See the details of the apoptosis, then we will come on the necrosis, then we will see the differences between them. Let's start with apoptosis. The first point here. The first thing we will discuss is the apoptosis. In short, if you ask me the definition of apoptosis, it's cell suicide. In short, in short, it's cell suicide. Number one, learn the thing. It's cell suicide. Okay. Now, uh, let me define it properly. So if you want to learn the definition, this is the definition. You cannot understand it directly if I read. Let me show you a diagram, then I will read the definition. Can you see a cell? Yes. Now the point is that my question is again, why a cell want to do a suicide? Nobody wants to do a suicide. I do not want to decide. You do not want. Why a cell want to do a suicide? There are two reasons. Either this cell has performed its function in the body, and it is no more required. The function is already done, and this cell is no more required in this, in this human body, in this world. Number one. Number two, the cell DNA, the nucleus, or the DNA is damaged by some physical, chemical, or biological agent. Not DNA enough. P53 will try to repair it fast. But the DNA damage is too much, and P53 is unable to repair it. It is beyond repair. So in this way, this is a cancerous cell. Now we do not want to keep it in the body. It is an abnormal cell. It is a damaged cell. So we will ask the cell to commit suicide because you are damaged, the DNA is damaged. So the, these are the two reasons by because of which we will ask the cell to commit suicide. Yes, the body will send the signal to this cell. Either the cell has already performed its function in the human body and is no more required, or else its DNA is damaged beyond repair. In both of these situations, we will ask the cell to commit suicide. So whenever the cell gets the signal that I have to commit the suicide, at that point, inside the cell, there are enzymes. The name of the enzyme is caspase. Please learn the name of the enzyme. Normally, these enzymes are inactive. It is present in all human cells. The caspases are present in all our cells, but they are inactive. They are inactive. Whenever the cell gets the signal that you have to commit suicide, at that time, the caspase present in the cytoplasm get activated. Once the caspase become activated, what did, what they do? Inside the cell, there are three things. The cell has a nucleus. You will say, "Yes, ma'am." The cell has a nucleus. The cell has a cell membrane, and the cell has a cytoplasm. Three things are present in the cell. So basically, the caspase divides the entire cell into multiple small, small apoptotic bodies. Each apoptotic body contains three things. Small, small portion. So nucleus gets fragmented into multiple pieces. Each apoptotic body contains a small amount of nucleus. Each apoptotic body contains a small amount of cytoplasm, and each apoptotic body contains a small amount of cell membrane. And during this process, when the entire cell, you can see the entire cell get converted into multiple small, small apoptotic bodies, during this process, there is no leakage. During this process, there is no leakage outside. Since there is no leakage, there is no inflammation. No leakage, no inflammation is the hallmark of apoptosis, which differentiate apoptosis from necrosis. In necrosis, there is leakage. There is inflammation. Here, leakage, no. That's why I am comparing this, the apoptosis with suicide. You know, if someone wants to commit suicide, it will be done in silence, you know? It is done personally, silently, in a closed room. It is not, the person will take a loudspeaker and shout everywhere, "I am committing suicide! I am committing suicide!" It is done silently, you know? So in this way, here also, the cell is committing suicide. So silently, the cell will convert into multiple apoptotic bodies. There is no leakage, there is no inflammation. The inflammatory cells do not come to know that something is going wrong. No, it's silently, you know, chip shop, commit. And in the end, what will happen? A phagocyte will come. You know what is a phagocyte? A phagocyte. It will engulf all the apoptotic bodies, and the cell disappeared from the world, disappeared from the from the from the human body. Say yes if you got it. Say yes if you got it. Okay. Yes, it is required in organogenesis also. Shake. Yes. So have you got it? Can we go ahead? So this is the definition of apoptosis. So what is apoptosis? Can you define now? You will say, "Ma'am, apoptosis is the type of cell death." Yes, it is one of the type of cell death. There are two types of cell death. Apoptosis is one of them. It is a tightly regulated intracellular program during which the cell which is destined to die, the cell which gets the signal for death, that cell activates an enzyme. The name of the enzyme is caspase. And caspase degrades the DNA and the cytoplasm into multiple apoptotic bodies. In the end, the apoptotic bodies are phagocytosed. During the entire process, no leakage, no inflammation. Highlight the negative findings. This is the definition of apoptosis. No need to learn, just understand. So apoptosis is a type of cell death in which the cell which is destined to die, that will activate caspases. The caspases convert the cell into multiple apoptotic bodies. A phagocyte will come and engulf all the apoptotic bodies. No leakage, no inflammation. Give me a thumbs up. Got it? This is the definition of apoptosis. Now you should ask me, "Ma'am, what is the mechanism?" In the mechanism, there are two pathways in the apoptosis. There are two pathways: extrinsic and intrinsic. What do you mean by extrinsic and intrinsic? Okay. So this is the cell. This is the nucleus of the cell. The nucleus of the cell containing DNA. As I told you, the signal, the cell is receiving the signal to do the suicide. From where the signal is coming? Can you tell me? From where the signal is coming? The signal can come from the outside or the signal can come from the inside only. Okay. If the signal is coming from outside, it's known as extrinsic pathway. Extrinsic means outside. And if the signal is coming from inside, it is known as intrinsic pathway. Intrinsic means inside. Say yes. Okay. So this is the meaning. Now, each of the pathway has two, two phases. So in extrinsic also, in intrinsic also, there is initiation, there is execution. There is initiation, there is execution. Right? So there are two, two phases in each of the pathway: extrinsic pathway and intrinsic pathway. In each of them, there are two, two phases. So we will understand the mechanism of apoptosis. Are you people with me? Can I tell you the ultra-important topic? The mechanism of apoptosis. I will tell you like a movie story, you know, in a fun manner. We will understand the entire complicated mechanism of apoptosis like this, like this, we will understand. Give me just three minutes. In three minutes, I will explain you the entire mechanism. Okay. So I told you the meaning of the extrinsic and intrinsic. The meaning of the extrinsic and intrinsic. This is the cell. This is the nucleus of the cell. Now, this cell wants to commit the suicide. This cell wants to commit the suicide. Now, from where the signal is coming? If the signal is coming from outside, it's extrinsic pathway. And if the signal is coming from inside, it is known as intrinsic pathway. Okay. Now, each of them having two, two phases. The first, how, what is the sequence? I will teach you. First, I will let you know the initiation phase of extrinsic pathway. Then I will let you know the initiation phase of intrinsic pathway. And in the end, I will tell you execution of both of them together. Because execution is common for for both of them. So I'm going to teach you three stories now. The first story is the initiation of extrinsic. The second story is the initiation of intrinsic. The third story will connect the two stories together. And it is the third story that is execution, which is common for both of them. This is the sequence I will teach you like this. Say yes if you got it. Say yes. Can we go ahead? Can we go ahead? Yes. So let's start. So let's start with the extrinsic pathway initiation phase. Okay. Now, can you see yourself? All human bodies have receptors on their surface. These are known as death receptors. What is it known as? Death receptors. There are two types of death receptors: Fas, which is known as CD95. One and the same thing. It is the name of receptor. The Fas receptor or CD95 receptor. It's a type of death receptor. And second is TNF, Tumor Necrotic Factor. TNF. So please appreciate the cell on the surface of the cell. Please appreciate the receptors. Can you appreciate these receptors? This one, this one. These are death receptors. It can be Fas, CD95. It can be TNF. Okay. So these are the death receptors. They are inactive currently. They are inactive. I'm really sorry. I'm really sorry. So these all are inactive. These are the death receptors present on the surface of the cell. Now you can see here, this is the signal. This is the signal coming to the cell that this cell has to commit the suicide. The signal is coming. The signal is in the form of the ligand. It is in the form of the ligand. So this signal is coming from outside or inside? You can see it is coming from outside. That's why it is extrinsic pathway. It is extrinsic pathway. I'm teaching you now. Extrinsic pathway. The signal is coming from outside. So either the cell has performed its function, it is no more required. So the signal is coming. Whenever the signal is coming, the ligand is coming. The ligand will come. So let me zoom. So I'm zooming the diagram. Okay. This ligand is coming and binding with the receptor. One of the receptor. So ligand is coming, binding with one of the receptor. You can see. Once it will bind with one of the receptor, the receptor get activated. Once the receptor, the death receptor, the death receptor get activated, multiple death receptors come closer now. You can see a distance between them. They are inactive. There is a distance between them. These are the death receptors. CD95 receptor, Fas receptor. One and the same thing. CD95 is one and the same thing. It's not different. These are synonyms. Okay. Now, once the ligand binds with the receptor, multiple receptors come closer like this. Can you see multiple receptors coming closer like this? And they are forming a domain. It is known as death domain. It is known as Fas-Associated Death Domain. Say FADD. So it's not my mnemonic. It is given in Robbins also. FADD. So Fas-Associated Death Domain is formed, right? Because of the formation of this domain, what will happen? Now, in the cytoplasm, caspases are present. I told you now, the main enzyme here are the caspases. Okay. There are many types of caspases: caspase number 1, 2, 3, 4, 5. So because of the formation of FADD, the first caspase which is activated is caspase number 8. The inactive caspase 8 converted into active caspase. Caspase 8. The story is over. I will continue. This is intermission of this story. I will continue the story in execution phase. This is the initiation phase. You got it? Initiation phase. So same thing whatever I have drawn you in this sketch diagram, the same shown here. So can you see the cell membrane? So this is the cell membrane. You can see. Can you see these are the receptors? Let me show you. These are the death receptors. Okay. On the death receptor, this is the ligand. The coming signal is coming and binding. So multiple death receptors coming closer. And because they are coming closer, this is FADD formation. Because of FADD formation, the caspase 8 converted into active form. Active caspase 8 is formed. And that will lead to apoptosis. I will let you know how it is. So Fas receptor, Fas ligand is coming, binding with the Fas receptor. Multiple Fas receptors coming closer. And FADD is formed. FADD leads to conversion of pro-caspase 8.

To active Casper, date sometimes caspase 10 also get converted to active gas base 10. So, learn two cases: 8 antenna, do they get converted from inactive to active form? So, this is over. This is over and leaving it to caspase 8 and 10 activation. What will happen after this? I will continue here in the execution phase, but later on, let me first tell you the initiation phase of the intrinsic pathway also. Then I will tell you the two execution together. Say yes if you got it right. So, let me start. You know, you just learned the endpoint here. I will continue later on. Let me tell you the initiation of the intrinsic pathway. Intrinsic pathway. Intrinsic, what do you mean by intrinsic here? The signal will come from inside the cell. Okay. So, here, can you see a cell in front of you? Yes, you all can see a cell. Inside the cell, you can see the nucleus, and inside the nucleus, you can see the DNA. This is the DNA. It is intact. Now, there is no problem. It's a healthy DNA. You can see the mitochondria, the two membranes of the mitochondria, the inner membrane, the outer membrane. Between the two membranes of the mitochondria, there is a protein known as cytochrome C. So, cytochrome C is present between the two membranes of the mitochondria. Cytochrome C never comes in the cytoplasm. Once it comes in the cytoplasm, it will cause the apoptosis, right? Currently, it is present inside the two membranes of the mitochondria. This is normal. This is normal. Now, let me zoom it. Now, you should ask me, "Ma'am, you are saying cytochrome C is present between the two membranes of the mitochondria, but mitochondria have a door?" Now, the transit, this is the door, the door or the transit in the mitochondria. You should ask me, "Ma'am, why cytochrome C is not leaking out of this transit?" Transit, why is it not coming out? Because three guards are present. The three guards are present. You know, they are like guards. They prevent the cytochrome C to come out. The name of the three guards is Bcl-2, Bcl-x, and Mcl-1. So, these are preventing the apoptosis. Since cytochrome C is not coming in the cytoplasm, they will not cause the apoptosis, right? So, these three proteins are known as anti-apoptotic proteins. These three, the anti-apoptotic proteins, prevent the cytochrome C from coming out normally in all of our cells. So, currently, in all of our cells, these three guards are preventing the cytochrome C to come out. But imagine the DNA is damaged. Now, the DNA is damaged. The p53 will try to repair it, but it is beyond damage, beyond repair. p53 is unable to repair it. So, this will give the signal to the mitochondria that "I am gone." The nucleus is giving the signal to the mitochondria that "I am gone and damaged. I cannot be repaired. Commit suicide." It's not suicide. Who is giving the signal? The nucleus. To whom? It is giving the nucleus is giving the signal to the mitochondria. So, from where the signal is coming? Is it coming from outside? No, no. It is not coming from outside. The signal is coming from inside only. So, that's why it's the intrinsic pathway. Please appreciate intrinsic. The signal is coming from inside only. So, that basically the nucleus is giving the signal to the mitochondria. So, nucleus is asking the mitochondria to start the suicide, to commit the suicide. How does the mitochondria will do so? The mitochondria will replace the three guards with four other guards that will open the door. These were the three guards that closes the door, that that inhibit the transit. But it is replaced by another guard. The name of another guard is Bax, Bak, Bim, Bad. They are ultra important. They will open. They will open the transit, and cytochrome C will leak out. They cause the apoptosis. So, these were anti-apoptotic proteins. These are pro-apoptotic proteins. So, basically, on receiving the signal, the mitochondria replaces the anti-apoptotic protein by pro-apoptotic protein. Please note the example: anti-apoptotic proteins are replaced by pro-apoptotic proteins. Anti-apoptotic proteins close the door. They prevent apoptosis, and pro-apoptotic proteins open the door. They cause the leakage of cytochrome C. The anti is replaced by pro. You can see cytochrome C is coming out. Once cytochrome C comes out, the first caspase, it activates caspase 9. So, caspase 9 is the first caspase which is activated here. And caspase 8 and 10 were first caspases which were activated in the extrinsic pathway. Here, caspase 9 is activated. The story is over. The story is over. The story is over. Okay. So, whenever the stimulus is given, the stimulus is the DNA damage. On DNA damage, receiving the signal, the mitochondria replaces, replaces the anti-apoptotic protein with pro-apoptotic protein. So, basically, the anti-apoptotic proteins are replaced by pro-apoptotic proteins. On receiving the signal, the pro-apoptotic proteins open the door. So, cytochrome C leaks out. After coming out, it activates caspase 9. Say yes if you got it. So, we are done with this also. So, till now, I taught you the initiation of both of them. Can you tell me the endpoint here? The endpoint was activation of caspase 8 and 10. Here, the endpoint is activation of caspase 9. You will see my bots ahead. Here, the death receptors were required. Here, mitochondria and cytochrome C were required. Okay. Now, what's ahead? So, let me tell you the execution phase of both of them together. The execution is common for both of them. So, in the execution phase, which is a convergence point for both of them, in the extrinsic pathway, the first caspase activated is 8 and 10. And in the intrinsic pathway, the first is activated as caspase 9. So, here caspase is 8 and 10, and here caspase 9 activates the next caspase 3, 6, 7, and they can activate all other caspases. And once all the caspases are activated, you know what happens? All the caspases will convert the cell into multiple apoptotic bodies. So, multiple apoptotic bodies are formed. In the end, a phagocyte will come and phagocyte will engulf all the apoptotic bodies. The cell will disappear from the world. No leakage, no inflammation. This is the mechanism. Say yes if you got it. So, I taught you the two mechanisms, the extrinsic pathway, the intrinsic pathway. In both of them, I taught you two, two phases: the initiation, the execution. Initiation is different in both of them, but execution is a common feature for both of them. I want all of you to appreciate that you got it. Kindly write down "you got it," or if you have any doubt, please ask it or give me a thumbs up. Can we go ahead? Okay. So, let me tell you the next thing. The next thing is the morphological changes on apoptosis. There are seven morphological changes in apoptosis. You have to learn the sequence. During extrinsic or intrinsic, whatever pathway, seven things takes place one by one. Let me tell you the seven features. Let me tell you the seven features of apoptosis. Can you see a normal cell? This is a normal cell. Now, this cell is receiving the signal either from outside or from inside that it has to commit suicide, right? So, it is starting the suicide. So, the first thing happens is cell shrinkage. Please appreciate cell shrinkage. The first thing, the cell reduces in size. It's a very important question. The earliest feature of apoptosis is cell shrinkage. Repeatedly asked PYQ. Okay. You can see the cell is decreasing in size. After that, you know, inside the cell body, is present in the cytoplasm. You will see my mitochondria, endoplasmic reticulum, ribosomes, multiple cell organelles are present. If the cell reduces in size, the multiple cell organelles, they will come closer, closer, closer. Because of the multiple cell organelles coming closer, the cell cytoplasm become more pink in color. Can you see the cytoplasm become more pink in color? It is known as eosinophilia. So, second thing is the eosinophilia. Because of the shrinkage, so, the first thing is the shrinkage, and second thing is eosinophilia. Learn the sequence. The sequence of the seven is important. The earliest is the cell shrinkage. And you can imagine the cell is shrinking, so the cell organelles are coming closer. So, cytoplasm looks more pink. It's known as eosinophilia. Okay. After that, coming on the nucleus. See, the nucleus become more compact. The nucleus become more compact, more dense. It is known as pyknosis. Pyknosis is compactness of the nucleus. After that, the nucleus, nucleus, ah, fragmented into multiple pieces. The conversion of the one nucleus into multiple pieces. It is known as karyorrhexis. Pyknosis and karyorrhexis takes place in the nucleus first. It gets condensed, then it gets fragmented. So, that is the third feature. The two we will take together, the nuclear features. So, first is shrinkage, then eosinophilia, and then nuclear features, that is pyknosis and karyorrhexis. After that, on the cell surface, multiple blebs are formed. Multiple blebs are formed because of the cell injury. The fourth feature is the bleb formation. Right? Now, caspases are activated. If it is extrinsic pathway, caspase 8 is activated. If it is intrinsic pathway, caspase 9 is activated. And now, in the execution phase, all the caspases are activated. Caspases convert the cell into multiple apoptotic bodies. So, apoptotic body formation is the fifth feature. In the end, a phagocyte will come and engulf all the apoptotic bodies. That is the sixth feature. Can you please enumerate? Mirza, Nikhil, Jewel, Shake, Sachin, Shalini, everyone. I cannot read all the names. So, can you tell me the six features? The sequence of the apoptosis, please. One, two, three, four, five, six. Six sequence. Yes, the first thing is yes, the cell shrinkage. Very good. It's shrinkage. Now, this is a very important feature. The earliest feature that differentiates apoptosis from necrosis. In necrosis, the cell swells. Here, the cell is shrinking. Okay, cell shrinkage is there. The second is the eosinophilia. Eosinophilia is due to compactness, due to the multiple cell organelles are coming closer. Okay, that is the eosinophilia. The cytoplasm looks more pink. What is the third feature? The nuclear feature. The two nuclear features. Nucleus become compact and it become fragmented. Compactness is known as pyknosis, and fragmentation is known as karyorrhexis. Okay, that is the third feature. After that, blebs are formed on the surface, then apoptotic bodies are formed, and in the end, phagocytosis takes place. Say yes. So, these are the six features. These are the six features. Now, let me ask you two questions here. Two questions, two answers. Who will answer the two questions? The first, tell me the earliest feature of apoptosis. Of course, everyone can see. Earliest feature of apoptosis. It's a PYQ. And tell me the characteristic, characteristic feature of apoptosis. Two different questions, two different answers. Don't get confused. What is the earliest feature? What is the earliest feature? Very good, Osama. Very good, very good, Saya. Yes, very good. You have enumerated all the six features very correctly. Yes, the earliest feature is the cell shrinkage. Everyone knows. Everyone knows it is visible. But what is the characteristic feature? I mean to ask the characteristic or the pathognomonic, pathognomonic feature. The characteristic or the pathognomonic, its nuclear features, the pyknosis and karyorrhexis. So, read your question very carefully in your exam. What they are asking? If they are asking earliest feature of apoptosis, go, go with cell shrinkage. If they are asking characteristic or pathognomonic or specific feature, go with the nuclear feature, pyknotic and karyorrhexis. So, please read your question very carefully. Can we go ahead? Yes. So, you can see the same thing. Cell shrinkage is the earliest feature. Can you see in this diagram? This cell which is marked with an arrow, this cell which is marked with an arrow, I have highlighted the cell with blue color. It is smaller than the rest of the cells. See this cell. It is smaller than the rest of the cells. It is more pink than the rest of the cells. See this cell. It is smaller as well as more pink than the rest of the cells. So, cell shrinkage is also visible, and cell eosinophilia is also visible. Pyknosis, you can see either cells. See the nucleus. See the nucleus. It gets condensed. Condensation is known as pyknosis, and fragmentation into multiple pieces is known as karyorrhexis. That is the most specific or pathognomonic feature. Pathognomonic feature. See the bleb formation. Appreciate the bleb formation. See normal cell. See apoptotic cell. In electron microscopy, you can appreciate the blebs are formed. So, multiple blebs are formed on the surface. Okay. After that, multiple apoptotic bodies are formed. Phagocytosis. Yes. No leakage, no inflammation is the hallmark. The last thing in the apoptosis. Tell me the diagnosis of apoptosis. How to diagnose apoptosis? Tell me two features. How we can do the diagnosis of apoptosis? Tell me two features. Two, two features. There is a marker for apoptosis. Just suppose I am giving you this slide and I'm asking, "Can you identify an apoptotic cell?" You will see them. The cell which is smaller, the cell which is pink, the cell which the nucleus is condensed. That cell is an apoptotic cell. But still, you have confusion. "Ma'am, this is looking like others only. I am not very much trained to pick it up." So, the marker is available in the market. Don't worry. The name of the marker is Annexin V. And Annexin V is the name of the marker. It's a liquid, brown color liquid. Spread it on the slide. Spread it. Leave it for some time. Wash it. Only apoptotic cells will pick the marker. It will become brown color and it will be highlighted. Other cells will not pick that marker. Say yes. So, what is the name of the marker? It's very important PYQ. Annexin V. You should ask me a question, "Ma'am, why Annexin V is picked only by the apoptotic cell, not by other cells?" What is the principle behind that? Please ask the questions. More and more questions arise in your mind. You know, retention power you will have. Okay. So, apoptotic marker Annexin V is there that is highlighting the apoptotic cell. But why the question is why? Let me draw a diagram for you. This is a normal cell. Okay. And this is an apoptotic cell with bleb formation. It is converting into an apoptotic cell. Normal cell has a protein, a phospholipid, which is present on the inner surface of the cell membrane. The name of that phospholipid is phosphatidylserine. During apoptosis, during apoptosis, there is flip-flop. I am using the word flip-flop. Flip-flop. Flip-flop. During which the phosphatidylserine is coming on the outer surface. The phosphatidylserine is coming on the outer surface. Now, Annexin V binds with phosphatidylserine. So, it will not bind with the normal cell. It will bind only with the apoptotic cell. So, the answer is phosphatidylserine. Say yes. Phosphatidylserine is the answer. Phosphatidylserine. You can see it is present normally on the inner surface. This is a normal cell. And during apoptosis, there is a flip-flop. During this flip-flop, it is coming on the outer surface. That's why Annexin V is not binding here. It is binding here. This is the first way. The second way of the diagnosis of apoptosis is agarose gel electrophoresis. Do you know what is electrophoresis? Let me draw a normal cell. Let me draw an apoptotic cell. See the nucleus. This is the nucleus of the normal cell. And this is the nucleus of of the apoptotic cell. Am I right? Have I drawn it rightly? Correctly? You will say, "Yes, ma'am," because in apoptosis, the nucleus undergoes fragmentation, which is known as karyorrhexis. We know that, right? So, if I do the electrophoresis here, in this. So, let's do the electrophoresis. So, here the DNA is continuous, right? We will get one band. The DNA is continuous. But here the DNA is like this. We will get multiple bands, you know. So, on electrophoresis, we can identify whether the DNA is continuous, single band, or it is multiple bands. The multiple band DNA, it is looking like a stepladder. CD, CD. It is known as stepladder appearance. Step. It's a PYQ. Stepladder appearance. It is. Yes, very good, Andhra. Very good. It is the stepladder appearance. So, this is the stepladder appearance. The fragmentation of the nucleus is caused by an enzyme, endonuclease. You can see here. It's continuous. Here, it's continuous or it is discontinuous also. So, big, big pieces are there normally. But here, small, small pieces. It is looking like a step ladder. So, this is an apoptotic cell. These all are normal cells. Say yes. You got it. So, we are done with apoptosis. Everyone, give me a thumbs up. Everyone. Do you have any doubt till now? Can I tell you the differences between apoptosis and necrosis? The differences between apoptosis and necrosis. Please consider apoptosis as suicide, and I am going to teach you the next topic, necrosis. That's like murder. Apoptosis takes place of a single cell. Necrosis takes place of a group of cells. If someone is committing suicide, he will do it alone. Now, suicide is done alone. It is not the complete town is doing the suicide or complete family is doing the suicide, right? You can consider like that, just for learning purposes. A single cell. But murder can be done of multiple persons at one time. Okay. So, here the necrosis, like murder, it's a group of cells. Your cells shrink. Your cells swell. So, here cells shrink in size. Your cells swell in size, right? Here, nuclear features are both common in both of them. Here also, pyknosis, karyorrhexis. Here also, pyknosis and karyorrhexis. But here, cell membrane is intact. So, no inflammation, no leakage. Here, cell membrane disrupts. The cell bursts, right? So, inflammation is present. Leakage is present. Here, inflammation and leakage are absent. So, please learn. Please learn the differences between them like this. We will solve some MCQs on apoptosis and move on to the next topic very quickly, necrosis. So, you have to be fast. You have to give me the answer. What's the correct answer here? Please tell me. CD95 is a marker of. Is it intrinsic pathway, extrinsic pathway, monocyte, or leukocyte? CD95, just now I told you. Okay, let me give you a clue. CD95 is the other name of the Fas, Fas receptor, or Fas ligand. So, what is the correct answer now? CD95 is a marker of. Yes, yes, very good, very good. CD95, Fas, or TNF, these are the death receptors which are which are present in extrinsic pathway, not in intrinsic pathway. And you all are right. Very good, very correct, very intelligent, very good. The next question. The following is an example of anti-apoptotic proteins. I told you three anti-apoptotic proteins and four pro-apoptotic proteins. I told you during intrinsic pathway. So, is it Bax, Bcl-x, or Bim? What is the correct answer here? Yes. So, I told you anti-apoptotic proteins are the proteins which uh closes the door, and pro-apoptotic proteins open the door. Okay. Here, I told you three examples: Bcl-x, Bcl-2, and Mcl-1. And here, I told you four examples: Bax, Bad, Bim, Bak. Okay. Yes, you all are right. The correct answer is Bcl-x here. Okay. The remaining three are from pro-apoptotic. It is a very important MCQ. The next. Everyone knows the earliest change in apoptosis. I guess everyone knows the answer. Earliest change in apoptosis. Earliest. So, is it cell shrinkage, pyknosis, formation of apoptotic bodies, or fragmentation of the cell? What is the correct answer? I'm asking the earliest. Mind members. Earliest feature of apoptosis. What is the correct answer? Yes, I'm waiting. So, there are two different questions. Earliest is different, and most specific and characteristic is different. You all are right. The earliest is the cell shrinkage. But if I change the question from the earliest to the pathognomonic, what is your answer? No orthognomonic feature or specific feature. In that case, your answer will become B, pyknosis. Right? In that case, pyknosis and karyorrhexis is the answer. Coming on the next question. The last question. All of the following are the features of apoptosis except. I am using the word except. Can you tell me the answer? Cell swelling, is it a feature? Yes or no? Nucleus become compact, yes or no? Cell membrane is intact, yes or no? And cytoplasmic eosinophilia takes place, yes or no? So, what do not take place? You have to tell me what do not take place. I'm using the word except. What is the correct answer? Yes, very good. The correct answer here, very good, is A, cell swelling. Swelling takes place in necrosis, never in apoptosis, right? The next question. I should not ask. Annexin V is a marker of. I guess each and every one of you know the answer. Is it apoptosis, necrosis, atherosclerosis, or inflammation? Now, the question looking very simple to you because just now I taught you apoptosis. I am putting this question. But once you finish all 19 subjects, now the same question looks difficult to you. So, please learn. And Annexin V is a marker of apoptosis. It's a repeatedly asked question. So, we are done with apoptosis. Coming on the next, necrosis. Okay. Necrosis is another type of cell death. That is the murder. We are done with apoptosis. Now, coming on necrosis chapter. One will be done. Then we will move on to the next chapter, that is inflammation. Can I start? Are you people there? So, let's start with necrosis. Let's start with necrosis. What is necrosis? The necrosis is also a type of cell death. But here, the cell will undergo bursting, and the cytoplasmic leakage is there. Because of which, inflammation is present. Inflammation is present. So, basically, there are five types of necrosis. I'm going to teach you now. The differences between them: coagulative, liquefactive, caseous, fat, fibrinoid. The liquefactive also known as colliquative. Poly. So, you can learn a mnemonic: Triple C, double F. The five types of necrosis. The five types of necrosis. What are the five types of necrosis? Triple C and double F. The five types of necrosis: coagulative, liquefactive, caseous, fat, and fibrinoid. The five types of necrosis. So, basically, all of them are cell death. Okay. All of them are murder. Okay. In all of them, the inflammation is present. Okay. Then you will ask them, "Why are there five types?" Come on, they all are cell death. So, how can death be of five types? Yes, there can be five different types of death. In all of them, the cell is bursting, the cytoplasm is leaking out, the inflammation is present in all of them. But still, there is some, some, some, some minor difference between them. I want to highlight those differences to understand you the differences between the five types. Give me a thumbs up. Give me a thumbs up. You got it. You got it. So, let me explain you the five different types. I want all my dear students to make this comparative table with me. Otherwise, I am providing the notes. Anyways, if you don't make it, it's good. But if you, you make it, it will fit in your permanent memory. Okay. So, I request you to make this table in which in the introduction, write down the definition of all five necrosis. Then causes, gross and microscopy. Draw the microscopy. So, you will never do a wrong question on necrosis. Okay. So, let's start with the first one, coagulative. Before that, before coming on the five types of necrosis, let me tell you something. Can you see a cell in front of your screen? Yes, you all can see a cell in front of your screen. You can see yourself. The cell has a particular shape. The shape of the cell is known as architecture. Architecture or the outline. It is the shape of the cell. The shape of the cell is known as architecture. Inside the cell, cytoplasm is present. Now, see the color of the cytoplasm. See the amount of the cytoplasm. Is it scanty or abundant? See the granularity, whether the granules are present or absent. Right? And see the nucleus. The nucleus. See the location. Is it central or eccentric? See the color. Is it dense or see its composition? So, based on the three details, you can identify a cell. How many types of cells are present in the human body? You will see, "Ma'am, we have hundreds or thousands of types of cells." Few of them are in front of your screen. So, can you identify the different types of cells? You will see, "Yes, ma'am, we can identify." Is it a muscle cell, stem cell, intestine cell, liver cell, blood cell? We can identify. You can identify any cell because of the three features. See their architecture, I mean shape. See their cytoplasmic colors. See their nucleus. Based on that, you can identify what type of cell it is. So, if you want to identify any cell of the human body, there are many cells now. You have to see for three details. You have to look for architectural detail, cytoplasmic detail, and nuclear detail. By architecture, I mean the outline or the shape of the cell. Give me a thumbs up. Got it, right? So, please appreciate. Go on appreciating that you got it. Okay. So, this is the thing. Now, let's start the necrosis. The first type of the necrosis I'm starting is coagulative necrosis. In coagulative necrosis, uh, not necrosis takes place of a group of cells. Can you see here a group of four cells? All of them are alive. See the four, not four, I mean there are multiple cells. They are alive. See the three details. See their outline. See their shape. See their cytoplasm. See their nucleus. Okay. And see they undergo death. They are coagulative now. So, you will say, "Ma'am, what two things are changing?" Your cytoplasm is changed. Okay. You can see the cytoplasm is changed. Okay. You can see the nucleus has also become pyknotic and karyorrhectic, or it disappears. The nucleus is also changed. The only thing which is same here also is the shape. The shape is still same, right? So, in coagulative necrosis, the architectural details are maintained, but cytoplasmic and nuclear details are lost. This is the definition of coagulative necrosis. No one will teach you with such a simplicity in such a short duration of time. The coagulation that crosses, how will you define it? You will see, "Ma'am, the architectural details are maintained, but cytoplasmic and nuclear details are lost." Such and necrosis is known as coagulative necrosis. Say yes. Got it. Got it. This is the most common type of necrosis among the five. Among the five, this one is the most common. Write down the definition here in the introduction. Architecture present, but cytoplasmic and nuclear details are lost. I will tell you the differences between the five. So, okay. So, here, architectural outline persists, but the cytoplasmic and nuclear details are lost. It is known as coagulative necrosis. Since out of the three details, at least one of them is still present, it is still present. We can identify the cell. Identified because at least the shape you can see now. You cannot see the cytoplasm, not the nucleus, but at least the shape you can see. Have you seen a ghost? Ghost? Have you seen? I have never seen. But the ghosts have only outline. It doesn't have inner detail. So, can I say the cells in the coagulative necrosis? Can I compare the cells in the coagulative necrosis with the ghost? Because ghosts also have outline only, no inner detail. Or Alice, have you seen a tombstone? What is a tombstone? It is a stone which is present over the graveyard. Okay. So, it is also having only outline, no inner detail, no inner detail. So, can I compare the cell in coagulative necrosis with ghost and tombstone? Yes. Both of them, the meaning is same. Only outline persists. I want to highlight the thing. The outline persists, and the cytoplasmic and nuclear details are lost. But the outline persists. And that's why the cell is known as ghost cell or tombstone cell. Say yes. Ghost cell or tombstone cell. Learn this terminology. Okay. So, that is the coagulative necrosis. Definition. Coming on the causes. You know, human body, from head to toe, we are supplied with blood. Each and every organ has blood supply. What happens if any organ or any cell do not get the blood? You will say that organ will die because of the necrosis. So, which necrosis takes place because of ischemia? It's the coagulative necrosis. So, in any organ of the human body, if blood supply is not there, if there is ischemia, ischemia means no blood supply, that organ will die. The cells of that organ will die because of coagulative necrosis, except brain. Learn the exception. That's brain. So, is and all organs leads to coagulative necrosis, but ischemia and brain leads to liquefactive necrosis. The second type, liquefactive necrosis. Okay. The second, uh, ischemia and brain leads to liquefactive necrosis. If you have burns anywhere, just suppose I am having a small burn here or multiple burns are there. In burns, the cells of that portion undergo death because of coagulation necrosis. And Zenker's degeneration is also an example. Please learn. Grossly, the organ is pale. Form. Microscopically, all the cells look tombstone or ghost appearance. Now, compare in this diagram. You can see a kidney here. You can see a kidney here. You can see this is normal kidney, and you can see this is coagulative necrotic kidney. Compare. And at the junction, you can see the inflammation. Let me show you. You can see the junction. It contains the inflammatory cells. It contains the lymphocytes. So, in all necrosis, inflammation is a hallmark. Inflammation is present at the junction. Now, see the cells here. See the cells here. Compare the cells. So, you can see, "Ma'am, the outline is exactly same." You can see the outline is exactly same. These are the cells. Now, outline is same, but the cytoplasmic and nuclear details are lost. But outline is same. So, the cells are looking like tombstone or ghost. So, this is the diagram. Can we go ahead? Can we go ahead? Uh, Andhra, brain is not spared. I am saying in ischemia of the brain, it's liquefactive necrosis, not the coagulative one. Because brain has multiple hydrolytic enzymes in which the liquefactive necrosis will take place. I mean to say, the entire necrotic tissue will convert into a gel-like material, which is liquefied. I am coming on the second one. After that, you will understand your point. Can we go ahead? Yes, yes. Mohit, absolutely right. Okay. The second type is the liquefactive, also known as colliquative necrosis. Uh, why is it known as liquefactive? Because after necrosis, the necrotic tissue is semi-fluid, like a gel, like a gel, jelly, gel. That's why it is known as liquefactive. It's looking like liquid. So, what is the difference? See here, a group of alive cells. Can you see this architecture? You will say, "Yes." Can you see the cytoplasm? Can you see the nucleus? Yes. But when it undergoes necrosis, everything disappears. Architecture detail is lost. Cytoplasmic is lost. Nuclear is also lost. So, all three details are lost. In contrast, coagulative necrosis, we are at least architecture was maintained. Cytoplasmic, nuclear details were lost there also, but at least architecture was maintained there. But here, architecture is also lost, and the cells are converted, a group of cells converted into a gel-like material, liquid material. That's why known as liquefactive necrosis. Say yes. So, here the architecture is maintained. That's why known as ghost cell or tombstone cell. Here, the group of cells get converted into a liquid, a gel-like material. That's why known as liquefactive. See the two diagrams. See the contrast between them. Appreciate. Appreciate it. And if you have appreciated, let me know. Okay. Okay. So, here the architecture, cytoplasmic, nuclear, all three details are lost. That is liquefactive necrosis. Okay. Causes. One of the causes you already know. It's ischemia of the brain. Ischemia of all organs is coagulative, but ischemia of brain is liquefactive. Okay. And if you have pyogenic, pus-forming bacterial infection in any body, any body organ, so it also leads to liquefactive necrosis. Grossly, you can see this is the brain. This is a diagram of the brain. Intentionally, I put a diagram of the brain to learn you that in brain, there is liquefactive necrosis. See the cavity formation, and inside the cavity, appreciate the gel, the liquid. It's liquefactive necrosis, right? Microscopically, this is the diagram. Again, a diagram of the brain. Okay. Let me show you. This is a normal brain. This side is normal. Okay. And this side, it's liquefactive necrosis. And I appreciate the junction. At the junction, it is all inflammation. Inflammation with granulation tissue. It's all inflammation. Junction is inflammation. There is nothing in that. Compare the normal with the necrotic site. Okay. Let me show you. Normally, I can see the neurons. See the outline. See the cytoplasm. See the nucleus. I can see all three details, right? But see when it converted to necrotic tissue, I can see nothing. What I can see is dot, dot, dot, dot, dot. This is all liquid material. So, neither architecture, nor cytoplasm, nor nuclear details. Say yes. Appreciate the diagram. Okay. This is liquefactive necrosis. The third one is the caseous necrosis. You know the word caseous. It's a Greek word. It means cheese. You like cheese? I love cheese. You know, I like cheese. So, see this is cheese. It's looking white. It is known as caseous necrosis because grossly, it looks like cheese. How does the cheese look? You will see when the cheese is white or yellow in color, it's granular in appearance. Granular. I'm using the word granular. It's dry, dry, granular, white cheese. It is cottage cheese. The necrosis looks like that. That's why it is known as caseous necrosis, right? What is the definition now? So, this is the meaning. Because it is looking like cheese, what's the definition now? See the three types of. See the three types of necrosis in front of you. So, in caseous necrosis, here the architecture, cytoplasmic, nuclear, all three details are lost. So, you will see them. The same three details were lost in liquefactive also. Then what is the difference between liquefactive and caseous? You are saying here also all three details are lost. So, the difference is that here in liquefactive, all three details are lost, and the group of cells converted into a gel or liquid-like material. Here, the group of cells converted into granular debris. Solid granular debris, not liquid. Solid granular debris like cheese, you know. So, that is the difference. And in coagulative, you know, the architecture is maintained, but the cytoplasmic and nuclear details are lost. That's why giving a ghost or tombstone appearance, you know. See the three things in front of you. See, I appreciate my hard efforts behind all this. You can appreciate the alive cell have all three details: architecture, cytoplasmic, and nuclear. Now, you have to see which details are lost, and accordingly, you can decide the type of the necrosis. Appreciate. Appreciate it. Yes, yes. Can you, can you got it? Do you got it? Give me a thumbs up if you got it. The three types of the necrosis. No one will teach you with such a super simplicity. The three types of necrosis. Define them. Coagulative necrosis, liquefactive necrosis, caseous necrosis. Have you understood the differences between them? Now, can I come on the examples of the caseous? In the caseous, there are two bacteria, two fungus. So, the two bacteria are TB and syphilis. And the two fungus is Histoplasma and Coccidioidomycosis. So, learn the two bacteria along with the two fungus. The four causes. The four causes of the liquefactive necrosis, right? Uh, caseous. Grossly, it looks like cheese. I told you, it looks like cheese. And microscopically, this is the diagram. It is a diagram of the lymph node. You all can see a diagram of the lymph node in which you can see this is the normal lymph node. This section is normal. In all the necrosis, one is normal, one is necrotic tissue. This is necrotic tissue. And at the junction, you can appreciate the inflammation. At the junction, please appreciate the inflammation. This is the inflammation at the junction, right? At the junction, I am not interested in inflammation, but here the inflammation is a special inflammation. It's chronic granulomatous inflammation. I can see the giant cells, epithelioid cells. The inflammation is special. It's granulomatous inflammation. And see the normal cells. The normal cells, they have this architecture. These are the lymphocytes. You can see the shape, size. You can see the cytoplasm, nucleus. But here, you can see nothing. A pink color material, the debris, the granular material. This is caseous necrosis. It is looking like cheese, the dry, the granular. Say yes. Got it or didn't got it? So, that is the third type. Coming on the fourth type. The fourth type is the fat necrosis. It's a special necrosis which occurs in fat-rich locations in the human body. Tell me three fat-rich locations in the human body. Fat-rich location in the human body, three locations. Number one, female breast. The female breast has abundant of. Female breasts have abundant of fat. Number one. Number two, pancreas. Okay. And number three, mesentery. Number three, mesentery. Okay. These are the three fat-rich locations. So, they contain adipocytes. They all contain adipocytes. Adipocytes are the fat cells. So, death of adipocytes is known as fat necrosis. So, basically, fat necrosis takes place in three organs. Right? Female breast, pancreas, and mesentery. Inflammation. These are the causes because of which the adipocytes undergo death, leading to fat necrosis. Basically, fat necrosis, death of the adipose cells. The three causes I told you: female breast, pancreatitis, and mesentery inflammation. Because of which, grossly, it looks like chalky white. Can you see chalky white? Due to saponification. You can see the chalky white deposits or yellowish deposits. Grossly. And microscopically, it is having a cloudy appearance. Take the word cloudy. Cloudy. Can you see cloudiness? Appreciate the cloudiness. I want to highlight the cloudiness. If you are getting the word cloudy in your question, they are talking about fat necrosis. Because they contain fat. Now, the fat is cloudy in appearance, right? So, that is cloudiness. That's it. The last one is the fibrinoid. The last one is the fibrinoid necrosis. Okay. The fibrinoid necrosis. It is a special type of necrosis. Takes place in the wall of the blood vessel. You know, blood vessels have three layers. The innermost is the intima. The middle layer is the media. And the outermost is the external. These are the three layers. In the media, in the media, a pink color, ribbon-like material is formed. Let me show you the diagram. Can you see this? It is a wall of the blood vessel. See the innermost layer. This one. This one is the lumen containing the blood. It is intima. And this is all media. In the media, I can see the inflammation. Along with the inflammation, I can see a pink color material, a ribbon-like, a ribbon-like eosinophilic structure, less material. It is fibrinoid necrosis. The fibrinoid necrosis takes place in the wall of the blood vessel due to vasculitis. Due to vasculitis. That's it. Nothing important. We are done. We are done with the five types of necrosis. The master table is in front of you. If you have understood it correctly and completely, you can revise the necrosis hardly in two minutes with this table. Can you please revise with me? Everyone. Everyone. Can you please revise with me? The first thing is to learn the name of the five types of necrosis. The mnemonic is Triple C, double F. There are five types of necrosis. The first one is the coagulative. The second is the liquefactive. Then fat. Then fibrinoid. The five types of necrosis. Tell me the definition. Come on, everyone. Tell me the definition. So, in coagulative, the architecture is maintained, but cytoplasmic and nuclear details are lost. That's why it is known as ghost or tombstone appearance. In liquefactive, all three details are lost. Here also, in caseous, all three details are lost. But in liquefactive, it's gel-like formation. And in caseous, it's the debris, granular formation. The fat necrosis takes place at fat-rich locations, you know, the three fat-rich locations. The female breast, pancreas, and omentum or mesentery, one and the same thing. And fibrinoid necrosis takes place in the wall of the blood vessel. So, first, learn the definition. First, learn that. Then learn the examples. So, ischemia for all organs except brain is coagulative necrosis. Ischemia of brain with pyogenic infection is liquefactive necrosis. Caseous, you know the bacteria and parasites. Fat and fibrinoid, I told you. Burns is not important. And microscopy, I have given you. I had given you the diagram for all of them. So, in all of them, on one side, there was normal. On one side, there was necrotic tissue. And at the junction, there was inflammation. Can we go ahead? Can you solve the MCQs? Are you ready for solving the MCQs? Can we solve it right now? Are you people ready? Give me a thumbs up. You have to be fast, huh? Very fast. You have to match your speed with me. Are you, are you ready? Can we start? Okay. So, this is the first question in front of you. We are done with necrosis also. Necrosis. Which cell body is retained as ghost cell? It is seen in which necrosis? Little necrosis, liquefactive necrosis, coagulative necrosis, or none? What is the correct answer? Yes. So, I am asking about the ghost cell or tombstone appearance. I told you in which type of cell this is seen. The type of necrosis in which the architecture is maintained, but the inner detailed cytoplasmic and nuclear details are lost. So, yes, the correct answer here is the coagulative necrosis. You all are right. I guess everyone is right. The correct answer is coagulative necrosis. Very good. The next question is in front of you. All of the following organs likely to undergo coagulative necrosis except. Very repeatedly asked question. Tell me one organ in which never, never coagulative necrosis takes place. Is it spleen? Is it heart? Is it kidney? Or is it brain? Yes. What's the correct answer? I told you, ischemia of all organs except one, in which coagulation necrosis never takes place, but liquefaction necrosis takes place. Yes, brain is the exception. In brain, coagulative necrosis never takes place. Can we go ahead? Yes. So, we are done with chapter number one. We are done with chapter number one. Let's start chapter number two, the inflammation. Are you people ready? Can I start? Chapter number two, inflammation. Okay. So, first, let me start with acute inflammation. Then I will be coming on chronic inflammation. Before starting the inflammation, you should understand what is inflammation. What is inflammation? You know, there are four types of microbes that can enter the human body: bacteria, virus, fungus, and parasite. And they all, after entering the human body, what do they cause? They cause the ill effects. They cause the disease. They cause the disease. But the human body does not want to have disease. So, the body has a defense mechanism for them. The body does not want it. The body wants to defend the ill effects caused by them. And that defense mechanism is known as inflammation. Okay. And what is inflammation? Inflammation is the body's defense mechanism. Infection is the harmful effect caused by the microbes, and inflammation is the protective response against them. So, inflammation is useful for us. That is the meaning of inflammation. So, you can understand inflammation is the defense mechanism. Or anything which is foreign for the human body. It can be bacteria, virus, fungus, or parasite. You can learn like, every country has an army. Now, every country, India also has an army. Every country has an army. So, the army is the defense for that country. So, whenever any foreign, harmful, foreign, like the terrorist enters the human, enters the country's territory, the army gets activated. So, there is a fight between the army and the terrorist. Who wins? Depending on who wins, what is the result? If the army wins, that is WBC wins, it is inflammation. And if the terrorist wins, I mean the bacteria wins, it's the infection. So, in our body, infection or inflammation, what is taking place? That will result decide the fact. Give me a thumbs up. You got it. You got it. What is inflammation? So, there are two types of inflammation: the acute inflammation and the chronic inflammation. Acute inflammation, take the example of tonsillitis. Take the example of tonsillitis. Chronic inflammation, take the example of TB. Okay. Both of them are caused by bacteria. Tonsillitis is caused by bacteria Streptococcus pyogenes. TB is also caused by bacteria Mycobacterium tuberculosis. Both of them are caused by bacteria. So, here, as soon as you have tonsillitis, of course, I guess everyone has had tonsillitis till now. So, from childhood, we have multiple episodes of tonsillitis. Now, we are aware what is tonsillitis. So, as soon as bacteria enters inside the human body, within a few hours, the symptoms appear. So, onset is very fast. Here, but in TB, the bacteria enters the lung, remains there for years or months, and when the immunity drops, then the patient has symptoms. So, your onset is very slow. Once the person has tonsillitis, it will resolve. It will, you know, the person will become normal in seven days, whether he takes treatment or does not take treatment. But TB lasts for one year, two years, six months. So, your duration is short. Duration is long. Okay. So, here, onset is fast. Your onset is late. Here, duration is short. Here, duration is long. Your edema is always present. Here, granuloma is also always present. Here, the hallmark features, edema. Here, the hallmark feature is granuloma. Your main cells.

Are neutrophils here? Main cells are macrocytes or monocytes. Give me a minute, okay? So please learn the differences between acute and chronic. Understand the example. Now, for acute, there are five cardinal signs. Acute inflammation takes place from head to toe, at any part of the body. Acute inflammation can take place in any part of the body, from head to toe. Acute inflammation can take place in any organ. Whenever acute inflammation takes place, five things happen one by one. The five things always happen one by one, okay? Example, I will always tell you tonsillitis to learn the example of tonsillitis because we can understand it better, right? Not only in tonsillitis, in all organs, acute inflammation, these five things take place. These are known as the cardinal signs. So that organ turns red in color. You can see the tonsils become red in color. That organ's temperature is more as compared to surrounding temperature. That is increased local temperature. That organ swells up. You can see the swelling. The organ swells up. In that organ, there is pain. There is pain in that organ. We have tonsillitis, we have pain, okay? And there is temporary loss of function of that particular organ, temporarily, okay? So that is the five signs. You don't have to learn the five signs in English language. I taught you in English. Now, do you know Latin? I don't know Latin, but in the exam, you have to learn these five cardinal signs in Latin language. It's an important answer, Q. So redness in Latin language is known as rubor. Increased temperature in Latin language known as calor. Have you heard the calorimeter instrument? The instrument used to measure the heat, calor, okay? Then swelling is known as tumor. Don't get confused, okay? Don't get confused. Tumor is not English. It is not cancer. Tumor, I am asking tumor in Latin language. In Latin, the tumor is the swelling. Pain is known as dolor. And loss of function is known as functio laesa. The piece enumerate the five features: rubor, calor, tumor, dolor, functio laesa. Rubor, calor, tumor, dolor, functio laesa. So rubor means redness. Calor means increased temperature. Tumor means swelling. Dolor means pain. And functio laesa is temporary loss of function. So please learn the five cardinal signs of acute inflammation. It's a very important MCQ. Let's start acute inflammation, okay? In acute inflammation, there are five vascular, six cellular, total 11 events. I am going to teach you all 11 events in one diagram. So these are the five vascular events. I will, I am not reading it. I will directly explain you. These are the six cellular events. I am not reading directly. I will explain you. At the end, after 5 or 10 minutes, in 10 minutes, I will explain all 11 events. After that, you will be able to say all the events. We will revise all 11 events in the end, okay? All 11 events I am going to explain in one diagram. The master diagram. Everyone here on the screen, please concentrate. Now, on your gadgets, everyone. It's a very important topic. I am going to explain you all 11 events in one diagram. If you don't understand this diagram, you cannot understand the acute inflammation. This is my sketch diagram, my way of teaching, okay? Can you see this master diagram? In this master diagram, can you see the yellow line here? I have drawn a yellow line, okay? Just a second. You can see this is the yellow line. Imagine this is the skin, the human skin. Imagine this is the skin of this portion, okay? Now, some bacteria have entered the human body. It can be bacteria, it can be virus, it can be fungus, it can be anything. It can be the injurious agent. So let's take an example, bacteria. I will call it a terrorist. It is a foreign material. Now I will call it the terrorist, okay? You can see the blood vessel just below that. There is a blood vessel. This is the endothelial lining of the blood vessel. And inside the blood vessel, we have three types of cells: RBC, WBC, platelet. Currently, I am interested in WBC, which is the army, the defense mechanism. These are the army. These are WBC. This is the army, right? Now, there is a terrorist. There is army. You can see the terrorist. You can see the army. The terrorist causes the disease, and the army protects us. You got my point? But there is a, they should fight with each other. If the terrorists win, then infection takes place. If the army wins, inflammation takes place. Let them fight. Let's see who's winning, who is more powerful. Let's see, and that will decide the fate whether the person has infection or inflammation. That will decide after the fight. But there is a problem. There is a problem, a small problem for which we have to conduct the 11 steps. What's the problem? Can you see what is the problem? Huh? You all can see. You will see, ma'am, the terrorist is extravascular. I mean, the bacteria is extravascular, and the army is intravascular. So how they can fight? They cannot meet. Now, one is extravascular, one is intravascular. They cannot meet with each other. If they cannot meet, how they can fight with each other? So you will see them. There are two ways. Either, either, either, uh, take, I'm sorry, either take the bacteria inside the blood vessel. If you take the bacteria inside the blood vessel, they will meet and they will fight, right? They will meet and they will fight. But it's a bad idea. If you take the bacteria inside the blood vessel, there is sepsis. There is sepsis, no? So the other way around, we will take the army out. Yes, it's a good idea. Take the WBC out and let them fight. So for taking WBC out, we have to do 11 steps. So that is the motto. Why we are doing 11 steps? Everyone learns the 11th struggle. At the five hospital or the six cellular event, students don't know why it is happening. What is the purpose? Why we are performing all this tedious exercise? We want to take the WBC out so that it can fight or it can do the phagocytosis of the bacteria, and bacteria is dead. This is the purpose. Say yes, everyone with me? You got it? So I will tell you the 11 steps one by one. Among the 11 steps, the five are vascular events, and six are cellular events. The last event in which the WBC will do the phagocytosis of the bacteria. Can I start? Are you people with me? If you say yes, then only I will start, okay? So this is the master diagram in which I'm going to explain you all 11 events, okay? Let me start with the five vascular events first, then I will come on cellular. In the five vascular events, the first event is the vasoconstriction, transient vasoconstriction. See the diagram. See the diagram. Can you see this is the, uh, bacteria or a terrorist, whatever you say? So the blood vessel just below that undergo vasoconstriction due to sympathetic stimulation. So that portion undergo vasoconstriction, but it is transient. It is only for few seconds, hardly, hardly for few seconds. So say the word transient vasoconstriction. The first event, transient vasoconstriction, the first event. So as soon as, so just suppose this is my skin, and just below that I am having a blood vessel. So if some injury is here, so the blood vessel just below this injurious agent, the blood vessel in that segment, not the complete blood vessel, blood vessel in that segment undergoes construction transiently. So transient vasoconstriction is the first event. It is only for few seconds or minute. Appreciate it. The first event, transient vasoconstriction. I am teaching you the 11 events of acute inflammation. The five vascular, the six cellular. The first is over. The second is vasodilation. Now, after that, the same portion which was initially undergo vasoconstriction, not undergo vasodilation. It's also dilated now, and it is persistent. It's not transient. So say the second event is vasodilation, and it's persistent, okay? Now, imagine again, this is the portion. This is the point where the bacteria is entering. So the blood vessel just below this portion of the skin, this is undergoing, this portion, not the complete blood vessel, only this blood vessel portion which is below this section, it is undergoing vasodilation. Only vasodilation. You will say vasodilation means more blood. So this portion has more blood. So if I see from above, this portion looks red to me. Yes, obviously, Hannah? So it is explaining the rubor. I told you the five cardinal signs. Now, one is explained. If I ask you, what is the reason for rubor? You can answer, Mom, it is the second step, that is persistent vasodilation leading to rubor. And if I touch this portion as compared to surrounding temperature, it's more hot because it is having more blood, more blood, more hotness as compared to more warm, I mean, as compared to surrounding area. So rubor and calor can be explained because of this. So second step, step number two, that is persistent vasodilation is explaining the two features, rubor and calor. Say yes, say yes. Or can be explained because of persistent vasodilation. We are done with two features till now. The first is vasoconstriction, the second is vasodilation. The vasoconstriction is transient in nature. The vasodilation is persistent in nature. Vasoconstriction leading to nothing. Vasodilation leading to two features, rubor and calor. Everyone, yes? Everyone, give me a thumbs up. Everyone, can we go ahead? Yeah, coming on the third, third picture, the third feature. For understanding the third, uh, step, you have to understand the Starling's law. What is Starling's law? Starling's law says that in a blood vessel, in a capillary, two types of pressure always operate. One is outward, that is hydrostatic pressure, and one is inward, that is osmotic pressure. Hydrostatic is always outward. Osmotic is always inward. Hydrostatic, as the name says, hydro, hydro, water. It is the pressure due to water. The water is leading to this pressure. And osmotic or oncotic is due to protein. It's always inward. And normally, they are equal and opposite. So whatever coming out is going back. There is no fluid, no edema. This is normal Starling's law, I guess. Um, like you all have, have read this thing in the physiology, okay? So, can we go ahead? Okay, yes. So this is the two types of the pressure. Now, you tell me, because of the last step, the second step was vasodilation, which pressure will increase? Is it hydrostatic or oncotic? Is it hydrostatic or oncotic? Which pressure will increase? Common sense. We will say, ma'am, vasodilation means there is more blood. More blood in this section, in the section. More blood, more blood means more water. More water means hydrostatic pressure. The hydrostatic pressure will increase. So outward is more, inward is less. Outward is more, inward is less. Since outward is more, inward is less, there is an imbalance. The imbalance because of the imbalance, the fluid will come out. The fluid will come out, leading to edema. It will accumulate here and leading to edema, leading to edema. Say yes. This is step number three. So step number three leading to edema. Because of the edema, there is swelling. This portion will swell out. This portion will just suppose I am having an injury. Yes, it can be insect bite, Arthur, yes, it can be an injury, bacteria, virus, insect bite, whatever. So that portion will swell out. Do you have a mosquito bite any time? Of course, we all have experienced that. So we have a swelling, focal swelling at that point. Now, where the mosquito is biting or any insect is biting, the swelling is due to this step. So the third step is explaining the swelling or the tumor out of the five cardinal features, yes? So this is the thing. Can you have you got it? Have you got it? The fourth step. Till now, we have studied three steps: one, two, three. The one was vasoconstriction, which was transient. The second is vasodilation, which is persistent, which is persistent. And third is increase hydrostatic pressure. Okay, uh, vasoconstriction leading to nothing. Vasodilation leading to two features, rubor and calor. Increase hydrostatic pressure leading to edema. Edema also known as tumor, okay? Edema, only fluid came out. So this type of edema is transudate edema. You know, there are two types of edema: transudate and exudate. Here, only fluid was coming out due to imbalance in the pressure. Now, coming on the fourth step. The fourth step, the fourth step is increase vascular permeability. You must ask me, ma'am, what do you mean by vascular permeability? Have you seen a blood vessel? In the blood vessel, these are the endothelial cells. These are the endothelial cells. They are continuous, one behind the other. They are continuous, one behind the other. There is no gap in them. I'm using the word gap. There is no gap, you can see, okay? But now, the increased vascular permeability means the gaps will be created. The gaps will be created. Creation of gap, can you see the gaps now? These are the gaps. Creation of gaps is known as increased vascular permeability. You must be thinking, ma'am, by the gaps, you are creating the gaps. I want to take WBC out. Now, what is my ultimate purpose? I want to take this WBC out and make a fight between the bacteria and the WBC. If there is no gap, how the WBC will come out? Ultimately, we have to create the gap, and from that gap, we have to take the WBC out. So that is creation of gap. The creation of the gap is known as increased vascular permeability. And this step is the hallmark out of the 11 steps. This step is the most important, okay? Now the gaps are created. You can see these are the gaps. These are the gaps. The gaps are created. From this gaps, the protein will also leak out. Protein will also leak out. Fluid was already there. Now protein also leak out. So edema will increase. And this edema is exudate, okay? Let me explain you. You can see here, the first diagram. In the first diagram, see the wall of the blood vessel. See the endothelial cells. They are continuous. There is no gap. Appreciate there is no gap in the first diagram. And see the two pressure. Outward is equal to inward. So everything was normal. Everything was normal. In the second diagram, you can see the gap is still not there. It's, it's continuous. It's continuous, okay? There is no gap, okay? But the outward pressure is more and inward is less. So because of the imbalance, only fluid came out. Can you see the fluid is coming out? See the background blue color here. Appreciate the background blue color here, which is accumulating. So only fluid is accumulating. So this is known as transudate. Transudate contains only fluid. Now, see the third diagram. In the third diagram, this is endothelial cell. This is the endothelial cell. This is endothelial cell. Now, at the junction, you can see the gaps. You can see the gaps at the junction. From this gaps, the protein is going out. The protein is also going out. Now, the fluid along with protein is known as exudate. Initially, only fluid was there. So there are two types of edema. What are the two types of edema? Transudate, exudate. Transudate contains only fluid. Exudate contains fluid plus protein. So here, among the six steps, are five steps, I am telling you the third step that is increase hydrostatic pressure leading to transudate. And the fourth step, increase vascular permeability leading to exudate. That is my point to explain you both of them leading to edema. Both of them causing the swelling. So initially, the swelling contains only fluid. After that, the swelling contains fluid with the protein. That is pus formation. Say yes. So you got my point? You got my point? That is the thing. So transudate followed by exudate. The reason for the transudate is increase hydrostatic pressure. The reason for exudate, increase vascular permeability. Say yes. You got it everyone? So let's revise the fourth step. Till now, we have studied the fourth step, then I will come on the fifth one. Can you please tell me the four steps? Anyone from the audience? Anyone from the audience? Can you tell me the four steps? Please. I'm teaching you the vascular, vascular steps. The first step is the vasoconstriction. The second is the vasodilation. The vasoconstriction is transient. The vasodilation is the persistent. Okay? The third is increase hydrostatic pressure. The fourth is increased vascular permeability. Increase vascular permeability is the hallmark step. Increase hydrostatic pressure leads to edema. Increase vascular permeability also leads to edema. But increase hydrostatic pressure, only fluid came out. That's why edema is transudate in nature. And increase vascular permeability, along with fluid, protein also came out. That's why edema is exudate in nature. So till now, I taught you this. Anyone having any confusion in that? Anyone having any confusion in that? Can we go ahead to the last step? Okay, don't go in the mechanisms. There are five mechanisms of creating the gaps. You must know the name, but don't go in detail. The five mechanisms of creating the gaps, we can skip. And, yeah, the last and the fifth step is the slowing, the slowing like stasis of the blood. Now, the fluid also came out, the protein also came out. So what remains now in the lumen of the blood vessel in this section? Only cells are present. So there is stasis of blood. So the fifth and the last step is the stasis. We are done with five vascular stems. Yes, everyone? Yes, you all are genius. Good, great, and very happy. Good, good, everyone, everyone, yes. Okay, so Namin, you have, you have a trouble in understanding exudate. Can I repeat? You got it or you are asking? So there are two types of edema. I mean, there are two types of edema. There is transudate and there is exudate. Okay? In transudate, only fluid comes out of the wall of the blood vessel. And in exudate, along with the fluid, protein also comes out. This also leads to edema. This also relates to edema. But this is a watery edema. Only fluid is there. And this is pasty, thick, like along with the fluid, it contains protein and cell also. It looks like pus, white thick pus. So that is the two types of the edema, right? So whenever the wall of the blood vessel is continuous, now it's like this, so only fluid can come out. Only fluid can come out. But whenever there are gaps present in the wall of the blood vessel, along with the fluid, protein also comes out. So whenever there is increased hydrostatic pressure, it's only fluid coming out. But whenever there is increased vascular permeability, the protein also comes out. You got it? I hope you got it now, right? Tastes. So stasis, there is nothing to understand in stasis. Stasis is just, you know, the fluid and the protein is already leaked. Whatever remaining is the stasis. So that's the stasis. There is nothing to learn in that. So the five, the five, you should learn the vasoconstriction, which is transient. Vasodilation, which is persistent. Increase hydrostatic pressure. Increase vascular permeability. And stasis. Please learn. And among them, the hallmark feature is the increase vascular permeability. And you know the consequences of each of them. Yes, give me a thumbs up. You got it? Can we go ahead? So we will solve some questions on these five, and then I will come on the six cellular events. In this way, all 11 will be done. So please solve some MCQs. The first question is in front of you. Can you give the answer, please? Can you tell me the sequence of the events in acute inflammation? I told you the vascular events. You can read the four options. I told you the five events. Can you tell me the sequence? Is it vasodilation followed by stasis followed by transient vasoconstriction or permeability? Read the four options. I'm not reading the four options. Please read the four options and tell me the correct sequence of the vascular events of acute inflammation. Who will tell me the correct sequence, please? What is the correct sequence of vascular events in acute inflammation? Yes, what is the correct sequence, please? Yes, very good, very good. No matter, it's not C. Read again, read again. Others, you all are right. Correct answer is D. The first is vasoconstriction, followed by vasodilation. Increased hydrostatic pressure is not given the third. The fourth is increased vascular permeability, and then the last one is the stasis. So out of the five, four are given, but you have to arrange them in a sequence, right? It is a very commonly asked PYQ. Okay, the next question is in front of you. Can you tell me the first step in acute inflammation? The first is it vasodilation or construction? Is it increased vascular permeability or decreased vascular permeability? The first step, the first step. Yes, hydrostatic is missing, Mohit, right? What's the first step? Yes, you all are right. I guess the question is very easy. The first step is vasoconstriction. Although it's transient, but don't miss it. Although it's transient and only for few seconds, only for few minutes, but please don't miss it. Although it's transient, but don't miss it. So correct answer here is B. Yes, everyone is right. You all are right. So going to the next question. All of the following vascular changes are observed in acute inflammation except. In your question, there are many questions having the word except. Don't miss the word except. What are the four options which do not take place in acute inflammation? Vasodilation takes place? Yes or no? Stasis takes place? Yes or no? Increase vascular permeability takes place? Yes or no? Decreased hydrostatic pressure takes place? Yes or no? So tell me what is the correct answer? What is the correct answer here? Yes, yes, you all are. Yes, Osama, absolutely right. And everyone else is also right. The correct answer here is D, because it's not decreased hydrostatic pressure, it's increased hydrostatic pressure. And rest all the three options are right. You all are right. So correct answer here is D. We are done with vascular events. Coming on the cellular events very quickly. Can I start the cellular events? Yes, we should start quickly. Now, the cellular events of, uh, acute inflammation. So till now, tell me the summary. First, tell me the summary of these five vascular events. We have done the five vascular events: vasoconstriction, vasodilation, increase hydrostatic pressure, increase vascular permeability, and stasis. What is the summary? The last summary diagram is this. Till now, what we have done in the vascular events of acute inflammation? We have created a gap. We have created a gap. Now it's time to take WBC out of that gap. Take it out. Now, why you require six steps? It is not that easy. We require six steps to take WBC out, right? These six events are cellular events in which the cell will come out. The cell is the WBC, the army. You know, this is the terrorist. You can see the microbe is the terrorist. It's still present, and the army is still inside. But we are, you know, arranging, arranging a channel, arranging a, yeah, a promise. We will take the army out and take it towards the terrorist and let them fight. We will do the phagocytosis by the army to the terrorist, right? So this is ultimately we want. So we have already created a gap. We have already created a gap. But now we want to take WBC out of that gap. That is cellular events. So what is the problem? Have you read Bernoulli's theorem when you were a kid? I mean, in physics, in your sixth, seventh, eighth standard, Bernoulli's theorem? What is Bernoulli's theorem? So this is a pipe, you know, a luminated pipe. Whenever fluid travels in a pipe, the heavy portion travels at the center, and the light portion travels at the periphery. This is the statement of Bernoulli's theorem. Let's apply Bernoulli's theorem on a blood vessel. Blood vessel is also a luminated pipe now, right? In which we are having four things: we are having RBC, WBC, platelet, and, uh, the plasma. So which is the heaviest one? The heaviest will travel at the center. I told you now, the heaviest, unfortunately, the heaviest is the WBC. The WBC travels at the center, and after that, there is RBC. So this is all RBC surrounding the WBC. There is RBC, okay? After that, there is platelet. So surrounding that, there is platelet. And the most lightest one, the lightest one is the plasma. So this is the plasma, the lightest one, present the plasma at the most periphery. Now, there is a gap. Imagine this is my gap, right? I want to take WBC out. I do not want to take RBC and platelet and plasma out. I want to take WBC, which is present at the center. So how can I take it directly from the gap? It is present at the center. Now, first, I have to take it into the periphery. Then only I can take it out. It was a fun when it, the was very easy. I mean, when the WBC already presented the periphery, but it is not the case in all of our blood. The WBC present in the center. So during inflammation, we have to take it to the periphery so that we can take it out of the gap. You got my point? Normally, when the WBC travels at the center, right? It is known as axial blood flow. Axial blood flow. So basically, we want to convert axial to reverse axial. Axial to reverse axial, in which we want to take the WBC from the center to the periphery. Say yes. So this is the thing. So let me tell you the six steps now. So this is the summary. These are the six steps. See here, everyone here on the screen. Can you see this is a WBC? I'm drawing this one. See, this is the WBC present at the center. Say yes, right? The first step, taking the WBC from the center to the periphery. This is known as margination. Margin, you are taking the WBC from the center to the margin. That's why known as margination, okay? Margination also known as pavementation. After that, where is the gap? This is my gap. So gap is not immediate. Gap is not immediate. We have to take it a distance. It is, is rolling like a tire on a road, like a tire on a road. Who is the tire? WBC. Who is the road? It is the endothelial lining. Say yes. It's very important to understand. So here, you can see the tire is the WBC, and the road is the endothelial lining. So the tire is rolling on a road, road, road. This step is known as rolling. So the second step is the rolling. After that, just before the gap, it stops. Stoppage is known as adhesion. The third step is adhesion. First margination, then rolling, then adhesion. It stopped. After that, it comes out. Ultimately, WBC comes from intravascular space to extravascular space. Ultimately, it's known as transmigration. What is it known as? It is known as transmigration, in which WBC comes from intravascular space to extravascular space. It's transmigration, okay? Transmigration also known as diapedesis. That diapedesis is very important step. Yes, it's diapedesis. It's coming out, okay? Now, WBC don't have eyes. Whereas the bacteria, it's a three-dimensional space. In the three-dimensional space, how does WBC recognize that bacteria is in this direction? And in a three-dimensional space, I have to move this, not there, not there. WBC don't have eyes to see where is the bacteria or here is the bacteria. I have to move here, not here. So it is due to the chemical. How does it takes place? The bacteria secrete some chemical, and that chemical attracts the WBC. So this step is known as chemotaxis. Chemo means chemical. Axis means chemical oriented movement. So WBC will move towards the chemical. That is the fifth step. And lastly, you can see WBC is phagocytosing the bacteria. The last step, phagocytosis. Enumerate the six steps, please. What are the six steps? Can you tell me the same six steps from a book diagram? You can see this is my sketch diagram, okay? You can see that WBC at the center. WBC leave the center and come at the periphery, margination. After that, rolling, rolling, rolling. Just before the gap, it stops, that is known as adhesion. After that, it is coming out, that is transmigration or diapedesis. After that, it is moving towards the bacteria because of chemical, it's chemotaxis. Lastly, it is doing phagocytosis. It will perform phagocytosis. Absolutely right, absolutely right, Naveen, Osama, very good, very good. So these are the six steps. Among them, I will now margination. You already got it. To convert the axial blood flow into reverse axial, please learn this definition. The definition of margination. Now I will explain you how does rolling, adhesion, and transmigration and chemotaxis takes place. The details of them. So let me take the rolling, adhesion, and transmigration together. How does it takes place? How does rolling takes place? How does adhesion? How does? So can you see for rolling, it's rolling on the surface of the wall of the blood vessel. So with the help of the receptors, everything in pathology is like receptors. It's like receptors. So can you see here? The receptors are present on the surface of the WBC. The corresponding, I'm using the word corresponding, the corresponding receptors are present on the, on the wall of the blood vessel. So because of which interaction of these receptors, the rolling takes place. So the receptors are present on the surface of the WBC. The corresponding receptors are present on the wall of the blood vessel. So the receptor between the road and the tire, you know, this is a road and this is a tire. So because of the receptors, the bond is formed. It's very transient. It breaks, then it moves, then again the bond is formed, then again it breaks, then again the bond is formed. In this way, the rolling takes place. And for adhesion, the bonds are formed, it stopped. Right? So tell me the name of the corresponding, tell me the name of the corresponding receptors. It's known as complementary adhesion molecules, CAMs. Complementary adhesion molecules. There are six pairs. You have to learn the six pairs. And these are pairs. You cannot change. No, these are pairs, exactly. So you have to learn which member present on the road, which member present on the tire. This is road. I always call endothelium as a road. I always call WBC as a tire. So you will have a better imagination. What is road? What is tire? So what is present on the road? Correspondingly, what is present on the tire? And what is the pair? What is the pair? You have to learn it. So don't worry. I'm having a super simplified diagram for you. Super duper simplified. Nowhere it is given else in the world. In none of the book, this diagram is given. It is, I have drawn this diagram for you, right? You have to understand the six pairs. The six pairs are drawn in front of you. I will write their names in front of you to make the pair. You have to learn the pairs. So this is a diagram of complementary adhesion molecules, the CAMs, okay? These pairs, you can see this is tire, uh, the WBC, okay? This is WBC. You can see this is road, the endothelial lining, the road. Now, I appreciate the receptors, corresponding receptors between them. Let's write, let's write, okay? So the first is the P and E selectin. First pair, okay? Let me write. This is P selectin present on the tire, and this is E selectin, again present on the tire, I mean, on WBC. They form bond. What is present on the road? On the endothelium, P and E selectin. They form bond with Sialyl Lewis X. Sialyl Lewis X. Both of them form bond with Sialyl Lewis X. So first pair is P selectin, Sialyl Lewis X. The second pair is E selectin with Sialyl Lewis X. You have to learn the name of the pairs. I'm sorry, but you have to learn. I'm trying to simplify it, okay? The third selectin, P and E selectin present on the, I'm sorry, I'm sorry, I'm sorry. Let me erase it. I have done reverse. I have done reverse by mistake. Uh, how to erase it? Okay, we'll try. Done. Okay, okay. So we will try again, okay? I'm sorry, it was my mistake. So here, P is selectin and E selectin is present, I mean to say, P selectin and E selectin is present here. They form bond with Sialyl Lewis X. Sialyl Lewis X. The third selectin is L selectin. It is present on WBC. It forms bonds with GlyCAM. It forms bonds with GlyCAM. GlyCAM-1. They form bond with Integrin beta 2 integrin and beta 1 integrin. Please learn it. I know it's difficult. I know, but you have to learn the five pairs. So the first pair is in front of you, P selectin with Sialyl Lewis X. The second is E selectin with Sialyl Lewis X. The third is GlyCAM with L selectin. The fourth is ICAM with beta 1 integrin. The fifth is VCAM with beta 2 integrin. So if you don't change the sequences, it's easy to learn. I have written. You can see the name of the five pairs in front of you, right? The last, how does diapedesis takes place? WBC don't have eyes. There is a gap. Just fall down. It doesn't happens like this. Just fall down and go out. No, it's not like that. Again, it is with the help of receptors only. So what is the receptor for diapedesis? So you can see these are the receptors. Only one receptor which is present on both, which is present on WBC also, which is present on endothelium also, the road also, the tire also. So the name of that receptor is PECAM. Here also, here also, it's PECAM. PECAM is the only receptor which is common in the road and the tire, and that leads to transmigration or diapedesis. Ultra important MCQ. Say yes, if you got it. So can you try the pairs? Can we write it? Can you help me tell me what is present on the road? Tell me what is present on the tire. Tell me the pairs. Can you please help me try it out? At least try it out. The first pair is P selectin and E selectin. Okay, P and E selectin. So P and E selectin, they form bond with Sialyl Lewis X. Sialyl Lewis X. The third selectin is L selectin. It is present on WBC. It forms bonds with GlyCAM. It forms bonds with GlyCAM. GlyCAM-1. Integrins, ICAM and VCAM. They form bonds with integrins. They form bonds with integrins. So this is beta 2 integrin. This is beta 1 integrin. So learn the pairs. It's not very tough. I tried, okay? You can see and the last, ultra important, super duper important pair, you cannot afford missing is also PECAM, also known as CD31. Learn other name also. And this one is responsible for transmigration or diapedesis. So say yes, say yes. Now learn the first and the third responsible for rolling. Fourth is responsible, fourth and fifth for adhesion. But the second pair is responsible for both. Second pair, that is E selectin and Sialyl Lewis X, responsible for both rolling as well as adhesion. And the last one, we all know, is for diapedesis. So this is the thing. Can you see here? Here also, you can see the first, let me write the first and the third responsible for rolling. Rolling. The fourth and the fifth responsible for adhesion. Adhesion. And the second pair responsible for rolling and adhesion. It's a PYQ, okay? And the last one, PECAM with PECAM, it is responsible for transmigration or diapedesis. You get many MCQs on this. No one will teach you this complicated topic with such simplicity. You can see in front of you. You can appreciate the pairs. Give me a thumbs up. So the next is the chemotaxis. I told you the bacteria, this is the bacteria. It is secreting the chemicals. It is secreting the chemicals, and chemicals is attracting the bacteria, attracting the WBC. So this WBC travels towards the bacteria because of the chemical secreted. It is known as chemotaxis, which is a unidirectional motion, unidirectional chemical oriented motion. Say unidirectional motion or movement because of the chemical gradient, okay? Name the chemical. Name the four chemicals. What are the four chemicals here? Can you name them? One is leukotriene. One is interleukin. And two are complement. Learn the numbers. Leukotriene is B4, okay? Interleukin is 8, okay? And the two complement are C3a and C5a. The four chemicals, please learn. So these are the chemicals. The four chemicals secreted by the bacteria that attracts the WBC. So that WBC moves towards the bacteria in a three-dimensional space. Do not go anywhere else. B4, interleukin 8, complement C3a, complement C5a. Say yes, okay? So can you see these are the four, uh, chemicals? So you have, among them, C5a is most potent. C5a is most potent. There is multiple time PYQ on that. We are done with all. And lastly, there is phagocytosis. So we are done with cellular events also. Congratulations. We are done with acute inflammation. So do you want to solve some MCQs or shall I skip this MCQs or you want to solve it? You want to solve it? Okay, so the first question is in front of you. Can you please give me the answer? What is the correct sequence in extravasation of the WBC? Tell me the sequence for, uh, cellular events. I told you the six cellular events. Now arrange them in a sequence. Can you please arrange them in a sequence for me? You know the six events. Read the four options. If you know the sequence, you can tell me. Yes, what is the correct answer? Okay, so is it margination followed by rolling, adhesion, or transmigration? Or transmigration followed by margination, rolling, adhesion? We can read the options and tell me what is the correct answer. Yes, absolutely right, absolutely right. The correct answer here is the A. So it's margination followed by rolling, followed by adhesion, followed by transmigration. Chemotaxis and phagocytosis is not given here. The next two. So out of the six, four are given. Yes, you all are right. The correct answer is A. The next question is most important for that diapedesis. What is diapedesis? The transmigration. Tell me the receptor responsible for that. Is it PECAM? Is it one of the selectin? Is it integrin? Or mucin-like glycoprotein? What is the correct answer? What is the correct answer, please? Yes, yes, margination and pavementation is same, Metroid. It's same. Yes, you all are right. The correct answer here is PECAM. Ultra important question, PECAM. And if I change the question, instead of diapedesis, it's rolling. Answer will become selectin. Please selectin. And if I change it to adhesion, answer selectin and integrin both. So that's how we can change the question according to, we can change the answer according to the question. So the next question is in front of you. Chemotaxis is mediated by. I told you the chemicals for the chemotaxis, huh? I told you one leukotriene, one interleukin, and two complement. You have to learn the numbers and you have to match it here. Is it histamine? Is it leukotriene B4 and C5a? Is it leukotriene C4 and C3a? Or bradykinin? If you know the numbers, you can answer it very correctly and very easily. So let me help you. Let me help you. So leukotriene is B4. Interleukin is 8. And the two chemicals are C3a and C5a. Now match it correctly. Match it correctly. Among the options, leukotriene B4 is given, and C5a is also given. If you see the option number C, C3a is correct, but leukotriene C4 is not there. So yes, you all are right. The correct answer here is B. Very, very good. Excellent, excellent. And most potent among them is C5a. Okay? So correct answer here is B. We are done with acute inflammation. The next thing is the chronic inflammation. Another 10 minutes, 10 or 15 minutes, we will be done with chapter two also. Inflammation. I have to teach you five important chapters in general. The two will be done. I mean, the first chapter was important cell adaptation, cell injury, cell death, and inflammation was also important. After that, we will come on hemodynamics. After that, we will come on neoplasia. The next, we will come on genetics. And lastly, we will see something on immunopathology, right? So these are the four, five, five, six important topics in general. After that, we have to see hematology, the RBC anemias, the leukemia disorders, okay? So let's finish chronic inflammation quickly. So what is chronic inflammation? Chronic inflammation is a prolonged duration in which inflammation, injury, and attempts to repair takes place simultaneously. Before understanding the chronic inflammation, you have to understand a concept. Let me explain you. You know, where are the blood cells formed in human body? Where does the blood cells formed? The all the blood cells are formed in bone marrow. In the bone marrow, the first cell is always hematopoietic stem cell. This is the first cell. The hematopoietic stem cell. From the hematopoietic stem cell, RBCs are also formed. WBCs, platelets are also formed. There are five types of WBC. What are the five types of WBC? Neutrophil, eosinophil, basophil, monocyte, and lymphocyte. I am interested in monocyte because I am teaching you chronic inflammation now. I am interested in monocyte. So from the hematopoietic stem cell, monoblasts are formed. Monoblasts. And this is the blood vessel. From the monoblast, monocytes are formed. So these monocytes will come in the blood. So in the, in the bone marrow, these are known as monoblasts. In the blood vessel, these are known as monocytes, right? After that, once the monocyte comes out of the blood vessel in the tissue, this is any tissue. Once it comes out of the blood vessel, these are known as macrophages. These are known as macrophages, okay? Macrophages get modified. They get modified. They become, become bigger. Nucleus become bigger. These are known as epithelioid cells. Epithelioid cells are nothing. They are modified macrophages. Epithelioid cells are the modified macrophages, okay? And multiple epithelioid cells fuse with each other, and they form giant cells. They form giant cells. To learn the sequence, I mean to say, so they all are same, one behind the other, they are forming. So tell me the sequence. The first cell is monoblast in the bone marrow. It gave rise to monocyte in the blood. Monocyte in the tissue is known as macrophage. Macrophage become modified, known as epithelioid cell. And epithelioid cell fuses with each other, and they form the giant cell. Give me a thumbs up if you want it. So the same thing is seen here. Monoblast giving rise to monocyte, giving rise to macrophage, giving rise to activated macrophage, known as epithelioid cell. You can see. And epithelioid cell fuses with each other and from the giant cell. The same thing you can see. The bone marrow, hematopoietic stem cell, monoblast, this is monocyte, this is epithelioid cell, okay? Same thing is changed. Let's start chronic inflammation. Are you people with me? Can I tell you the steps of chronic inflammation? Acute inflammation have 11 steps. The five vascular and six cellular. Chronic inflammation have only three steps. It's a small, it's small. It's not as big as acute inflammation. So the chronic inflammation have only three steps. The chronic inflammation is also known as granulomatous inflammation because, uh, because, uh, it is, uh, here the granulomas are formed. I will send you the notes now after the session. Yes, definitely. After the session, I will send you the notes on the group, on the Telegram group of the Pro CM. You will get it, okay? The granulomatous inflammation, also known as chronic inflammation. Here granulomas are formed. The Anderson is granuloma. It's Type 4 hypersensitivity reaction. I will draw all the three steps in one diagram. Everyone here on the screen, see the diagram. This is the antigen entering human body. The specialty of this antigen is it is non-digestible. It is non-degradable. Like the TB bacteria, like the talcum powder, right? They are non-degradable antigen. Once they enter the human body, the first cell they interact is antigen presenting cell. Antigen presenting cell engulf the antigen, try to degrade it, but unable to degrade it because the antigen is non-degradable. So what does antigen presenting cell will do? This antigen presenting cell will take the antigen to the T lymphocyte, helper T lymphocyte, helper TH1 lymphocyte to be specific and precise. Helper TH1 lymphocyte will get activated. The helper TH1 lymphocyte on activating, it will secrete three cytokines on the tip of your tongue. The three cytokines that will lead to formation of granuloma. The first is Interferon gamma. Please learn it. The first is Interferon gamma. Please learn it. Interferon gamma. The second is TNF alpha, okay? And the third is Interleukin. Interleukin 1 and 2. Multiple interleukins are there, right? What does the three cytokines will

Do you now see this? This is a blood vessel. From the blood vessel, they will take one cell out. Let me tell you the name of the cell. Okay, so let's talk about interferon gamma. Interferon gamma takes the monocyte out. Let's take the monocyte out. Monocytes, after coming out, convert into macrophages. Okay, so basically, it causes accumulation of the macrophages. And not only this, it modifies the macrophages, and the macrophages convert into epithelioid cells. Not only this, epithelioid cells fuse with each other and it leads to formation of giant cells. So, macrophage, epithelioid cell, giant cell are all due to interferon gamma.

Coming on to the next, the next is TNF-alpha. What does it do? TNF-alpha takes the fibroblast out. Fibroblast out. And fibroblast will do the collagen formation or fibrosis. And last one, the interleukins. Interleukin. Now, interleukin, they will take the T lymphocyte out. T lymphocyte out. So, they will cause the proliferation of the T lymphocyte.

Now, at last, we have three types of cells. What are the three types of cells due to the three types of cytokines? Can you tell me what are the three types of cells with the three types of cytokines, please? We have epithelioid cells and giant cells because of interferon gamma. We have fibroblast because of TNF-alpha. We have T lymphocyte because of interleukin-1 and 2. Please learn which cytokine is leading to which type of cell.

Now, these cells will arrange themselves. This one, this will form the center. This will form the middle zone, and this will form the outermost zone. And this is known as granuloma. On the next page, I will draw a granuloma for you. You got it? Let me draw a granuloma. In the granuloma, in the center, epithelioid cells are present, which are slipper-shaped like this. Epithelioid cells. Some of them fuse with each other and they form the giant cell. Some of them, not all. So, in the center, there is epithelioid cell and giant cell. It is surrounded by T lymphocyte. It is surrounded by T lymphocyte. And outermost, it is surrounded by fibroblast. Outermost, it is surrounded by fibroblasts like this. And fibroblasts secrete collagen and do the fibrosis. So, most outermost is the fibrosis. This is granuloma. People don't understand what is granuloma. This is the most simplified version of granuloma I've made for you. Say yes.

So, how does a granuloma form? In the granuloma, there are three types of cells. The central epithelioid cells and giant cells are due to interferon gamma. The middle T lymphocytes are due to interleukin-1 and 2. And the outermost fibroblasts are due to TNF-alpha. Are you people there, or everyone is gone? Are you still there? Give me a thumbs up if you got it. This is the diagram of a granuloma. The well-structured diagram. How does a granuloma form? This is chronic inflammation, step by step. You have to tell me what is chronic inflammation. Say yes if you got it. Everyone, just a second. Everyone got it. What is inflammation? The chronic inflammation.

Now, there are two types of granuloma. Sometimes, just a second. You can see just a granuloma. There is no necrosis at the center. It is known as hard tubercle or hard granuloma. Sometimes, at the center, there is caseous necrosis. I told you five types of necrosis. Now, the third type, the caseous necrosis at the center, the cheese-like. It is known as soft granuloma. This is known as soft granuloma. This is how a granuloma is formed. This is chronic inflammation. Can you tell me the steps of the chronic inflammation, please? The first, antigen will come in the human body. The antigen is non-degradable. It will go to APC. APC will try to degrade it but unable to degrade it. APC will take it to Th1 cell, helper Th1 cell. Helper Th1 cell, on stimulation, secretes three cytokines. Name the three cytokines. You cannot miss that. You cannot miss interferon gamma, the most important. Okay. After that, interleukin-1 and 2. Okay. And after that, TNF-alpha. After that, TNF-alpha.

Now, they will take one by one cell from the blood out. The interferon gamma takes the monocyte out and converts them to macrophage. Converts them to epithelioid cell and fuses some of them to form giant cell. Yes. Out. Okay. And I'm sorry, interleukin takes the lymphocyte and TNF-alpha will take the fibroblast out. They will arrange themselves and they form a granuloma. This is the center. This is the middle zone. And this is the outermost zone. Just arrange them. Center, middle, outer. A granuloma is in front of you. Okay. It is as simple as that. Thank you. Thanks for the compliment. It's as simple as that. So, please learn the steps. You know, it should be crystal clear in your mind, step by step. It's Type 4 hypersensitivity. The antigen is poorly digestible. The same thing is shown here. Whatever I have drawn for you, let me show it here also. Can you all see antigen? Yes. It is entering the human body. This cell is APC. APC is capturing it, engulfing it. See, trying to degrade it but unable to degrade it. So, that's why taking it to the next cell. The next cell is what? It is helper Th1. It is not helper Th2. You will get helper Th2 also in your option. It's helper Th1 cell. On stimulation, it will secrete three types of cytokines. The interferon gamma, TNF-alpha. They are taking one by one cell out. And in this way, a granuloma is formed. The granuloma is in front of you. Same thing is written. The antigen is coming. Macrophage, APC is engulfing it. Try to destroy it but unable to destroy it. Fail to digest it. That's why it is taking it to the helper Th1. The helper Th1 will get activated and secrete the three, secrete the three cytokines. The three cytokines will do one by one thing. The interleukins will take the T lymphocyte. Interferon gamma takes the macrophages and converts them into epithelioid cell and giant cell. TNF-alpha takes the fibroblast out. They will rearrange themselves. And this is granuloma. Everyone on the screen. This is granuloma. You can see the central purple colored cells. These are epithelioid cells. Some of them fuse and form the giant cell. The epithelioid cells and the giant cells are due to interferon gamma. I'm repeating again and again. The middle zone, the red colored cells, can you see the middle zone? The red colored cells. These are T lymphocytes. These are due to interleukin-1 and 2. And outermost, you can see the fibroblast, the spindle-shaped fibroblast. These are due to TNF-alpha. We are done. We are done.

Okay, let me tell you the types of the giant cells and pathological inflammation also. How many types of giant cells do you know? This is how granuloma is formed. Now you understand what is acute inflammation. In acute inflammation, in chronic inflammation, acute inflammation, chronic inflammation. In acute inflammation, we have 11 events: the five vascular, the six cellular. I guess you know the sequence. In chronic inflammation, we have only three events. Ah, what are the three events? The first event is the engulfment of the antigen by the APC and unable to destroy. The second is activation of helper Th1 cell. And third is secretion of the three cytokines which is taking one by one cell out and forming them. That's it. But here we have five vascular and six cellular events. You know the detail. So, this is how acute and chronic inflammation differ from each other. You got it?

Now, let me tell you the types of the giant cells. There are four types of giant cells. Foreign body giant cells, Langhans' giant cell, Touton giant cell, and tumor giant cells. Let me explain you all. Giant cells have multiple nuclei. You know, 20 to 100 nuclei in one cell. That is a giant cell. The foreign body. See, first, the foreign body giant cell. In the foreign body, can you see this is a foreign body? Whereas the nucleus, the nucleus is present haphazardly throughout the cytoplasm. There is no sequence. In foreign body, the nucleus is present haphazardly throughout the cytoplasm. Okay? But in Langhans, the nucleus is not haphazard. It is present at the periphery. It is present at the periphery, forming a two-third ring. A two-third ring. It is known as horseshoe ring. Or as the nucleus is present at the poles, the North Pole and the South Pole, right? This is known as Langhans. Now, see the difference. The foreign body and the Langhans. Please appreciate the foreign body and the Langhans. In the foreign body, the nuclei are present haphazardly, right? Right. And in the Langhans, the nucleus is present either at the poles or in the form of the horseshoe ring. Examples are important. TB is a common example of both types. In TB, both type of foreign body as well as Langhans giant cells are seen. It's very important PYQ. Along with TB, in foreign body, the second example you have to learn is sarcoidosis. And along with TB, the second example in Langhans, you have to learn is leprosy. It's leprosy. Please learn the examples. The third is the Touton. In Touton, where is the nucleus? Where is the nucleus? The nucleus is present at the center, not at the periphery. The nucleus, multiple nuclei are forming a ring. Multiple nuclei forming a ring. And not only this, in the cytoplasm, you can see the vacuoles. The vacuoles in the cytoplasm is very important. It's Touton type. Only one example: xanthoma. See the diagram. You can get an image-based question very frequently. See the definitions, I mean, where is the, what is the arrangement of the nucleus, and see the examples in each of them. Yes. Say so. The three types of the giant cells, the three important types. The first is the foreign body, then Langhans, then Touton. I'm coming on the tumor giant cells also. Okay. These three. First, in the foreign body giant cells, the nucleus is scattered throughout the cytoplasm. Example, uh, you have to learn here is the TB, leprosy. Foreign body. The second is the Langhans. I told you reverse, I guess, examples here. In Langhans, the example is TB and sarcoid. Leprosy and sarcoid. I told you reverse, but learn this one. In Langhans, the nucleus is present. The nucleus is present either at the periphery in the form of the horseshoe ring. They are clustered at the two poles, right? And you can see here, please appreciate this diagram and this diagram. See, whereas the nucleus haphazard throughout the cell. See where is the nucleus? In the form of the horseshoeing, two-third ring. This is foreign body. And this one is Langhans. Say yes. Got it? The third one is the Touton. In Touton, the nucleus is present. You can see a real diagram. They are formed. They are present at the center and they are forming a ring. They are forming a ring. See the cytoplasm is vacuolated. Learn example is xanthoma. Learn the example. Foreign body, Langhans, Touton. We will revise. Foreign body: nucleus present haphazard throughout the cytoplasm. Example: TB, example: leprosy. The second, Langhans: the nucleus is present at the periphery, horseshoeing, or at the poles. Example: TB, example: sarcoid. Okay. And Touton: the nucleus is present forming a ring at the center. And this cytoplasm is vacuolated. Never forget. Never, never. The last one, the last type of the giant cells. Sometimes in tumors, they are present, but not important at your level, you know. Read Sternberg cell. You know, in Hodgkin's lymphoma, today only I will teach you. It is a type of giant cell. And other tumors also have that. So, we are done with the various types of the giant cells.

Now, there is a special type of granuloma known as stellate granuloma. What do you mean by stellate? Star. The meaning of the stellate is star. Can you see here? The granuloma, the shape of the granuloma is looking like a star. You know, how does a star? It's like this. The granuloma is like a star. That's why known as stellate. Very commonly asked PYQ in your exam. Learn the two examples of the stellate granuloma. At the tip of your tongue. Star-shaped granuloma. It is the only granuloma in which the center has neutrophils. Normally, granuloma don't have neutrophils. You know, the three types of the cells. The center has epithelioid cells and giant cells, surrounded by T lymphocytes, and outermost is the fibroblast. But it is an exception where the center has the neutrophils. Example is cat scratch disease and LGB lymphogranuloma. You have to learn the two examples. Cat scratch and LGB. These are the two examples where stellate-shaped granulomas are the same.

Lastly, before ending this chapter, let me tell you the examples. How many examples of granuloma do you know? Can you tell me? Milind, Shalini, yeah, anyone, anyone? I cannot read the names. Anyone can you tell me how many examples of granuloma you know? Examples, just examples. I know every one of you will guess more examples. How many examples do you know? I want you to tell me at least 18, 20 examples, right? How many of you know? Okay, let me tell you. There are eight bacterial causes. Can you see the eight bacterial causes of granuloma? There are four fungal. Eight plus four, twelve. And there is one parasitic, thirteen. And there are four miscellaneous. Fourteen, fifteen, sixteen, seventeen, eighteen causes of granuloma. Eighteen. Sarcoid is right. TB, everyone knows. Shalini, apart from that, I am asking. Okay, let me tell you. Learn the eight causes of the bacteria. One is TB, that everyone knows. TB is a granuloma. Granulomatous disease, leprosy, syphilis. You should learn also, right? Granuloma inguinale, brucellosis, cat scratch. My cat scratch disease. Learn the eight: TB, leprosy, syphilis, granuloma inguinale, brucellosis, cat scratch, tularemia, and glanders. If you don't learn it's also okay, but have a look on the examples so that in MCQ, you can pick it up. These are the eight bacteria. Learn the causative organism also. TB is caused by Mycobacterium TB. Leprosy is caused by Mycobacterium leprae. So, these are the eight bacterial causes. There are four fungal causes. One is actinomycosis, blastomycosis, cryptomycosis, coccidioidomycosis. Right? You know the causative organism. Please learn the fungal causes. Parasite, only one parasite. Schistosomiasis. Schistosomiasis. Okay. So, Schistosoma is the parasite. And in miscellaneous, there is sarcoid, Crohn's disease, silicosis, berylliosis, foreign body granuloma. So, please, these are the examples. Yes. In malaria, there is drug granuloma. Absolutely right. It is also a specialized form of granuloma in which Plasmodium falciparum is forming the granuloma. The granuloma is filled with the parasite. Plasmodium. Drug granuloma. Very good. So, we are done with chronic inflammation also. We will solve some MCQs and pack this chapter also.

So, the first question is in front of you. Can anyone try? The first question is in front of you. Can you try, please? What's the correct answer? The macrophages are converted to epithelioid cells by which cytokine? By which cytokine? Is it interleukin-2? Is it interferon gamma? Is it TNF-alpha? And is it TGF-beta? What's the correct answer? So, I told you, macrophages are converted into a specialized epithelioid cell by which cytokine? And then the same cytokine, um, causes the fusion of multiple epithelioid cells and convert them to giant cells. Yes, absolutely right, Nikhil. Everyone else is also right. No, no, no. Answer is not C. What is the correct answer? Yes, the answer is B, not C. It's interferon gamma, which converts the macrophages to epithelioid cells. Interferon gamma. Interferon gamma. Some of you are saying TNF-alpha. No, TNF-alpha is responsible for the fibroblasts. Interferon gamma is there.

The next question is in front of you. The epithelioid cells and multi-nucleated giant cells, these are giant cells of granulomatous inflammation, are derived from basophil or eosinophil or T lymphocyte or monocyte-macrophage. So, what does epithelioid cell and multi-nucleated giant cells are derived from? Have you understood the question? I have told you the entire sequence now. What is the correct answer here? What is the correct answer? Yes, so the epithelioid cells and multi-nucleated giant cells are derived from which cells? From the blood. Which cells is coming out and converted into epithelioid cells and multi-nucleated giant cells? Yes, you all are right. The correct answer here is D. I told you the sequence. In the bone marrow, it's monoblast. Once it goes in the blood, it is known as monocyte. Once it comes out of the blood, it is known as macrophage. Once the macrophage is modified, it is known as epithelioid cell. And epithelioid cells fuse with each other and known as giant cell. So, in the question, they are asking for epithelioid and giant cells. So, basically, they are derived from monocyte and macrophage. You all are right. The correct answer here is D.

Okay, the next question is: Not a characteristic feature of granuloma. Not. Tell me one feature which is not characteristic of granuloma. What is the correct answer? Is it chronic inflammatory infiltrate? Is it epithelioid cells? Is it giant cells? Or is it PMN with fibrinoid necrosis at the center? PMN means neutrophil. What is not seen in granuloma? Tell me, which thing is not seen in granuloma? Very easy question. If you know the composition of granuloma, you can answer it very easily. Which thing is not seen in granuloma? Yes, yes, you all are right. The correct answer is again. The granuloma never contains neutrophil. No, it's not contained. Epithelioid cells are present. Giant cells present. Chronic inflammation is there. But neutrophils are not present. And it's not fibrinoid necrosis. It's caseous necrosis. Both the things are wrong. And PMN is seen only in one type of granuloma, stellate granuloma. That is an exception. Answer is not B. Gasly. Answer is D. Epithelioid cells are present. Now, they are asking not a characteristic feature. So, PMNs are not present, right?

The next question is in front of you. Seen in which two diseases? I told you the two examples. What is the correct answer here? Yes, star-shaped granuloma. Beautiful granuloma. The exceptional granuloma where the center contains the neutrophils. Yes, what is the correct answer? Yes, you all are right. The correct answer here is the cat scratch disease. The correct answer here is the cat scratch disease.

We are done with inflammation also. Till now, we are done with two chapters. The third chapter, hemodynamic, we will start after a break. So, let's continue the session and welcome for this uh session. Uh, so after the break, let's continue the session. Let's start with hemodynamic disorders. Here, basically, I would like to discuss four disorders. I would, I would like to discuss edema, thrombosis, embolism, and shock in detail. And after that, we will move on to the next chapter quickly. Okay? So, let's start with hemodynamic disorders. Let's start with edema. What is edema? How will you define edema? Does anyone know what is edema? What is edema? So, in Hindi, if you say edema, in layman language, it's swelling. Swelling on any portion of the body. Swelling, you know, that is the edema. You know, human body is made up of cells from head to toe. We all are made up of cells. All our organs are made up of cells. The cells are like this in the organ. The space between the cell is known as interstitial space. Can you see the space? The space between the cell is known as interstitial space. Can you say the space? Yes, it's interstitial space. It is all interstitial space. Normally, interstitial spaces are dry. There is no fluid in that. But if fluid accumulates in the interstitial space, it gives rise to edema. Can you see here? It's edema. Edema is the accumulation of the fluid, abnormal and excessive accumulation of the fluid involved in interstitial space. But students have trouble in understanding what is interstitial space. Interstitial space is the space between the cells. If fluid is accumulating here, the fluid is accumulating, it is known as edema. Please learn the definition of the edema.

There is a related term known as effusion. Effusion and edema are same. The pathophysiology is same. Here also, the fluid gets accumulated. The abnormal and excessive fluid accumulation is there. But where? Not in the interstitial space, but in the body cavities. We know that we have few cavities in our body. Like the lungs are surrounded by pleural cavity. You can see the heart is surrounded by pericardial cavity. So, if there is fluid in pleural cavity or pericardial cavity, it is known as effusion. So, can anyone define edema and effusion for me? What is edema and effusion? The pathophysiology of both of them is same. That's why I am taking the two topics together: edema and effusion. So, what is edema? What is effusion? In both of them, abnormal and excessive accumulation of fluid. Here, in edema, in interstitial space. But in effusion, it is accumulated in the cavities, like pleural cavity, pericardial cavity. Whatever cavity. So, edema and effusion. That is the definition.

Now, for understanding the pathophysiology of edema and effusion, you have to understand the Starling's law. The normal fluid exchange. Uh, you know, human body from head to toe. We have cells. We have organs. All the organs receive blood. We all know all the organs receive blood. Why all the organs receive blood? Why blood is required for all the organs? For all the cells? All the tissues? Why? Because of supply of oxygen. Basically, organs do not require blood. Oxygen requires oxygen. Organs require oxygen from the blood, you know. So, let me draw an organ. Imagine this is any organ of the human body. These are the cells of the organ. These are the cells of the organ. This is the blood supply. This is the blood supply. So, this is the pure blood. This is the artery. The pure blood, or oxygenated blood, is coming here. See the arrow. It is coming towards here. Here, exchange takes place, and it converts. This is capillary. And here, it is converted to green. In the vein, it is deoxygenated blood. So, how does oxygenated blood convert into deoxygenated blood? Have you ever thought? Can you tell me how oxygenated blood converts into deoxygenated blood? How does it happen? How does? So, basically, at cellular level, exchange takes place. So, at cellular level, the fluid comes out. Those the exchange. The oxygen is given to the cell, and carbon dioxide is taken from the cell. So, after the exchange, whatever fluid comes out, the same fluid goes back. And that's why the tissue is dry. There is no edema. The tissue is dry. Only for exchange purpose, the fluid is coming out momentarily. The fluid is coming out, doing the exchange, going back. The fluid is coming out, doing the exchange, going back. So, this happens normally, physiologically. At arterial end, fluid comes out. At venous end, fluid goes back in the capillary. So, basically, you can see a capillary. So, basically, there is a capillary. Let me draw a capillary for you. This is a capillary. So, capillary has two ends. This is the arterial end of the capillary. This is the venous end of the capillary. This is a capillary. So, at arterial end, the oxygenated blood enters. And at venous end, the deoxygenated blood takes out. So, what is happening in between? In between, this is happening. The oxygenated blood comes out, does the exchange, and then at venous end, it goes back. Give me a thumbs up if you got this basic concept. So, this is the fluid exchange. We will talk. So, for this fluid exchange, you have to understand the pressure. How does the pressure act? Normally, there are two types of pressure. Let me draw a capillary. There are two types of pressures acting. The one is the hydrostatic pressure. The pressure due to water. It's outward. Look at the arrow. It always outward. It is due to the water. The second is osmotic pressure. It is due to protein. You know, the protein, the albumin present in the blood. It is always inward. Look at the arrow. To learn the basics. Hydrostatic pressure is outward. Osmotic or oncotic pressure is inward. To learn these two things right now. You can tell me the values of hydrostatic and osmotic pressure at the arterial end and at the venous end. Again, this is a capillary. This is a capillary. This is the arterial end. This is the venous end. Please tell me hydrostatic pressure, osmotic pressure here. And please tell me the values of the hydrostatic pressure and osmotic pressure here. Right? Osmotic pressure is always same. It's always 25, 25 mm. 25 mm. It's throughout. There is no problem in that. There is no change in that. Protein is throughout same. Whatever protein present here, the same protein present here. That's why it's always 25. But see the values of the hydrostatic pressure. At arterial end, the hydrostatic pressure is 38. Because water is more. After that, water will leave. So, hydrostatic pressure will fall. Because water is leaving, right? And it is falling. It is falling up to 12 here. It becomes 12 mm. Right? Now, see the change. The change in the hydrostatic pressure. You have to learn the values. Come on. You have to learn the values, right? Hydrostatic is outward. Osmotic is inward. You know the basics. Okay. Now, tell me at arterial end, what is the net? Net, which is more? So, you will see my net is 38 minus 25. Can you do the calculations? Yes, it's 13 mm. 13 mm outward or inward? Which is more? 38 is more or 25 is more? Of course, 38 is more. Hydrostatic is more. So, net 13 is outward. So, with 13 mm, fluid goes out. And do the calculation at the venous end. At the venous end, it's 25 minus 12. Again, it's 13. But this time, it's inward. This time, it's inward. So, with the same 13, the fluid comes back. You got my point? So, basically, at high, at arterial end, you can see 38 minus 25, the fluid is going out with 13 mm. Lose the exchange. By exchange, I mean two things. I mean two things. The fluid is giving oxygen to the cell, taking carbon dioxide from the cell. And after all the exchange, at venous end, it is coming back. So, with 13 mm, it is going out. With 13 mm, it is coming back. So, whatever is going out, it is same coming back. So, there is no balance. There is no balance here. That's where the tissue is dry. After that, at the end, the tissue is, the tissue is dry. You got my point? So, at arterial end, the fluid goes out. At venous end, it is coming back. So, the tissue is dry. The tissue is dry at the end. With 13 mm, the fluid is going out. With the same 13 mm, the fluid is coming in. Give me a thumbs up, everyone. Give me a thumbs up, everyone. Give me a thumbs up. Kindly don't spam. Medical Nepal, please don't spam. Sending the same, same message again and again. Okay. So, this is the thing. Okay. So, with whatever pressure, the values, you have to learn the values. Okay? Now, any change in pressure? If the outward is more, imagine a condition. Outward pressure is more, or inward is less. What will happen? More fluid will come, but less will go. So, what will lead? It will lead to accumulation of the fluid. And accumulation of the fluid is in, is known as edema. The accumulation of the fluid is known as edema. Okay? So, hydrostatic pressure is the outward pressure. Osmotic pressure is the inward pressure. So, osmotic pressure is always 25. But hydrostatic pressure at arterial end is 38. At venous end is 12. You have seen the values. You do the calculation at both. Here also, you do the calculation. Answer is 13 mm. Here, the calculation answer is 13 mm. But this 13 is outward. This 13 is inward. So, there is a balance. Whatever goes out, you can see here, with the same pressure, it is coming in. So, tissue is dry. Insist the word dry. There is no edema. There is no edema. When the edema will occur? Whenever come more and go less. So, there is accumulation of the fluid, right? You will say, ma'am, this is very complicated. Is it really? Means when I, I read it for the first time, now, when I was in second draft, I was really wondering. This is operating in my body constantly. I'm not aware of it. At every moment, whether we are aware or don't aware, this all mechanics is applied in our body. In each and every capillary. This is automatically taking place. We don't have to take care of that. We don't have to take care of that. Like, what is my hydrostatic pressure? What is my osmotic pressure? We don't have to take care of that, right? It is taking place automatically. Okay. So, that is the hydrostatic pressure, osmotic pressure balances take place. Now, what happens when a small change? Just suppose, instead of 13, it is 14. Just suppose, instead of 38, maybe 12. So, what happens? A little bit accumulation. Who does take care of it? So, God has given a backup. The name of the backup is the lymphatic. The name of the backup is the lymphatic. We all have lymphatics. So, whatever a small amount of fluid is accumulated here, now it is taken away by the lymphatic. At the end, the tissue is dry. We don't have edema. I don't have edema. The healthy human don't have edema because God has given this mechanics inside us. This is the precious operating at our capillary. That's why we don't have edema. Even a little bit edema is there, that is taken care of by the lymphatic. So, tell me the causes. So, normally, there is a balance between the outward and the inward pressure. Even after the balance, a small amount of the fluid is there, it is taken care of by the lymphatic. If you got it, let me know. Okay? Okay. If you got it, let me know. Okay? So, this is how normally we don't have edema. This is the reason for that. Now, you tell me the causes of edema. If you have understood this, you can tell me three causes of edema out of why you can tell me from this diagram. Can you tell me? You will say, I'm the first reason, it can be there. Outward pressure is more. It can be the reason. I mean, hydrostatic pressure is more. Oncotic pressure is less. Oncotic pressure is less. Inward is less. So, if outward is more, or inward is less, or both of them, it leads to edema. Yes, agree or do not agree? Outwards, so there is accumulation of fluid. So, increase hydrostatic pressure, decrease osmotic pressure. And the third reason is lymphatic obstruction. Lymphatic, if lymphatics get obstructed, this also leads to edema. So, these are the three main reasons of the edema in front of you. If you understand the Starling's law, there is no need to learn. You can yourself tell me the three, three reasons for the edema. Okay? So, increase hydrostatic pressure, decrease osmotic pressure, and lymphatic obstruction. These are the three main causes of edema. Learn these three. Increase hydrostatic pressure, decrease oncotic, osmotic pressure, oncotic and osmotic is same. And lymphatic obstruction. The fourth one you have to learn, sodium water retention. I will explain. And fifth is increased vascular permeability. In inflammation, we have seen. I will explain. So, there are five causes of edema. Out of which, the three can be understood from the Starling's itself. Okay? Now, let me give you the causes or examples of each of them. Now, the patient, you are a doctor. Now, of course, you are a doctor. And the patient will come to you. Doctor, I'm having swelling. I'm having swelling. Now, the cause of the swelling can be anything. Certain can be any, any part of the body. No, it can be due to increased hydrostatic pressure. It can be due to decreased osmotic pressure. It can be due to lymphatic obstruction. It can be due to sodium and water retention. And it can be due to increased vascular permeability. It can be affecting different organs, different physiology. So, treatment is different. Prognosis is different. So, for patient, it's only swelling. But being a doctor, swelling has all these differentials. So, let me give you the examples of each category. Let me give you the first, increase hydrostatic pressure. Do you know some example of increased hydrostatic pressure edema? There are two examples. The first is the cardiac left heart failure or right heart failure. Let me do right heart failure. Imagine the right ventricle is not pumping. What will happen? Common sense. What will happen? The right ventricle is not pumping. What will happen? The blood will not go ahead in the lungs for the purification. The lungs, the blood will not go ahead. It will go backward. The right ventricle is not pumping. Now, right heart failure. So, blood will go backward. From the right ventricle, it will go to the right auricle. From the right auricle, it will go to SVC, IVC. From SVC, IVC, it will go to all organs, all organs' veins. So, more blood, more blood is going because of the backward flow. More blood means more water. More water means more hydrostatic pressure. So, this is the reason. This is the reason. So, heart failure can be the reason. Or second, postural edema. Especially seen in the persons who are standing. Like traffic policemen and all. So, you can see the person is standing. So, you know, gravity is operating all the time. Newton has given gravity. You know, he discovered gravity, I mean. So, gravity is operating all the time. So, because of the gravity, most of the blood is present in the leg veins. Means, so, out of five liters of the blood in the body, most of the blood is in the leg veins because of the gravity. More blood means more water. More water means more hydrostatic pressure. So, this person will have edema of the legs and the foot. So, this is known as postural edema. To learn two examples. Cardiac edema and postural edema are due to increased hydrostatic pressure. Give me a thumbs up if you got it. Everything is very conceptual. If you understand now, there is nothing to learn in pathology. Just understand it. It will be forever, you know. And it will be like fun. Okay? So, please learn. Please learn the two things. The cardiac edema and the postural edema are due to increased hydrostatic pressure. You have seen this diagram. You can see right heart failure. At the backward pressure, more blood, more water, more hydrostatic pressure, leading to edema. Such edema in all organs is due to heart failure. It's hydrostatic pressure. And edema in the person who is standing. Not only traffic havaldar, only, uh, all the persons whose job is like more and more standing. Because of the standing, because of the gravity, more blood is in the leg veins. More blood, more water, more hydrostatic pressure, leading to edema, right?

That the second cause of the edema is decrease osmotic pressure. Decrease osmotic pressure means due to decreased protein content. The protein content is less. Decrease osmotic pressure is decreased protein content. Which protein? The main protein here is the albumin. The main protein here is the albumin. And albumin is the main protein. Okay? The main protein here is the albumin. Uh, we have albumin also, globulin also. But when, when total protein, what's the normal protein in our blood? Normal protein is six to eight gram per deciliter. You, me, all healthy individuals have this level. If it is below five, it will lead to edema. Please learn the values. If it is below five gram per deciliter, it will literally remind. Main protein which leads to edema, the decrease is the albumin. Give me the causes. Examples from where the protein comes in the blood? Blood vessel. Simple question. Simple answer. Do you know from where protein comes in the blood? Osama, Shalini, Kuldeep, anyone? Do you know from where protein comes in the blood? There are two sources. Number one, whatever protein we eat in the diet. Do you eat protein? Of course. The pulses, soya bean, egg, meat, whatever we eat, veg, non-veg, contains protein. So, the protein is absorbed. And from the GIT, it is coming. Number one. Number two, liver also synthesizes protein. So, it is coming from the liver. So, here it is coming by absorption. Here it is coming by synthesis. Okay? In the blood, it is coming. Thus, protein excreted in the urine via kidney? No. Normal human don't have protein in the urine. Normally, healthy individual don't excrete it. Don't excrete it. Now, there can be three causes for fall of protein in the blood. Either the absorption is less. There is problem in the intestine, like malabsorption. Or the synthesis is less. There is problem in the liver, like cirrhosis. End-stage disease or cirrhosis. Or absorption is normal, synthesis is normal, but the excretion is more. Right? The kidney, kidneys are defective. In the kidney, there is glomerular nephritis or some disease. Nephrotic syndrome is there, leading to more and more excretion. So, there can be three causes. The three causes of decrease oncotic pressure. You know, in malabsorption, patients have edema. In liver cirrhosis, patients have edema. In glomerulonephritis, nephrotic syndrome, patients have edema. But the reason for all these three edema is same: decrease oncotic pressure. Give me a thumbs up if you got it. So, patient will come to you. Doctor, I am having edema. So, you have to look for the albumin level, protein level. If the protein level is low, there can be three organ problems. Problem in the kidney, problem in the liver, or problem in the intestine. So, you have to look for that. For liver, you will do LFT. You will do imaging. For kidney, you will do RFT and imaging. For intestine, you will do endoscopy. You will do biopsy. You can do some imaging, whatever. So, based on that, you will make the diagnosis. You will treat the disease. So, for patient, it's very simple swelling. But being a doctor, there are multiple differentials. You got it? Say yes. So, there are three reasons for decrease, decrease oncotic pressure or decrease protein. Number one, problem in the intestine, decrease absorption, that is malabsorption. There is problem in the synthesis, decreased synthesis, that is liver disease or cirrhosis. Or increased excretion, problem in the kidney, that is nephrotic syndrome. You got it? Everything is conceptual. If you get it.

So, you can see, decrease absorption, decrease synthesis, or increase excretion. The three causes of decrease oncotic pressure leading to edema. Coming on the third, third cause is the lymphatic obstruction. What do you mean by lymphatic obstruction? Can you give me the example when lymphatic obstruction leads to edema? At least give one example. At least give one important example of lymphedema. The edema due to lymphatic obstruction is lymphedema. Why God has given us lymphatics? The lymphatics are the backup. Now, I told you, right? Imagine a lady is coming to you. Doctor, I am having a lump in the breast. A lump in the breast. Okay? So, you are doing the biopsy. And it's a cancer. It's malignant cancer, not benign one. It's malignant. So, what is the treatment? Of course, the treatment is surgery. You will ask the lady to get it operated. It's a malignancy. It can do metastasis. So, in operation, we don't remove only cancer. We remove the axillary lymphatics also, right? Because these are the regional lymphatics. And tumor can spread via the lymphatics, you know that. Every teacher neoplish also, right? So, we will remove the tumor. We will do the lumpectomy, mastectomy. And we will remove the lymphatics also. It is necessary to prevent the metastases. But these were not vestigial organs. The lymphatics. God has given the lymphatics as a backup. So, after the surgery, this lady will present like this. Edema of the of that particular limb, right or left. Edema of that lymph. So, it is the breast surgery with axillary lymph node removal. It is the post-surgery morbidity. So, if we don't do it, the patient will have metastasis. And if we are doing it, the patient is having lifelong morbidity. There is the most common example of lymphedema. Number one. Number two, there is a parasite known as Wuchereria bancrofti. The name of the parasite. It's a nematode. Okay? What does it do? It blocks the lymphatic. The adult form lives in the lymphatic. Can you see the worm? The male and the female worm. They are blocking the lymphatic. Once the lymphatics are present, but they are blocked, they are non-functional. It leads to edema of the leg. It is known as elephantiasis. You see the leg is looking like an elephant. That's why known as elephantiasis. Elephantiasis, got it? And third is Milroy's disease. You know, congenital. God has given the de facto lymphatics or absent lymphatics. It is Milroy's disease. We will learn the three examples. Removal of the axillary lymph node after breast cancer, obstructing the lymphatics, known as elephantiasis. And number three, Milroy's disease, hereditary lymphedema. You got it? So, these are the three examples.

The fourth cause is the sodium water retention. So, you know, sodium, wherever there is sodium, there is water. So, due to any reason, either due to renal failure or due to heart failure, there is sodium water retention in the body. And all the pressures are normal. Hydrostatic pressure is normal. Oncotic pressure is normal. Still, the patient can have edema. And this is due to sodium water retention. Okay? And last is increased capillary permeability. Have I told you this diagram in, in inflammation chapter? You can see the blood vessel here. The endothelial lining is continuous. Okay? The endothelial lining is continuous. You can see the blood vessel here. Here also, see the blood vessel. But here, the endothelium lining is not continuous. There are gaps in between. See the gaps. The gaps are present in between. So, I told you when the endothelial lining is discontinuous and the gaps are present, the gaps are known as increased vascular permeability. When the endothelial lining is continuous, only fluid goes out. But when the gaps are present, along with the fluid, protein also goes out. So, this edema is exudative. Basically, it's pus. It's acute edema. It's acute edema. Right? So, whenever there is the inflammation, I told you the five vascular events. Now, the fourth event is the increased vascular permeability that leads to exudate type of edema. Now, learn two things. The edema can be generalized throughout the body. Throughout the body. It is known as anasarca. Anasarca is throughout the body edema. And it can be focal, localized. Mosquito bite or an insect bite. So, it can be focal. It can be generalized. So, these are the five causes of the edema. Can you please enumerate? Can you please enumerate? Increase hydrostatic pressure, lymphatic obstruction, sodium retention, and inflammation or increase vascular permeability. Learn the examples. The examples are important. So, increase hydrostatic pressure is cardiac failure, right heart failure, leading to edema of all organs. Postural edema, traffic policemen. Okay? Decrease osmotic pressure, three causes: decrease absorption from the intestine, decrease synthesis from the liver, and increase excretion in the kidney. Right? Lymphatic obstruction, again, three examples: after breast surgery, axillary lymph node removal, leading to elephantiasis, and Milroy's disease. Okay? Sodium retention, heart failure, renal failure. And inflammation, May, acute inflammation, basically. Acute inflammation.

Everyone, give me a thumbs up. At least I tried giving you the causes of the edema. These are the causes as well as pathogenesis of the edema. Yes, yes. Can we go ahead? Can we go ahead? How many types of edemas are there? How many of you know the meaning of transudate, exudate? Diagram is in front of you. See, everyone here. Concentrate here on your gadgets. See the lining of the endothelium. It's continuous. It's continuous here. It's continuous. And the pressure is equal. Outward pressure is equal to inward pressure. No edema. See the background is clean. See the background? It's clean. There is no edema. See the second diagram. Here also, the lining is continuous. You will say, "Mum, the lining is continuous here also." I cannot see the gap. Yes, the lining is continuous. There is no problem. But see this arrow is thicker than that arrow. So, I mean to say, the outward pressure is more as compared to inward pressure. Either the outward pressure increases, or the inward decreases. So, only fluid comes out. Can you see the background? In the background, appreciate the blue color. Fluid is accumulating in the background. The only fluid is coming out. And this edema is known as transudate edema. Which contains only fluid. Only fluid. See the third diagram. In the third diagram, this is endothelial cell. This is endothelial cell. This is now you can see the gaps between them. Oh, there are gaps. From these gaps, the protein will come out. The cells will come out. Protein and cells. So, along with fluid, there is protein and there is cell. This edema is known as exudate edema. The exudate edema. You got it? So, transudate edema, can I say transudate is low protein or low cell? So, can I say transudate edema's protein poor, cell poor? No protein, no cell. But exudate is protein rich, cell rich. Because the gaps are present. Can I say this is non-inflammatory edema? It doesn't occur in inflammation. And this is inflammatory edema. This occurs in inflammation because of increased vascular permeability, the gap formation. Say yes. So, as I told you, here protein is less, cells are less. Here protein is high, cells are high. Since your protein and cells are less, specific gravity is also less. Since protein and cells are high, the specific gravity is also high. Okay? And LDH is also low. LDH is also low. And here, LDH is also high. So, four things are low: protein, cell, specific gravity, and LDH. And all four things are high. The only thing which is opposite is the pH. Here, pH is high. And here, pH is low. You have to learn. Okay? So, that you have to learn the differences between transudate and exudate. Does anyone have any difficulty in?

Understanding the transudate and exudate. Translated, accelerate the two types of edema. Can you please tell me so your protein is less, cells are less, specific gravity is less, and LDH is less? All the three, four things are more. Okay, but here pH is more than 7.3. Is it discon? I guess it is connected now. I guess it is connected now. Okay, so increased accumulation of fluid in the interstitial space is known as: Is it edema, effusion, transudate, or exudate? What is the correct answer? Please highlight the word "interstitial space." Increased accumulation of fluid in the interstitial spaces is known as what? Very good, you all are right, absolutely right, Shalini. What about others? Please answer. Is everyone answering it? The correct answer here is... Okay, very good, very good. If I change the question, instead of "interstitial space," I say the word "cavities," what is their answer now? Usama, would you like to change the answer? Dr. Parveen, Islam, anyone? Would you like to change the answer now? Yes, in this case, the answer will change. Instead of edema, we will say effusion. So, I told you the definition very correctly.

The next question: Edema occurs when plasma protein level is below what? What's the normal plasma protein in blood? Six to eight grams per deciliter. Six to eight grams per deciliter. When it is below what, it will lead to edema? When it is below what? I told you the value. When it is below 5. When it is below 5, then it will lead to edema. So, correct answer is 5. Correct answer is 5. Yes.

So, coming to the next question: All of the following are included in the pathogenesis of edema except. Don't miss the word "except." I told you the five causes of edema: decrease hydrostatic pressure. Is it a cause or does it not? Decrease osmotic pressure, plasma osmotic pressure, lymphatic obstruction, and increased vascular permeability. So, tell me which is not a cause of edema. Not, I'm asking not. You people are getting confused. You people are getting... Why are you saying C? You are saying C for which option? Easily. Yes, the correct answer is A. It is decrease. It is not never decrease osmotic pressure. The increase, uh, I'm sorry, increase hydrostatic pressure leads to edema, not decrease. So, incorrect among them is A. The remaining three are correct. And now, decrease osmotic pressure also leads to edema. Lymphatic obstruction also leads to edema. And increased vascular permeability also leads to edema. The correct answer is A. Okay, you're getting confused, I guess. The question is about "except." Got it? Can I move ahead?

Yes, moving to the next topic: Thrombosis. What is thrombosis? Can I move to the next topic? What is thrombosis? Imagine I have a cut here. What will happen? Of course, I will bleed. Everyone bleeds. Whenever we have an injury at any portion of the body, we start bleeding. How long do we bleed? We bleed for the next few seconds, same, next few minutes. After that, the bleeding stops automatically. Why does the bleeding stop automatically? Because of the clot formation. So, here, at the site of the injury, the blood vessel is sealed. There is injury in the blood vessel. It is sealed with the help of a clot. So, let me draw a diagram for you. Imagine this is the blood vessel, and this is the site of the injury. Okay, here the endothelial lining is continuous, and here it is discontinuous. So, this is the site of the injury. This is the site of the injury. You can see. Imagine. So, here the person is bleeding. Whenever we have injury, so first the platelet will come and form a clot here, the primary clot. The platelet will seal it, stop the bleeding temporarily, and after that, it is stabilized by fibrin by coagulation cascade, the fibrin. So, secondary clot is formed. So, basically, this site is sealed, and patients stop bleeding. You will say, "Yes, ma'am, we all know that this is known as clotting." This is known as clotting, right? So, this is the normal physiological clotting. It is not a disease. It is known as hemostasis. Hemo means blood, stasis means stoppage. Stasis, stasis means stoppage. So, bleeding stoppage. Whenever we have a cut anywhere, we don't think, we see, okay, we just press it for a few seconds, it stops automatically because it is a physiological phenomenon given by God in all human bodies. It is hemostasis. It is not a disease. It is a useful physiological phenomenon.

Tables in mum? Yes, we can understand hemostasis. But how does you are teaching us thrombosis right now? Now, how does thrombus? Thrombosis is related to this? Why are you teaching this here? Because thrombus is the same as that hemostasis without injury. If the same thing occurs without injury, itself is a disease. If it occurs after injury, it's physiological, it's useful. But if it occurs with just, imagine I don't have injury anywhere on the body, and still inside my blood vessel, small, small clots are formed. They are not known as clots now. They are known as thrombus because they are without injury. They are not useful. They are harmful. They are causing obstruction in the flow of the blood. Now, this, um, it's this is a blood vessel, artery supplying to some organ now. So, this organ can have ischemia because of the obstructed blood flow. So, it is harmful to have thrombus. So, with injury, it is known as hemostasis. It's physiological, it's useful. Without injury, clotting is known as thrombus, and it's harmful, and it's a disease. Say yes if you got it. Yes, I am coming on with children, but you got it. What is thrombus? So, thrombus is the clotting without injury. In short, what is thrombus? It's the clotting, same as that clotting, like hemostasis, but the glitch here, the glitch to be taken here is without injury. Without it is occurring without injury in an intact blood vessel. Okay, the formation of a blood clot in an unruptured blood vessel. And rupture means uninjured. So, that is the glitch you have to take here. That is thrombosis. It is the pathological form of intravascular fibrin. Platelet. Two things are there now in the clot. First, platelet come and they form a clot. Then it is stabilized by a thread-like material that is fibrin. So, it is also made up of the same thing. It is also made up of the same thing, and it is known as thrombus. It is known as thrombus. You can see in the intact blood vessel, how does the clot is forming in the intact blood vessel? You can see these are the platelets. You can see these are the RBCs. These are the platelets, and the thread-like material. Can you see the thread-like material? It is fibrin. So, this is the thrombus. This is a thrombus. So, the same thing is written: hemostasis, thrombosis. Hemostasis after the injury, thrombosis without injury. Right? So, please understand the differences. One is hemostasis, one is thrombus. This is after injury, this is without injury. This is useful, physiological. This is harmful, causing ischemia. Everyone say yes. Everyone say yes. Got it? Got it.

Coming on the pathophysiology now. You may be thinking, why without injury, the clot is formed? Why without injury, the clot is formed? There can be three causes which are known as Virchow's Triad. The three causes. What are the three causes? So, imagine this is the blood vessel. This is the endothelial lining of the blood vessel. Endothelial lining is injured by some toxin or something present in the blood. And easily, but there is no bleeding. Means endothelial lining is injured, but bleeding is not there. Still, the blood vessel is intact. So, because of the endothelial lining injury, the clot can be formed here in an intact blood vessel, which is not bleeding. Now, it is not hemostasis. It is thrombus. So, the first cause is the endothelial injury. Say yes. The first cause is endothelial injury. Number two, I said you, this is the blood vessel. I told you Bernoulli's Theorem. Now, I guess I told you now in the last, first session. What is Bernoulli's Theorem? The the heavy thing travels at the center. So, basically, the WBC and the RBC travel at the center, and in the periphery, there is plasma. The WBC, RBC is at the center, and the periphery, there is plasma. And this blood flow is known as axial blood flow. Axial blood flow. So, till the blood is flowing in all of us, the heart is pumping continuously, the blood is flowing continuously. It is never stopping. The blood is flowing continuously. This is axial blood flow. Imagine for a few seconds, the blood's blood flow stopped due to any reason. There is stasis of the blood, like in inflammation. The last step was stasis. So, blood is not flowing into stasis. So, due to the gravity, the RBC will fall down. The platelet will fall down. You know, the revolution will fall down. You know, because of the gravity, and they form a clot there. They form a clot there. So, stasis can lead to formation of clot. Altered blood flow, that is stasis or turbulence. The second cause. And third cause, hypercoagulability. Now, in a blood, in a blood, God has given two things: the procoagulant and the anticoagulant. What are procoagulant? They promote coagulation, they cause coagulation. Anticoagulation coagulants inhibit coagulation. So, basically, we all have a balance. We all have a balance. In my blood, procoagulants are equal to anticoagulants. So, they neutralize each other. They balance each other. But due to any condition, if procoagulants are more and anticoagulants are less, so such a blood is known as hypercoagulable blood. Hypercoagulable blood, and that leads to clot formation even without injury. So, the third cause is the hypercoagulability. So, can you tell me the three causes? Please, Osama, Sage, Deep, Mohit, Debanjan, anyone? Can you tell me the three causes of the thrombosis? The Virchow's Triad. What are the three causes? The first one is the endothelial injury. Okay. The second one is the stasis of the blood or, um, the stasis or the turbulence of the blood. And the third one is the, what is the third one? I told you, hypercoagulability. Hypercoagulatory. Please write down the three causes. Ultra important PYQ. The three causes of the thrombus. Okay.

Now, coming on the types of the thrombus. Ultra important. Where does the thrombosis present? If the thrombus is present in the artery or vein, both are intact. No injury. No injury. Where is the thrombus? So, if the thrombus is formed in the artery, it's arterial thrombus. It is formed in the vein, it's venous thrombus. Both are intact. There is no injury. Without injury, it is forming. So, basically, it is of two types: arterial thrombus, venous thrombus. There are two types of thrombi: arterial and venous. See this diagram. I have drawn this diagram for you. Everyone here on the screen, can you see? This is an artery. See the blood flow. See the direction of the blood flow. Can you see? This is a vein. See the direction of the blood flow. Can you see? The arterial thrombus, I have drawn yellow color intentionally. I have drawn yellow colored. It is white. Thrombocyte is having more platelet, that's why it is yellow, ocean color, yellowish or whitish. But the venous thrombus contains more RBC, that's why it's red in color. So, firstly, the arterial one is the white. The venous one is the red. Please learn. Please learn the color because of the composition. The arterial one, can you see here? It's partially obstructing. And the venous one is completely obstructing. Can you see here? The venous one is completely obstructing. The arterial one is partially obstructing. The venous one is completely obstructing. So, partial obstruction is known as mural. Complete obstruction is known as occlusive. So, arterial ones are partially obstructive. The venous ones are complete obstructive. Please learn that. The third one, in the arterial one, the lines of Zahn are present. Alternate light, dark, light, dark, light, dark lines are present. These are known as lines of Zahn. In the venous one, the lines of Zahn are absent. The lines of Zahn are absent. There are no lines of Zahn in the venous one. They are absent. Okay. In the arterial one, okay, you tell me, what does the artery do? It supplies pure blood to this organ. Now, because of the thrombus, the limited blood is coming to the organ. It is leading to ischemia. This is the effect of arterial thrombus. But what does a vein do? It carries impure blood away. The pure blood is coming, but impure is not leaving. Impure blood is accumulating in the organ because of the venous thrombus, and it will lead to edema of the organ. It will lead to edema of the organ. Can you tell me the arterial and the venous one? Arterial and venous one, more difference. One more difference, please. See the differences. One more difference. So, the last difference you can see here. Let me show you here. This is the point of origin of arterial thrombus. After that, where does it grow? See, it is growing in opposite direction as compared to blood flow. And venous one, it is growing in the same direction as compared to blood flow. So, arterial one is growing in retrograde direction, opposite direction to that of blood flow. And venous one, growing in the same direction, antegrade direction of the blood flow. Give me a thumbs up if you got it. Give me a thumbs up. You got it? Yes. Or some are lines of Zahn are alternate light or dark bands. Can you see here? Alternate light, dark. So, these are the, the dark bands are made up of RBC, and the light bands are made up of platelet and fibrin. So, basically, the RBC is then platelet, fibrin, then RBC, then platelet, fibrin. So, it occurs in arterial thrombus. But in venous thrombus, they all are mixed match, and basically there are more RBCs, that's why it is red in color. So, that's why lines of Zahn are absent in venous one. But in arterial one, the alternate light, dark, light, dark, light, dark bands are present. Let me show you. So, you can see, Osama, this is a thrombus. So, here also you can see the alternate light, dark, light, dark. And if I cut and make a slide, you can see the light, dark, light, dark. These are known as lines of Zahn, which are present in arterial but not in venous. You got it? Say yes or no. You got it? If you got it, can we go ahead?

Okay, so yes, so these are the differences between arterial and venous. Better to understand them in a diagram. So, don't learn the table, students used to learn the table like arterial, venous, this, that. Why you are learning? Come on, have a look on the diagram. Everything is crystal clear. Everything is crystal clear. Only here, okay, see the arterial thrombus. See the venous thrombus. Can you see the arterial one is white color, yellow color? Venous one is red color. You know the reason. Okay. Arterial one is partially obstructing. The venous one is completely obstructing. The arterial one, the lines of Zahn are present. In the venous one, the lines of Zahn are absent. Most important point: arterial one leads to ischemia. Why? You are learning. Come on. If the arterial blood supply is obstructed, what the organ will have? Organ will have ischemia, of course. And if the venous one is obstructed, the vein is obstructed, so impure blood will not leave, and accumulate in the organ leading to edema. Arterial one growing in opposite direction, retrograde. The venous one growing in the same direction, antegrade. So, please have a look on the diagram and enumerate, enumerate the differences. Don't try to learn that. So, these are the differences between arterial and venous. We are done with thrombosis. In the thrombosis, I told you the causes and the two types of the thrombosis. The causes of the thrombus, we have seen the Virchow's Triad, and the two types, arterial and venous. Everyone give me a thumbs up. Can I move it? Can we go ahead?

Yes, so this is the first question in front of you. Can you please tell me the answer? The most common source of embolism. What is the most common source of embolism? Please. Is it DVT, trauma, infection, or surgery? The most common cause of embolism. I told you, 90% of the emboli are thromboemboli. They are made up of thrombus. Once the thrombus gets detached, it leads to embolism. The 90% of them. So, what is the most common cause of thromboembolism? Now, I had given you a clue. Can you tell me the answer? Yes, DVT. Because in deep veins, most common site of thrombus is the deep vein, and this is the origin of the embolus. Yes.

The next question is in front of you. Typical case scenario question. Please pay attention. Take the clues. There is a 58-year-old man having a road traffic accident, okay? Came to the hospital. He had multiple fractures in the lower limb, in the ribs, in the lung contusion. Ultimately, he succumbed to his injury. He's dead. We cannot save him. Unfortunately, the person is dead. Now, at autopsy, the lung is showing the following slide. Typical slide given to you. You can see something in the lung. Can you see? What are these? These cells, white colored cells, cluster of white cells. These are adipocytes in the lung. You can see the fat. The fat in the lung. What is the correct answer? Yes, it's a typical case of fat embolism. So, see the slide also. It's a, you can do the special stains also, the Sudan black, the oil red, I have told you. So, sometimes you can get the question on the special stain. So, it can be a typical case scenario-based question. It can be image-based question, you know, it can be handy question like if you know the concept, you can make it out. We are done. We are done.

The last thing here, I will tell you the shock. Right? So, hemodynamics is also done. And after that, we will move on the last topic, neoplasia, genetics, and neoplasia. Two more are left in the general. Okay, you want me to take himata also today? Now, you want me to take himata also after general? I have to take himata also, right? Okay, okay. So, let's continue with shock. Let's continue with shock. Does anyone know what is shock? What is shock? How you will define shock? Don't read here. Just tell me what is shock. If shock is the disease of one organ? No, it is a disease of multiple organs. In shock, multiple organ failure takes place in human body. From head to toe, we are supplied with multiple organs made up of multiple cells. We require blood supply to all these cells. Why? Why all the cells require blood? Why all the cells are requiring blood? Can you tell me the answer? Why all the cells require blood? Because it contains oxygen. All the cells require pure oxygen. That's why all the cells. So, this is known as perfusion, you know. So, all organs require perfusion because of the oxygen. If oxygen is not supplied, the organs or the cells will undergo ischemia and infarction. So, ischemia and infarction can be there. So, uh, if all the organs simultaneously do not get the perfusion, if all the organs, not only one organ, all the organs of human body do not get proper perfusion, do not get proper blood supply, what will happen? First, the cells will start dying. The cells will start dying. Then, first cells will not function. It will show ischemia. Then cell death. Then particular organ death. Then multiple organ death. Then death of the person. So, it's a syndrome. One by one. So, if all the organs do not receive enough perfusion of the blood, the pure blood, first the cells will not function of multiple organs. Then cell death of multiple organs. Then organ death of multiple organs. Multiple organ failure, leading to the death of the person. This is shock. This is shock. It's a syndrome. One by one, the things take place. It's a syndrome. So, for cell death, then organ failure, then multiple organ failure, and then the death of the person. This is shock. Now, you may be thinking, why multiple organs are not receiving the blood at the same time? So, there are three types of shock having three different reasons: the hypovolemic, cardiogenic shock, septic shock. I request all my dear students to make a comparative table between them once for all: hypovolemic shock, cardiogenic shock, septic shock. So, I will tell you the causes of each of them, pathogenesis, how each of them leads to decreased perfusion, and the symptoms of each of them. So, treatment of each of them is different, you know. So, let's start with the first shock, hypovolemic shock. As the name indicates, okay, how many liters of blood you have in your body? All the adult humans, they have five liters of blood. I am having five liters of blood. You are having. All the adults have approx five liters of blood in our body. That is our fluid. That is our fluid balance, right? We all know we have five liters of fluid in our body, five liters of blood in our body, right? If you imagine someone is having some accident, road traffic accident, or there is a major surgery, or there is abundant vomiting, or there is diarrhea, or there is burns. In burns, everything evaporates. The use of the diuretics, right? Uh, okay. You can see what is the pathogenesis. If the blood in the body is less. See, in hypovolemic shock, due to the hemorrhage, road traffic accident, surgery, trauma, burns.

So, all these reasons lead to less than five liters of blood in the body. So, less than five liters of blood. So, bloody night. So, all the organs are receiving less blood. If I am having enough blood, I am having five liters, so my five liters is distributed. My brain is getting, my heart is getting, my kidneys, my liver, my all organs are receiving a proportion of five liters. That is fixed, and that is sufficient for them. But if, if some person is having less than five liters of blood, it can be four liters, three liters, two liters, depending on the blood loss, how much, right? So, whatever blood is left, so all the organs are receiving less blood. All the organs. And that shock is known as hypovolemic shock. So, all the organs undergo multiple organ failure. That will be known as hypovolemic shock. So, the name itself indicates hypovolemic. Hypo means less, volumic means less volume of the blood. So, out of the three types of the shock, this is the most common type of the shock. Hypovolemic shock is the most common type of the shock. It is the most common type of the shock in which there is decreased volume of the blood. What are the causes? It can be acute hemorrhage. It can be, you know, acute image like RTA, road traffic accident, surgery, dehydration, vomiting, diarrhea, burns. In burns, everything evaporates. The use of the diuretics, right? Uh, okay. You can see what is the pathogenesis. If the blood in the body is less. See, in hypovolemic shock, due to the hemorrhage, road traffic accident, surgery, trauma, burns.

Dehydration, vomiting, diarrhea. Less blood is present. Less blood. Matlab, less venous return. Less venous return means less cardiac output. Less cardiac output, less blood will go into the aorta. Less blood will be distributed to all the organs. All the organs have anoxia, and that will lead to shock.

Sure, give me a thumbs up if you got it. Give me a thumbs up if you want it. Okay, what is hypervolemia? What should I say about hypervolemia? Tej deep, it is related to hypovolemia, not hypervolemia. Hypovolemia is less than five liters of blood leading to shock. Okay, now what will be the symptoms? As soon as the blood supply to all the organs is less, the heart will try to compensate and increase the rate, right? So all the organs are not receiving enough blood, so the heart will try to compensate by increasing the heart rate, I mean, increasing the pumping, increasing the rate of the pumping. So heart rate is more, that is tachycardia. Since there is less blood in all the arteries, it will lead to low blood pressure. So blood pressure is less than 120 by 80, and heart rate is more than 100. So tachycardia with hypotension, the typical, typical two things which occurs in the typical two symptoms in shock.

So all the organs are receiving less blood. Kidney also receives less, less blood. It will lead to oliguria. The brain also receives less blood. It is leading to confusion and lethargic, and you know, coma and death can be there. That is hypovolemic shock. Got it? Now, it is of three types. How much blood is lost? You, you told me that there is five liters of blood. So if 20% is lost, 20% is only one liter. 20 to 40% means two liters, and more than two liters. How much it is lost? If only one liter or less than one liter has lost, its height might be hypovolemic shock stage one. If two liters is lost, stage two. If more than two liters is lost, stage three. Say yes if you got it. That is hypovolemic shock.

That is the first cause. Second, cardiogenic shock. Here normally five liters of blood is present. You will see then why organs are receiving less blood because the heart is not pumping. The left ventricle is not pumping. So there is some problem in the muscle of the left ventricle, you know, the muscle of the left ventricle. The muscle of the left ventricle is ischemic, it is cardiomyopathy, or some problem is there, so that it is not pumping. So although five liters of blood, five liters of blood is present, but since it is not pumping properly, it is not ejecting the blood into the aorta. So all the organs are receiving less blood. This is known as cardiogenic shock. Here the problem is in the heart. So here the blood is normal, but the problem is in the pumping of the heart, inadequate pumping of the heart. Okay, so when at least 40% of the left ventricle is destroyed by some disease, then inadequate pumping takes place, right? It can be MI, cardiomyopathy, rupture of the heart, cardiac arrhythmia, cardiac tamponade. It can be any cause. The basic problem is in the heart. That is known as circulatory failure. But here the volume is normal. It's normal volumic shock. It's a shock with five liters of blood. The blood is five liters, in contrast to hypovolemic shock. Still, the patient is in shock. The problem is in the circulation. I mean, the problem is in the heart. Say yes.

So in hypovolemic shock, the blood was less. Total blood is less than five liters. That's why cardiac output was less. In cardiogenic shock, blood is five liters, normal five liters, but since the heart is not pumping, that's why cardiac output is less. So cardiac output is ultimately less here also, here also cardiac output is less. Here it is less because blood is less, it is not five liters, that's why it is there. But left ventricle cannot eject it. Cardiac output is less. Less blood will go into the aorta. All the organs receive less blood, less oxygen, leading to anoxia, leading to shock. Say yes, say yes, got it.

So here the symptoms are same. Here also exactly same symptoms are there. All the organs will receive less blood. Kidney receives less blood, having oliguria and anuria. Brain receives less blood, again confusion, lethargy, coma, death. But one symptom is additional. Can you tell me what is the additional symptom here which was not there in hypovolemic shock? Here also tachycardia is there, hypertension is there. Here backward flow of the blood is there. That is not moving forward. The left ventricle is not pumping, so blood is not moving forward. It is going backward. So left ventricle, the blood is going backward from left ventricle to left atrium, from left atrium to pulmonary vein, and from pulmonary vein to the lungs. It is accumulating in the lungs. It is accumulating in the lungs and leading to dyspnea, pulmonary edema, leading to dyspnea. So dyspnea has an additional symptom here which was not there in uh, the dyspnea was not there in hypovolemic shock. But dyspnea is there in this shock, cardiogenic shock.

The last and most difficult shock to understand is people awaken or still there. Kindly interact in between, right? Don't keep the session as monotonous. So Shalini is awakened. What about others? Others are sleeping or listening to me? Ah, are you there? Okay, give me a thumbs up everyone. Give me a thumbs up. Can we go ahead? The third type of shock, the septic shock. Okay, the third type of shock is septic shock. Here due to the bacterial infection, the gram-positive or the gram-negative bacteria leads to the shock. How infection can lead to shock? How infections can lead to shock? I'm asking you, how does infection lead to shock? How does the infection lead to shock? Yes, the gram-positive bacteria and gram-negative bacteria, how does they lead to shock? Can you tell me? So let me tell you, it's a difficult mechanism, but I will try. Okay, listen. The gram-positive bacteria, sorry, then gram-negative bacteria have lipopolysaccharide on their cell wall, and gram-positive bacteria have lipoteichoic acid on their cell wall. I will draw it also for you. So in the blood vessel, whenever gram-positive or gram-negative bacteria, whatever entering, it will go to the macrophage and stimulate the macrophage. Lipopolysaccharide secretes through CD14 receptor, and lipoteichoic acid through TLR2 receptor. Macrophages, on activating, secrete interleukin-1 and TNF alpha. Okay, let me draw it. Okay, let me draw a blood vessel. In the blood vessel, these are the macrophages. Imagine this is a gram-positive bacteria, and imagine this is a gram-negative bacteria. The gram-positive bacteria, the gram-positive bacteria have lipoteichoic acid on their cell wall, and gram-negative bacteria have lipopolysaccharide on their cell wall, right? So here lipoteichoic acid, here lipopolysaccharide. It will stimulate the macrophage. On the macrophage, specific receptors are present for lipoteichoic acid, TLR2 receptor is present, and for lipopolysaccharide, CD14 receptor is present. If you want to learn the name of the receptors. So ultimately, macrophage is activated. On activating, macrophage secretes TNF alpha and interleukin-1. That causes two things. Please understand, it's difficult. These two will cause two things. Number one, it causes vasodilation. This is our artery supplying blood to some organ. It is causing vasodilation in the artery. What do you mean by vasodilation? By vasodilation, there is more blood supply to this organ. You are saying shock is due to decreased blood supply, but you are saying here there is more blood supply? Yes, it's a unique shock. It's a unique shock in which initially there is hyperdynamic circulation instead of hypodynamic. So there is more blood supply to this organ. In contrast to hypovolemic and cardiogenic shock, I taught you two shocks till now. In both of them, there was less blood supply to the organ. In hypovolemic shock, the blood is less, blood supply less. And cardiogenic shock, the heart is not pumping properly, that's why there is less blood supply. But in septic shock, I am saying there is more blood supply to the organ. You got my point? There is more blood supply. There is more blood supply to the organ. Okay, there is more blood supply to the organ. So it's a hyperdynamic situation initially, but later on, the vascular permeability is also increased. After vasodilation, the vascular permeability means gaps will be formed. The gaps will be formed. So what will happen? You can see the gaps are formed here. The gaps are formed. From this gaps, the fluid will leak out. Fluid will leak out, leading to edema, leading to edema. So less fluid will remain in the blood, and now it will lead to shock. So there are two stages in septic shock. First, hyperdynamic stage, and later on, in hypodynamic stage, that leads to shock. Hyperdynamic stage is due to vasodilation, and later on, increased vascular permeability. Increased vascular permeability leading to the shock. Say yes if you want it. Everyone. So this is the mechanism. This is the mechanism of the shock, the septic shock. Gram-positive bacteria, gram-negative bacteria, both of them can lead to shock. The vasodilation leads to hyperdynamic circulation, which is in contrast to other two shocks, right? And increased vascular permeability later on leads to edema. I tried at least appreciate my efforts. You got the mechanism of the septic shock. Septic shock has two stages, early hyperdynamic stage, in which there is more blood. So if you touch the extremities, the um, you know, the palms and the soles of the patient in cardiogenic and hypovolemic shock, they are very cool because of less blood supply. But here, initially, they are warm. Warm extremities, even the patient is in shock with warm extremities. It's a typical clue given to you in the question. Warm extremities with shock, it's septic shock. But later on, the patient has increased vascular permeability leading to the shock. Say yes if you got it. We are done with three types of shock. You want me to explain it again? The third type of shock, septic shock? You got it?

So in all the shock, whether it is hypovolemic shock, whether it is cardiogenic shock, or whether it is septic shock, in all of them, one thing is common: decreased perfusion. All the organs are receiving less blood supply. Less blood supply means less oxygen, less oxygen means anoxia. Multiple organs have anoxia, leading to multiple organ failure and leading to death. So this is common for all of them. But the reason is different. Here, less perfusion, the reason is less blood, less volume of the blood, less than five liters of the blood is present due to accident, surgery, vomiting, diarrhea, burns, diuretics, whatever. In cardiogenic shock, the left ventricle is not pumping. That's why this is the reason. And in septic shock, either gram-positive or gram-negative bacteria first leading to hyperdynamic circulation, that is increased perfusion, and later on, because of increased vascular permeability, decreased perfusion and decreased perfusion leading to the shock. So that is the thing. So yes, I hope you all got it. Yes, can we go ahead? Kindly everyone respond.

So you can see this is the master table of the shock. This is the master table of the shock. Here you can see. So hypovolemic shock, cardiogenic shock, septic shock. See the causes of hypovolemic shock. See the causes of cardiogenic shock. See the causes of septic shock. Septic shock is due to gram-positive, gram-negative bacteria. See the pathogenesis. Hypovolemic shock is decrease volume of the blood, less than five liters. Cardiogenic is due to left heart failure, right? And septic shock is due to bacteria, right? See the symptoms here. Increase heart rate, decrease BP, decrease urine output, altered mental status, unique, right? And here inflammatory edema is unique because of the increased vascular permeability. We are done with shock. We are done with shock. Are you ready for the MCQs? Can we try some MCQs now?

The first question is in front of you. Perioperative shock is an example of which type of shock? Perioperative, like during surgery, during surgery or after surgery, which type of shock the patient have? Hypovolemic, septic, cardiogenic, or neurogenic? I'm asking you, what's the correct answer? So during surgery, the patient can bleed. Sometimes the patient can bleed too much because of the bleeding, the volume of the blood will be less than five liters. Yes, absolutely right. And this will lead to hypovolemic shock. Is it right? Why people, you are not answering? Is it right? The perioperative shock is hypovolemic shock? Let me see. Yes, yes, very good. In shock, what is the characteristic feature which is present in all shock? Tell me one feature which is present in all types of shock, whatever type of shock it is. Tell me one feature. Is it cardiac failure, overperfusion, cyanosis, or edema? So is it cyanosis, edema, cardiac failure, or poor tissue perfusion which is present in all shock? Tell me one feature. Yes, you all are right. The correct answer is poor perfusion. Decrease blood supply to all the organs, whether it is hypovolemic shock, cardiogenic shock, or septic shock, it occurs in all of them. The hallmark feature of the shock. The correct answer is B, and you all are right. So we are done with hemodynamics also. Got it? Can we go ahead? Say yes if you can go ahead. Can we go ahead? Yes, yes.

So coming to the next chapter, very quickly, genetics. And after that, we are left with one more chapter, neoplasia. Okay, so general will be done. All the important topics are general. General is very big, but yeah, most of the important topics I'm trying to compile in a short span of time. So let's start with genetics. In genetics, let me tell you, the genetic inheritance of single gene disorders: autosomal dominant, recessive, X-linked disorder, X-linked recessive. If you are an FMG student, you always get one question on genetic inheritance of this. But in other exams also, directly or indirectly, there can be integrated questions on this. But in FMG, always there is a question, right? So let me tell you, genetics is the study of the genes. You know what is chromosome? What is human karyotype? In humans, how many chromosomes are present in each cell, in each nucleus, diploid nucleus? How many chromosomes are present in humans? I'm asking, how many chromosomes are present in humans? The 46 chromosomes. Either say 46 chromosomes or say 23 pairs. So if we arrange all 23 pairs, pair number one, pair number two, three, likewise till 23, so it is known as karyotype. Karyotype is the arrangement of all 23 pairs according to their length. See, it is the largest one. See, this one is the smallest one. So according to their descending order of their length, of the length of the chromosome, okay? So this is known as karyotype. You can see the karyotype. All out of the 23 pairs, the 22 pairs you can see these one, these one till here, it is common in all. It is common in all. But the last pair is known as sex chromosome, right? These are known as allosomes or sex chromosomes. These are different in male and female. We all know it's if a male, it's XY, and if it is a female, it's XX. So last pair is different according to the gender. The males have XY, and the females have XX. We all know that. But the first 22 pairs is common in all of them, right? We all, we all know that. Yes, the first 22 pairs. Absolutely right, Shalini. It's autosome, and the last pair is the sex chromosome. Absolutely right.

Now let me discuss some genetic inheritance, single gene disorders with you. Genetic inheritance, single gene disorders: autosomal dominant, autosomal recessive, X-linked dominant, X-linked recessive. Let's start with autosomal dominant. Basically, you have to learn the examples. You have to learn the examples. Here you have to learn the two things: the pedigree analysis and the examples. Basic is examples, okay? Let's start with the first one, autosomal dominant. Autosomal dominant. Can you see this is the pedigree? Now it is not related to sex. You can see the males, the square is a male, I guess everyone knows, and the circle is a female. To learn the basic sign, I know. So the, the filled one, the dark is the diseased, and the empty one or the healthy, I guess everyone knows that. So male and female both can transmit the disease. So it is not related to the sex, okay? You can see there is no skip of the generation. There is no gender bias. You can see in this generation, in this generation, in this generation, all the generations, the diseased persons are there. So no generation skip, no gender bias. You can see the male is also transmitting to the next generation, and here you can see the female is also transmitting to the next generation. The female is also transmitting. There is no gender bias also, and it is having variable onset, variable. Right? Learn the examples. Autosomal dominant. What is the example? I am having a mnemonic for you for the four inheritance. I am going to give you four mnemonics, okay? Yes, I'm giving you four mnemonics. So the mnemonic is [Music] Polyposis, hypercholesterolemia is hypercholesterolemia only. Autosomal is ADPKD, adult polycystic kidney. Dominant D-O-M-I-N-A-N-T. D stands for dystrophic myotonica, O for osteogenesis imperfecta, and for Marfan syndrome, I for intermittent porphyria. There are two Ns, neurofibromatosis one and two. A is for achondroplasia. T is for tuberous sclerosis, and HMD disease and hereditary spherocytosis. So please learn the full form. Try to learn the full form. I know it's not very easy, but at least with the full form, you can apply in the exam and rule out some options. Hypercholesterolemia, autosomal dominant. D-O-M-I-N-A-N-T. Hey, trying to say the full form. It's not very difficult if you try. B for Von Willebrand disease. F for familial hypercholesterolemia. H's I have to see. Hypercholesterolemia. A is adult polycystic kidney disease. D for dystrophic myotonica, osteogenesis imperfecta, Marfan syndrome, intermittent porphyria, neurofibromatosis type 1 and 2, achondroplasia, tuberous sclerosis, Hutchinson's disease. Maybe I have missed something or I am wrong, but at least that's right. So write down the mnemonic and try like this. These all are autosomal dominant.

Coming on the next one, autosomal recessive. Autosomal recessive. See the generation skipped. So if the first generation has, the second don't have, third don't have, then the fourth has. So generation skip is very common here. Generation skipped are there. Again, both sexes are involved. There is no gender bias, right? And it is early onset. That was variable and onset. This one is early onset. See the examples. The example is A, B, C, D, E, F, G, H, S, P, W. A stands for albinism. B stands for beta-thalassemia. C stands for cystic fibrosis. D for Dubin-Johnson and deafness, sensory neural deafness. E for E stands for enzyme deficiency, specialization deficiency. F for Fabry disease, ataxia, Friedreich's ataxia. G for galactosemia. H for hemochromatosis, Hurler. S for sickle cell anemia, very commonly asked. P for phenylketonuria. W for Wilson's disease. W for Wilson's. So please try to say A, B, C, D, E, F, G, H, S, P, W.

The next is the X-linked dominant. X-linked dominant disorders, right? Here you can see the gender variation is there. Everyone here on the screen, say here the female is affected. The mother is affected, but the father is healthy. So when they get married, out of the four children, the mother is giving out of the four children, you can see the four children, one, two, three, four. So out of the two sons, one is affected. Out of the two daughters, one is affected. Basically, 50% of the sons, 50% of the daughters are affected. The affected mother is giving it to 50% sons, 50% daughters. She is not doing any variation. But his, this is the affected father. The father is affected here. The mother is normal. If they get married, the father is very partial. The father is giving disease to 100% daughters, not the sons. So 100% daughters are affected, not the sons. The point is that the male gives the disease to 100% daughters, and the female gives the disease to 50% sons, 50% daughters. You can learn like mothers don't differentiate between the children, whether it is a son or daughter. So if she is affected, she is transmitting the disease to 50% sons, 50% daughters. But father is very partial. Father is not giving disease to the son, and father is giving disease only to 100% daughters. It's just a mnemonic to learn, okay? So you can learn. So this is X-linked dominant pattern. Say yes, say yes. It is X-linked dominant pattern. Please say yes. So typically looking at the pattern, you can see, see the mother, see the father, you can typically see the pattern based on that, you can answer it's X-linked dominant. Only four diseases are X-linked dominant. The mnemonic is FAIR AT AIR. F is Facial oral disease. A is Alport syndrome, very important. Alport syndrome is in Continental Pigmentosa, and R is Rickets. Okay?

And the next is X-linked recessive. X-linked recessive. You can see females are always carriers, they don't have the disease, and males are the males have the disease. Males are the cases. Females are the carriers, right? Males are the because it is X-linked recessive now. So if both the X's are involved, then only the disease is there. If one of them is involved, patients don't have disease, and females have double X. Males have only one X. So males will express it, but females will never express. So the mnemonic is GRAHAM BELL. G-R-A-H-A-M-B-E-L-L. So please read the full form. G for G6PD deficiency. R for Retinitis Pigmentosa. A for Androgen Insensitivity. H for Hemophilia, very important PYQ. Hemophilias are X-linked recessive. A for Adeno leukodystrophy. M for Mannosidosis. B for Becker's, there is a question on that. D for Duchenne muscular dystrophy, Lesch-Nyhan, and Lowe syndrome. So I know it's difficult. I know, I know. Still, I insist you to learn. Okay? There are four patterns. If you don't learn the pedigree, it's okay, but learn the mnemonics, learn the full form. So there are four patterns. We will revise. We will revise the mnemonics of all of them. Let's see. Let's see who will answer. Let's see who will answer. Tell me the mnemonics. Arthur, Shalini, Kiran, Habib, Nikki, Osama, HD, anyone can answer. Want to try to tell me the mnemonics? At least full form, I will say, but trying to see the mnemonics. Autosomal dominant, hypercholesterolemia. Autosomal dominant D-O-M-I-N-A-N-T. Dominant. Head. This is the mnemonic. The second mnemonic, ought, I guess it's connected again. I guess it's connected again. I guess it's connected again. Let's wait. I'm waiting for. Okay, connected now. Okay, okay.

So see, I have told you the mnemonics. The four mnemonics. If, if the four mnemonics you know, you can half the job is done. You know, you have to just say the full form, and at least if you are confused in the full form also, you can rule out some options. You will always get a question on these, or direct or indirect clues can be there. So please learn the four mnemonics as well as their full form. Can we go ahead? Can we go ahead? Let me show you some questions based on that. The first question is in front of you. Can you tell me the type of inheritance in Tuberous Sclerosis? In which mnemonic it was coming? Tuberous Sclerosis. Can you please give me the answer? In which mnemonic it is coming? The mnemonic was WOE. Familial Hypercholesterolemia. Autosomal. So yes, in which mnemonic it is coming? It is coming in the mnemonic of autosomal dominant. So correct answer here is autosomal dominant. The correct answer here is autosomal dominant. The next question is in front of you. Type of inheritance in Wilson disease. In which mnemonic it was coming? Just apply all four mnemonics and tell me where W was coming. SPW. Where it was coming? A, B, C, D, E, F, G, H, SPW. It is a mnemonic of autosomal recessive. You can see W is for Wilson. In none of the others, it is coming. So correct answer here is B. You got it? This is how the mnemonics will help you. Many questions are there on this. Which of the following is an X-linked recessive disease? X-linked recessive disease. So what is the mnemonic? Apply the mnemonic and look for the option which option is coming in this mnemonic. I see, as I can see, G is coming only. So G is G6PD deficiency. This is how the mnemonics will be useful for you. Okay? This is how the next is on the pedigree analysis, right? Look at the pattern of the pedigree and tell me the answer. Which type of inheritance is it? So I will see for male and female. There is no generation skip. I can see. I can see the male can transmit the disease to daughter, daughter, daughter. But the female transfer getting the disease to 50% sons, 50% daughters. 50% sons, 50% daughters. It's a typical pattern of X-linked dominant. I told you, it's a typical pattern of X-linked dominant, okay? So the correct answer here is D. So based on the pedigree, I have told you the pedigree of all four. I have told you the pedigree of all four, right? You got it?

Now coming on the next chapter, the chromosomal disorder. The last chapter in the genetics. After that, we will start neoplasia, right? So chromosomal disorder. The next is the chromosomal disorder. In chromosomal disorder, I will tell you Down, Patau, Edward. Their karyotype only. The symptoms I will give you diagrams. The five diagrams I will give based on the diagram, the important, important symptom, sign you have to learn. You don't have to learn all the symptoms and signs, only the important symptoms, signs you have to learn. But you have to learn the karyotype. So among them, you know the normal karyotype of a male and female. So during uh, dust pump or the gamete formation, I mean, so what is the male? Male is 46. Female is also 46. But in male, the last pair is XY. In female, the last pair is XX. So in male, when the sperms are formed, it's 23X and 23Y. Two types of sperms are formed. Two types of sperms are formed. But in females, when the ova are formed, when the gametes are formed, both are same. Both are 23X, 23X. I guess everyone knows that. There is no need to say, right? What I mean to say? Now, what I mean to say? If the female is more than 35 years of age at the time of the pregnancy, so sometimes there can be some problem which is known as non-disjunction. What it is known as? Non-disjunction. So in increased or older females, that's why it is said that first pregnancy or pregnancy should be before 35 years of age in females. Male age hardly matters, but female age matters, right? Because in females, what is the problem after 35 years of age? When the gametes form, see what, what is the distribution? It is 23 plus one in one of them, and in other gamete, it is 23 minus one. So here, in one of the ovum, it will be 24. In one of the ovum, it will be 22. So it will, it will, it will fuse with one of the normal, uh, it, both of them will fuse with one of the normal sperm. So total count will be in the fetus either 47 or 45. It's not 46. So the fetus which is formed because of the fusion of the defective ovum with normal sperm, I am repeating, the defective ovum and the normal sperm, the ovum is defective, either having one more chromosome or one less. The reason is the non-disjunction. What is the reason? The reason is the non-disjunction. Due to the non-disjunction, the two ova are formed, they are not saved, right? They are, they are abnormal. When the fuses with the sperm, it will lead to monosomy, trisomy. So the fetus which is born with 47 and 45, now, so 47 is known as trisomy. It is having one extra chromosome, and the fetus with 45 is known as monosomy. So monosomy and trisomy can happen. You got my point? So this is the meaning of the monosomy and trisomy. So this is known as aneuploidy. And aneuploidy is of two types: monosomy, trisomy. In monosomy, 45 chromosomes are there. Trisomy, 47 are there. You got my point? So the same thing is shown to you, okay?

Now, the three disorders: Down, Patau, and Edward. They occur due to autosome involvement. And the last two, that is the Turner and Klinefelter, they occur due to sex chromosome, the last pair involvement. In Down, there is trisomy of 21. But how is trisomy of 13 and Edward? Trisomy of 18. So all of them have 47 chromosomes instead of 46. Normal humans have 46, but these patients have 47 chromosomes in all the cells. Out of the 47, so I told you now, the chromosomes are in pairs. So this is pair number one, pair number two, pair number three, pair number four, likewise. So here, pair number 21, not two chromosomes, three chromosomes. Pair number 13, not two chromosomes, three chromosomes. Pair number 18, not two chromosomes, three chromosomes. So this is the main thing you have to understand here. So Down syndrome is the most common chromosomal abnormality among all. Most common is Down. See, see the karyotype. Can you see the karyotype? Please, can you see the karyotype? Now identify the disorder. Please identify the disorder. See, this is the abnormality. This is one pair. This is one pair. One pair. Count the. If you count total, it's 47, not 46. Subscribe. If you count, if you have the time, please count now. See which is the triplet? All of them are pair, pair, pair, pair. One is triplet. The 21 is the triplet. It's trisomy 21. So that's my answer. Give me a thumbs up if you got it. But don't learn the symptoms and signs. Have a look on the diagram. This is a Down baby. Down syndrome baby, right? So basically, the face, broad, flat faces there, right? The eyes are far away from each other, having the epicanthic fold in between. The hands, there is a single palmar crease, single palmar crease on the hand, okay? In the heart, there are congenital heart abnormalities, especially VSD, okay? And hernias are very common, umbilical hernia, especially very common. So I request you, I'm not reading all the symptoms. Have a look on the diagram. Mentally, the child is mentally retarded. So have a look on the diagram and learn main features. In the complication of the Down, the most important complication is VSD, I told you. In the heart, there is ventricular septal defect, and all types of leukemias may occur, okay?

Now coming on the Patau. The Patau is trisomy 13. Can you see here? If you count it, total, the total are 47 again, not 46. But what is the triplet? This is a pair. This is a pair. This is a pair. I can see 13th number is a triplet. So there is trisomy of 13, that is trisomy 13. The most, most typical feature is the cleft lip and cleft palate, very unique feature. Apart from that, many things are there, but most important is cleft lip and cleft palate, right? And polydactyly. You know, if you see the hands, it is not visible. More than five fingers are there. Polydactyly is a very unique feature, right? So please learn it. You can see all the features. And the next one is the Edward. Here you can see the Edward. Again, if you count again, it's 47. But this time, you can see the triplet is 18. It's 18 trisomy, right? The typical feature here is rocker bottom foot. Have you seen your foot? So the normal human foot is like this. It's like this. I appreciate the arch. I appreciate the arch. And see the foot here. It's opposite. It's opposite. This foot is known as rocker bottom foot. And opposite arch. This is rocker bottom foot. It is a very unique feature for Edward. Rocker bottom foot. Other features are also there. There is a typical, this thing also, the fist. Please do a fist. Fist, we can do it normally. Now here you can see if you ask the baby to to make a clenched fist, the digit number two and five are overlapping. Three and four. You can see two and five are overlapping. Three and four. This is two. This is five. They are overlapping. Three and four. So it is always like this, like yay. This is digit number one, I guess everyone knows. This is two, three, four, five. Count the. Count from one. Counting starts from the thumb. So digit number two and five are on the. I'm sorry, one and five. No, no, two and five are on three and four. It's like this. It's always like this. Very unique thing. So it is Edward. Say yes, it is Edward, okay? Edward syndrome. Ah, yes, it's Edward. Okay.

So we are done with the three disorders here. Down, trisomy 21. Patau, trisomy 13. And Edward, trisomy 18. So tell me the total number of the chromosomes. The total chromosome, 47, 47, 47, since they are trisomy. But here, pair number 21 is triplet. Here, pair number 13 is triplet. Here, pair number 18 is triplet, right? What about Klinefelter and Turner? Klinefelter and Turner involve the sex chromosome. So Klinefelter is also trisomy, but of the sex chromosome. And this one is a monosomy of the sex chromosome, right? Klinefelter is a male. Turner is a female. Tell me the karyotype here. It's 47. Normal male is XY. It's XXY. One additional X. And here it is 45. Normal female is XX. Here it's XO. So here one X is additional. Here one is missing, right? And you know, main, main symptom. So this is the crux. You have to learn the crux. Okay? And learn one, one, one, one, one, one main symptom in all of them. Please everyone, appreciate my efforts. Please give me a thumbs up. We are done with genetics. Congratulations. Can you please answer this question? What is Patau syndrome? What is syndrome? What is Patau syndrome? Please. Yes, you all are right. The Patau syndrome is trisomy 13. Yes, correct answer here is trisomy 13. I guess everyone of you is right. Everyone of you is right. Okay, yes. Instead of Patau, if I ask Down, the answer will become A. And instead of Down, if I ask Edward, the answer will become B. Very commonly asked question. Can we go ahead? Down syndrome is most commonly caused by what? Maternal non-disjunction or paternal? Maternal is mother, paternal is father, or translocation or mosaicism? So what is the most common cause of the Down? Not only Down, all these genetic disorders. Most common cause is maternal non-disjunction. Normally mother is 46 XX. If the age of the mother, as I told you, is more than 35 years or some other problems are there, so the two ova are formed, they are not equal. One of the ovum contains 23 plus one, one of the ovum contains 23 minus one. Normal ovum, 23, 23. And both of them are XX. So here, this is known as maternal non-disjunction. This is the cause of these disorders. In Turner, what is the number of chromosomes? Turner, what is Turner? Turner is a female. So what is the number of the chromosomes? Is it a monosomy or trisomy? 45, 47, 46, 42? What is the total number of chromosomes in a Turner female? You all are right. It's 45. The Turner female is XO. I'm not O, X zero, I mean, right? So one of the X is missing. So that's why it's 45.

Let me read one more question for you. There is a male. The biggest clue given in the question is a male. It's actually underdeveloped. The sex, sex organs are not developed. Rudimentary testes are there. Prostate gland is also rudimentary. Sparse pubic hair, facial hair is not there. Beard is not there. Mustache, but the male is long, long, tall. Right? Large hands, large feet. So can you tell me the diagnosis and the genetic makeup? So of course, based on the symptoms, they are talking about the Klinefelter syndrome. You can make it out. The male is with normal intelligence, long, tall. The only thing, the beard, mustache is missing. The pubic hair is missing, and atrophic testes are there. So what is Klinefelter? It's 47, XXY. Yes, you all are right. The correct answer, you see, it's a very repeatedly asked question. They can change the, you know, symptom signs, but ultimately, the crux of the question is that you have to make the diagnosis and tell the genetic makeup. Yes, we are done. Okay, so we are done here also. So what's now? Just a second. I will share the annotated version of PPT with you on the group after completing the session. Give me a minute. Okay, so now I am moving on to neoplasia. The next chapter to be discussed here is the neoplasia. Just a second. Let me see where it is. The last chapter which I will discuss here in the general pathology is the neoplasia. So let's start neoplasia. You people there? Can I start neoplasia? So let's start neoplasia. What is neoplasia? Neoplasia means new growth. Neoplasia, the new growth which is known as tumor. Tumor. The study of the neoplasia is known as oncology. So what is neoplasia? How you will define a neoplastic cell? How the neoplastic cell is different from the normal cell? Normal cell is different from the neoplastic cell. How can you tell me the answer? How does a normal cell is different from the neoplastic cell? Can you see this is a normal cell? I have drawn for you. In this cell, there is a growth factor coming, binding with a growth receptor. The red color is the growth receptor. The growth factor is coming, binding with the growth receptor, and because of which, the mitosis takes place. So the cell division takes place. The two cells are formed out of the muscle. So mitosis takes place only when growth factor or stimulus is coming. So mitosis is under physiological control. Okay? Now, see a neoplastic cell. See this is not a normal cell. This cell I have drawn here is a neoplastic cell. Why does a neoplastic cell? Here the growth factor is absent. Here the growth factor is absent. The stimulus is absent. Even in absence of growth factor, it is doing the mitosis. So such a cell in which the mitosis, the cell division is uncontrolled, it's uncoordinated, even on cessation of growth stimulus, it is going on dividing. So this cell will go on dividing, go on dividing, go on dividing. It will form a mass of cells, and that mass of cells is known as neoplasm or cancer. The only problem in the neoplastic cell is that their mitosis or cell division is uncontrolled. It's unregulated. They keep on dividing, keep on dividing, uncontrolled growth. Yes, absolutely right. More they have uncontrolled growth and uncontrolled growth leads to the neoplasm. So that is the thing. So what is neoplasia? It is the new growth. New growth. The new growth is the neoplasm. Okay? So when the growth is excess, uncoordinated, and even it occurs even after the cessation of the stimulus, it is known as neoplasia, right? Or neoplasm.

Now, there is a special type of cancer. You know, the human body is made up of three germ cell layers during embryology. You may have read the three germ cell layers: the ectoderm, the mesoderm, and the endoderm. All the germ cell layers lead to some organs. Like our blood vessels, our circulatory system is formed from the mesoderm. The nervous system is formed from the ectoderm. So I don't know exactly, but yeah, all the organs are made up of some or other germ cells. So one organ contains one germ cell. So whenever cancer occurs in one organ, it is arising from one germ cell. The cancer of that organ having one germ cell. But there are certain cancers which arise from totipotent cells. What are totipotent? They can give rise to all the three germ cell layers: the ectoderm, the mesoderm, and the endoderm. So basically, the tumor containing all three germ cell layers. Such a tumor which contains is a tumor which contains all three germ cell layers. Normal tumors contain one germ cell layer, but teratomas are derived from totipotent cells, and they contain all three germ cell layers. All three germ cell layers. So inside them, anything can present. So usually they occur in ovaries or testes. Now, if you take out the tumor, you can find teeth in them. You can find hair. You can find gelatin. You can form cartilage. You can find bone. You can find brain inside the tumor. You can find pancreas, adipose tissue. Technically, anything, anything, bone, muscle, anything can be present. It is a teratoma. Say yes. So that is the meaning of the teratoma. So please learn this special tumor that is teratoma.

Now I would like to, before coming on the main chapter of neoplasia, I would like to highlight two things: hamartoma and choristoma. What is hamartoma and what is choristoma? Both of them, these terminologies, they look like tumor, but they are not tumor. They look like tumor. You can see the suffixes -oma and -oma. So you can confuse that it is a tumor, but they are not tumor. Let me explain you both. What is hamartoma? What is choristoma? Let me explain you. Let me read the definition. I will explain. Don't be confused. So when the tissue is normal, but the site is abnormal, it's choristoma. But when the tissue is abnormal, but the site is normal, it's hamartoma. You will say, Mom, what does it mean? What does it mean? Let me explain you. Let me explain you. Let me come on the hamartoma. Can you see here? So this is lung. Inside the lung, you can see this is the cartilage. This is the cartilage. So does normal lungs have cartilage? Yes, normal lungs have the tracheal rings here and the cartilage in the bronchi. We know. So normal lungs have cartilage. But the only thing here, so site is normal. The site is normal. And have cartilage. But the only thing, the cartilage becomes malformed. It becomes underdeveloped. Malformation is there, right? It's not cancer. If you cut it, it's not dysplastic. It's not anaplastic. It's not cancer. The only thing it is disorganized. The cartilage becomes disorganized. It becomes malformed. It is known as hamartoma. So hamartoma, the site is normal, but the tissue is abnormal. The tissue is abnormal, that is malformed. That is hamartoma. See the second example is spleen. You know, in spleen, there is red pulp and there is white pulp. In the spleen, this is normal spleen. You can see it here. This is the normal spleen. Inside the normal spleen, you can see abundant of red pulp. The red pulp is normally present. The only thing it becomes malformed. It becomes, uh, it becomes malformation or a developmental maldevelopment is there. So but here the site is normal. Site is normal. Tissue is abnormal. It is a developmental abnormality. The tissue becomes disorganized. The tissue becomes malformed, okay? The tissue becomes malformed, okay? So hamartoma of the lung and hamartoma.

Of the spleen, Hamilton, of the lung, contain the cartilage hamartum. Of spleen, contain the red and the white pulp. The site is abnormal tissues. Tissue site is normal tissues. Abnormal. The next is the chorio stroma. In chorio stroma, reverse happens. Can you see this? This is the tongue. In the tongue, can you see the cartilage and the bone? Normal tongue doesn't have cartilage and bone here, right? So if you cut this cartilage bone, it's absolutely normal. It's not malformed. The only thing is the site is abnormal. The tissue is normal, but the site is abnormal. The site is abnormal, tissue is normal. Sight is abnormal. That is osteocarcissus. Chorio stroma of the lung. Here also, you can see. We are doing the endoscopy of the stomach. In the stomach, we found a mass. That is pancreas. Pancreas doesn't present inside the stomach normally. It's absolutely normal pancreas. The only thing, the site is abnormal. So say the thing. Say the two things what we have learned. What we have learned? Say about the tissue. Say about the site. Tissue and side. Say about the tissue. Say about the site. What do you say? What is normal? What is abnormal? So say, if the tissue is normal, but the site is abnormal, side is abnormal, means ectopic. Side is abnormal. What is this known as? Or say, the tissue is abnormal. Abnormal means it's not cancer. Mind it, it is malformation. Tissue is abnormal, but the site is normal. Sight is normal of that organ only. What is it known as? Can you tell me the answer? When the tissue is normal, side is ectopic, it is known as choriostoma. Okay. And when the tissue is abnormal, but site is normal, it's known as hamartoma. How you will learn? I don't know, right? Okay, you have to learn this. There is no mnemonic for that, okay? If you know Hindi, "site is normal," you can learn like that. It's a small mnemonic if you understand Hindi. My my own. So, site is normal. It's normal side, but tissue is abnormal. And you can make the reverse for the choriostoma if you want a mnemonic at all, okay? So, can we go ahead? Yes, yes, absolutely right. There are something different. You have got it, okay? So, can we go ahead? So, please get many questions on that. So, what we have learned, let's summarize. They are not tumors. Neither choriostomas tumor, nor hamartomas tumor. Both are tumor-like lesions, but they are not tumors. Choriostroma, the tissue is normal, but the site is not abnormal, that is ectopic. Hamartoma, the tissue is abnormal, but the site is normal. I hope everyone got it, okay? Okay, can we get it? Go ahead, okay? Yes, yes, you can learn. He means to say that, I guess. So, it's a good one. So, choriostomas. Chori, you know, stealing something. If we steal something, so this the site is abnormal. The site is abnormal. It's a good one. Thank you. Thank you. Good one. So, Kush has given a good mnemonic, "chori kamal." Okay? So, you can learn like that. Good one. So, can we go ahead? So, we have learned the two things. The summary is in front of you. Both of them, none of them is tumor. Both of them are tumor-like lesions, but none of them is real tumor. So, one is choriostoma. So, the site is ectopic, but the tissue is normal. Hamartoma, the tissue is abnormal, but the site is abnormal. Site is normal, but the tissue is abnormal. I hope you got it. Can we go ahead? Can we go ahead? We will solve some MCQs now based on that. So, the first question is in front of you. Humor containing cells of all three germ cell layers. I guess everyone knows the answer. I guess everyone knows the answer. What is the correct answer here? Please. Humor containing cells of all three germ layers. What is the correct answer? What is the correct answer? Yes, tell me the answer. Yes, of course. The correct answer is. I don't know why you people are not writing the answer. Yes, yes, very good. So, all three germs are here. The teratoma. Only tumor. What is hamartoma? Can you define? Is it malignant tumor? Is it metastatic tissue? Is it developmental malformation? Or is it hemorrhage in the vessel? Very easy question. Can you tell me what is hamartoma? Who will tell me what is hamartoma? Is it malignant tumor? Malignant tissue? Developmental malformation? Or hemorrhage in the vessel? Yes, I'm waiting for the answer. Of course, the correct answer is C. It's a developmental malformation. It's not malignant. You neither malignant nor metastatic, not hemorrhage. The correct answer is. The next question is in front of you. Ectopic rest of the normal tissue. I mean to say, the tissue is normal, but the site is abnormal. The site is abnormal. The tissue is normal, but the site is abnormal. What it is known as? Choriostoma, hamartoma, pseudo tumor, pseudo tumor, or lymphoma. What is the correct answer? Yes, you all are right. The correct answer is A. That ectopic site but the normal tissue. What is hamartoma? The next question. What is hamartoma? Is it proliferation of the cell in the foreign site? Proliferation of the native cell in the tissue? Malignant condition? Acquired condition? It's neither acquired. It's neither malignant. Now tell me answer from A and B. It is proliferative of the cell at foreign site? Or it is fault collaboration of the native cells of the same side in other tissue? So, what do you say? Yes, the correct answer here is B. It's the native cell. The site is normal. The same side. The tissue is abnormal. So, the word native is very important here. Yes, the correct answer here is B. So, we are done with this also. The next topic is benign versus malignant tumors, okay? So, what are the differences? You know, there are two types of tumors, the benign and the malignant. How to differentiate between benign and malignant tumor? What does what are benign tumor? What are malignant tumor? How to differentiate between the two? How you can differentiate the benign tumor from the malignant tumor? Can you please tell me? How you can differentiate the benign tumor from the malignant tumor? Yes, how you can differentiate the benign tumor from the malignant tumor? Based on the five features, we can differentiate based on their rate of growth, clinical feature, gross microscopy, and most important is the spread of the tumor. So, the benign tumor and malignant tumor, let me show you here only. The benign tumor are slow growing. The malignant tumors, fast growing. This is based on their rate of growth. Based on the clinical feature, benign tumors usually asymptomatic, usually exceptions are there. And malignant tumors, usually symptomatic, again exceptions are there. Gross feature, the benign tumors, they are well circumscribed. They are well circumscribed. They are capsulated. They are circle, oval. Malignant, they are irregular. They don't have capsule. They are infiltrating. The benign compress the tissue. The malignant infiltrate inside, invade the tissue, okay? Microscopic feature, I will explain you. I will explain the 10 features. The 10 features of the dysplasia, which makes the differences between benign and malignant. And most important, the last one is the spread of the tumor. Benign tumors do not do any spread. No metastasis, no local invasion. Malignant, you must do the both. So, based on these features, we can differentiate the benign tumor from the malignant tumor. Yes, based on the gross finding, Shalini, based on the size also, we can differentiate, okay? So, let me discuss the five points one by one. Let me start. Let me start the characteristic of the tumor. So, benign tumor, the rate of the growth here, they are slow growing. The malignant ones are the fast growing. Clinical features, the benign tumors, the benign tumors, they are asymptomatic, usually, except some like meningioma, they can produce the seizures and various symptoms. Malignant tumors, usually rapidly growing, usually they rapidly grow, they rapidly grow, they can ulcerate on the surface, and they can do the systemic features also, like weight loss, anorexia, anemia. Usually, they are symptomatic. Gross features, benign tumors are small, spherical, capsule present, well circumscribed. Malignant tumors are irregular. You can see here. Both of them are breast tumors. This one is benign, this one is malignant. Both are breast tumors here. You can see the benign tumor is well circumscribed. The malignant tumor is irregular. It is invading inside, right? So, based on the gross, we can identify. And the most important feature to differentiate benign and malignant tumor is the microscopic feature. The microscopic feature is the anaplasia. Can you see? These are the 10 points of the anaplasia, based on which we can define whether it is a benign tumor or a malignant tumor. Let me discuss the 10 points of the anaplasia. Can you see? This is a normal or benign, and this one is the malignant tumor. So, see, first is the basal polarity. In the morning, I explained you what is basal polarity. Basal polarity means the nucleus is present towards the basement membrane. So, basal polarity is present in benign, but it is lost in the malignant. The first feature is loss of basal polarity. Second, pleomorphism. Here, all the cells are of same size. Here, some cells are small, some are moderate, some are large. So, here pleomorphism is absent. Here, it's present. The presence of pleomorphism is anaplasia. NC ratio. Here, NC ratio, you can see small nucleus and more cytoplasm. Here, you can see the nucleus is big and cytoplasm is less. So, your NC ratio is high, right? And isonucleosis. Is the size of the nucleus. All the nucleus here, same size. Here, some are small, some are large. So, here no isonucleosis. Here, an isonucleosis is present. You can see the nuclear chromatin. Here, it's normal. Here, dark color nucleus is there. So, hyperchromatism is there inside the nucleus. Nucleoli. Here, there is no nucleoli. Your nucleoli is present here. There is no mitosis. Here, mitosis is present. Here, you can see no giant cell. Here, some of the cells having multiple nucleus, that is giant cells are present. So, these are the features. Basically, you have to learn differentiating between the benign and the malignant tumors. You got my point? So, just to let me go. And the next point is the spread of the tumor. There are two types of spread. Let me explain you after that, we will take a lunch break, okay? So, just five minutes more. So, you can see this is a patient. This is a patient. Just imagine she's having any tumor. Just suppose breast tumor, okay? So, if it is growing, growing, growing, and involving the pectoralis major, involving the ribs, involving the surrounding tissue, it is known as local invasion. Local means in continuity. It is growing. Local invasion means it is continuity involving other organs. Apart from that organ, involving other organs also in continuity. But the second option is that the tumor cells are going in the blood vessel or lymphatic vessel, and by a blood vessel, it is reaching in multiple organs of the body and involving multiple secondaries and multiple organs which are discontinuous with the primary. Discontinuous. This is known as distant spread. Distance spread is known as metastasis. Metastasis. The what to be picked here is the discontinuous multiple secondaries. So, there are two types of spread, local and distant. You got it? If you got it, give me a thumbs up. What are the two types of spread? Local spread, distance spread. Distance spread is known as metastasis. The local spread occurs in continuity, and distance metastasis, it is the discontinuous multiple secondaries. So, there are two types of spread, local and distant. You got it? So, same thing is shown to you. Can you see here? This is a tumor, but is going on involving the surrounding tissue in continuity. In continuity, this is local invasion. After that, it is moving to the blood. One of the cell is going to the blood. Via blood, it is going to multiply other organs and forming multiple secondaries here. So, this is metastasis. This is local invasion. This is metastasis. I hope you got it. I hope you got it. Now, please understand. Benign tumors, neither local invasion, nor metastasis. But malignant tumors, please, please. So, I told you the five. Now, please, I'm enumerating everyone here on the screen. So, I have told you the five differences to differentiate the benign and the malignant tumor, okay? Benign tumor, malignant tumor. Help me in filling. So, based on rate of growth, these are slow growing. These are fast growing, okay? Based on clinical picture, these are asymptomatic, exceptions are there. These are symptomatic, exceptions are there. Based on the gross finding, these are circular, oval, spherical, numbers, um, capsule is there. These are irregular, no capsule is there. Based on microscopy, I told you the features of the anaplasia. So, here the polarity is present. Here, the basal polarity is lost, right? Um, here hyperchromatism is present, pleomorphism is present, and isonucleosis is present. I mean, all of them are absent in benign and present in malignant. But please learn those 10 features. The last one, I told you, the local invasion and distant invasion. Both are absent in benign. Both are present in malignant. Both are present. Now, these are the differences. Everyone here, everyone here on the screen. Which is the shortest sign of malignancy out of the five? The most reliable sign, which differentiate benign versus malignant? One sign, the shortest one, tallest, most reliable sign to differentiate benign or malignant. It is known as shortest sign of malignancy. Can you tell me the answer? The shortest sign, Chara sign. What is the shortest sign of malignancy? The most reliable one? The most reliable one is the metastasis. Number one. So, if metastasis is present, it has to be malignant. There is no exception. There is no exception, okay? The second most shortest is the local invasion. Again, if it is present, it has to be malignant. Third most is the microscopy, right? Rest all are just clues. They will not give a shot, okay? So, most shortest sign is metastasis, okay? Please learn it. It's a very important MCQ. So, surest sign, most reliable sign is the metastasis. Second most reliable sign is the local invasiveness. Same thing is written in front of you. You got it? So, that is the benign versus malignant tumors. I told you we will solve some MCQs and we are done till now. Just a second. MCQs are not very important here. We can leave. So, let's take a break. Let's say a lunch break. After that, what topics are left? Let me tell you, okay? So, from neoplasia, metastasis is left, right? So, I will tell you the three roots of the metastasis. I will tell you the tumor markers. I will tell you the carcinogenesis. The physical, chemical, and biological. Yeah, these are the important topics from neoplasia. We are packing with general. So, I guess I was having more 30, 40 minutes. I can pack general before lunch. But yeah, I am lacking. First, I will take the lunch. In the next, after lunch, 30 minutes, I will try or 40 minutes, I will try to complete general. Right after that, in hematology, we have few anemias, leukemias, and platelet disorders. I will take only important ones here, not the detail. In anemia, I would require one hour. In leukemias, I would require one hour. Right? Platelet disorders, I will tell you only classification. And hemophilia is not important one here. So, I will take, I guess, two and a half hour session more here. Let me plan how we can do after the lunch, okay? So, let's start ahead. We were studying the general pathology. In general pathology, we have covered most of the topics. The last topic is the neoplasia. We are taking on. We have already seen cell adaptation, cell injury, cell death, acute inflammation, chronic inflammation, apoptosis, necrosis. We have already covered. Um, after that, hemodynamics, right? Thrombosis, embolism, shock, edema. We have already covered the genetics. And now we have started neoplasia. So, in neoplasia, uh, just a second. Give me a minute. So, I would like to continue neoplasia with the topic carcinogenesis. Give me a minute. So, let me start with carcinogenesis and tumor marker. These two topics are important here. Still in neoplasia, after that, the general pathology is done. The important topics are done. After that, we will move on hematology. So, let's start with carcinogenesis, okay? What is carcinogenesis? First, understand what is carcinogens. What is carcinogenesis? First, understand that, okay? Carcinogenesis is the mechanism of induction of tumor. Can you see here? Okay, let me show you. Can you see everyone? See on the screen. Can you see two cells in front of you? In the first cell, you can see the growth factor is coming. This is the growth factor. It is binding with a growth receptor. When the growth factor comes, binds with the growth receptor, the cell divides. In the second cell, you can see no growth factor is coming. In absence of growth factor, cell do not divide, right? Now, what is the genes which are leading this? Like the growth factor. In presence of growth factor, there is a gene known as proto-oncogene, which gets stimulated and causes the cell division. In absence of growth factor, there is another gene known as tumor suppressor gene inside the nucleus, in the DNA. These are the names of the genes. Tumor suppressor gene gets stimulated and it inhibits cell division. The proto-oncogene causes mitosis. Tumor suppressor Gene inhibits mitosis. Normally, in all of us, in me, in you, in all normal individuals, the cell division is caused by proto-oncogene in presence of growth factor, and cell division is inhibited by tumor suppressor Gene. Learn the name of the two genes, the proto-oncogene and tumor suppressor Gene. One is causing the stimulation of cell division, other is causing the inhibition of the cell division. Please understand. So, can I say proto-oncogenes like the accelerator? Have you drive any vehicle? Like car or any vehicle? So, if you want to increase the speed, what do you do? Of course, you will apply the accelerator. If you want to decrease the speed or stop the car, what do you do? Of course, you will apply the brake. So, can I say the proto-oncogene is like accelerator? It is causing the stimulation of the cell division or increasing the rate of cell division. Can I say tumor suppressor genes are the like the brakes? They inhibit or stop the cell division. Can I say this? Say yes or no. Say yes or no. Can I say this? So, these are the accelerator. These are the brakes. So, imagine I am driving a car. I want to increase the speed, I will apply the accelerator. I want to decrease the speed or stop the car, I will apply the brake. So, speed is balanced. This is known as balance. The same occurs in human body. The God has provided the molecular accelerator and the molecular break with us. We have a molecular accelerator. We have a molecular break. Okay? So, but imagine an unfortunate condition. If the brake is failed, you are driving a car, or anyone is driving a car, the brake is failed, or the accelerator got stuck at the highest speed, you cannot reduce the accelerator. What will happen? The speed increases drastically. Imagine if the same occurs in human body. In the human body, the proto-oncogenes get overstimulated. These are the accelerators. They got stuck at the highest speed. They are overstimulated. Or the tumor suppressor genes, they are inhibited because of the mutation. So, what will happen? The one which causes cell division is overstimulated. The one which stops cell division is inhibited. It will lead to uncontrolled cell division. It will lead to cancer. So, this is how the cancer takes place in human body. Cancer takes place because of two reasons. There are two reasons for cancer: overstimulation of proto-oncogene, inhibition of tumor suppressor Gene. So, you can see the two type of the genes. The accelerator got overstimulated, and the brakes got inhibited. The brake has failed, and accelerator is stuck at the highest speed. What will happen? Uncontrolled speed, uncontrolled cell division. Uncontrolled cell division leads to cancer. Give me a thumbs up. This is the simplified version how you can understand the molecular mechanism of the cancer. You got it? Now, the point is that you must ask me, ma'am, by the proto-oncogene get overstimulated? They are present in me. You all have the individual, but we have normal version. If they get mutated and get overstimulated, or if they get mutated and get inhibited, then they are abnormal and lead to cancer. You got my point? You must suppress a gene and proto-oncogene. They are not no abnormal. Normally, they are normal only. But once they get, they get mutated, they are abnormal. So, who is causing the mutation? Who is causing the mutation? The mutation can be caused by one of the three agents: either the physical, or chemical, or biological. And that is known as carcinogenesis. You got it? That is known as carcinogenesis. So, what is known as carcinogenesis? It is the mechanism of induction of mutation inside the cell. And the agents, the physical, chemical, or biological agents are known as carcinogens. So, basically, there are three types of carcinogens. They all cause mutations. Mutation of the two genes, either they cause mutation of proto-oncogene, that is gain of function mutation, that is they get overstimulated, or they can cause mutation of tumor suppressor Gene, that is loss of function mutation, they got inhibited. So, these mutations are caused either by the physical agent, or chemical agent, or biological agent. And this is known as carcinogenesis. First, understand what is carcinogenesis. Have we got it? Now, let's start with physical carcinogenesis. What is physical carcinogenesis? The physical carcinogenesis is, you know, radiation induced carcinogenesis. So, there are rays in the environment where we are living now. We are surrounded with multiple rays. You know, UV and IR are mainly. They can induce the cancer. We will discuss them one by one. UV and IR. The source of them. The cancers they cause. And the mechanism. The source. Let's start with UV light. What's the source of the UV light? From where we get the UV light? We get the UV light from sunlight. Imagine this is the Earth, and this is the sun. Let me draw the sun. This is the sun. We get sunlight from the sun, and it falls on the Earth. There are three UV rays present in the sunlight: UV A, B, C. Three UV rays are coming from the sunlight. C never reaches the Earth because C is filtered by the ozone. We know the Earth is surrounded by ozone. So, C is filtered by ozone. Only A and B are coming on the Earth. A is coming, B is coming on the Earth. Learn B for bad. B for bad. B is bad for humans. B for bad, right? So, A does not cause the cancer. B causes cancer. It's a very important question. B can cause cancers. UVB. You can learn the wavelength if you wish. The wavelength of ABC. C gets filtered by the ozone, not reaching the Earth. B is the carcinogenic among ABC. B is carcinogenic. Never, never forget. Which cancers it causes? It causes only skin cancer on the skin. It can cause squamous cell carcinoma, basal cell carcinoma, and melanoma. The three types of cancers in the skin. So, squamous cell carcinoma, basal cell carcinoma, and melanoma. Among them, the most common is basal cell carcinoma, right? What is the mechanism? Imagine this is a skin cell. It is a skin cell of human, the keratinocyte. This is the nucleus inside the nucleus. This is the DNA containing multiple genes. Now, this UVB is coming. UVB is coming from the sunlight. Once it comes, now, you know, normal Watson and Crick model of the DNA. You have read this in biochemistry. So, purine forms bonds with pyrimidine, right? Adenine forms bonds with cytosine. I'm sorry, thymine, and cytosine bonds form bonds with guanine. We know that purine forms bonds with pyrimidine. I guess everyone knows that. If the UV, UVB is falling on the cell, because of UVB on the DNA, there is pyrimidine, pyrimidine bond formation. I repeat my words. There is pyrimidine, pyrimidine bond formation. Pyrimidine, pyrimidine dimers are formed, which leads to mutation, and this mutation leads to cancer. The mutation can be in proto-oncogene or tumor suppressor Gene, that leads to cancer. Say yes, you got it. So, what is the mechanism? Due to UV light, pyrimidine, pyrimidine dimers are formed. Pyrimidine forms bonds with pyrimidine. Pyrimidine, pyrimidine dimers are formed that leads to mutation that leads to cancer. The mutation are two type, you know, either proto-oncogene gain of function, or tumor suppressor Gene, the loss function. Say yes. Are you people there? Are you understanding? The topic is difficult, but I am trying my best. So, this is the mechanism, right? Let me come on the next phase. The next rays are the IR. IR are present in sunlight. No, no, no. UV rays are present in sunlight. But IR are not present in sunlight. The IR rays are present in X-rays, gamma rays, beta rays. It can present that. How many cancers it causes? It causes all type of leukemia. How many types of leukemia? You know, it is acute myeloid leukemia, acute lymphoid leukemia, chronic myeloid leukemia, chronic lymphoid leukemia. There are four types of leukemia. IR causes three of them, not the fourth one. So, which one it doesn't cause? It never causes CLL. IR. It's a very important pyq. IR, IR means ionizing radiation. Ionizing radiation never causes CLL. Apart from CLL, it causes all leukemia. Say yes. It causes all leukemia, except, except, except, mind the exception, please. Mind the exception. Exception is CLL. It never causes CLL. Number one. Number two, it causes all thyroid cancer. There are four types of thyroid cancer: follicular, papillary, anaplastic, medullary. It causes all of them. Most common is papillary, but it causes all of them, right? So, that is the thing. That is the things. And CLL is never caused by IR. What is the mechanism? Imagine either this is a WBC, uh, bone marrow cell, I mean, or it is a thyroid cell. It is having the DNA. And IR is falling. This time, UV is not falling. The IR is falling on the cell. So, when ionizing radiation is falling on the cell, you know, in the cytoplasm, the cell is having water, of course. All cells have water. What is water? What is water? Is H2O. When IR rays fall on the water, water forms the free radicals, OH negative. Water forms a free radical, OH negative. And this OH negative will cause the mutation to form the mutation. Here, it is due to the formation of the free radical from the water. This is the mechanism. You got it? So, exposure to ionizing radiation dislodges ions from the water and it will form the free radical that causes is mutation that leads to cancer. You got it? So, we are done. Listen, listen. First, I will write for you, then you will tell me the answers. So, tell me UV rays, IR rays, the two type of the physical carcinogenesis, okay? You have to tell me the source of each of them. Number one, you have to tell me the cancers they are causing in which organ, and you have to tell me the mechanism in one, one line, not in detail. That's it. So, what is the source of UV? Who will tell me? What is the source of UV? Of course, it's sunlight. There are three UV, UV A, B, C. Which is bad? D for bad. UVB is bad. It is carcinogenic. C never reaches the Earth, and A is good. A is healthy, right? So, IR, the sources are X-ray, Alpha, Beta ray, Gamma ray. Which cancers does it causes? Here, UV rays causes skin cancer. The three type of skin cancers: squamous cell carcinoma, basal cell carcinoma, and melanoma. Okay? And here, it causes either thyroid cancer or blood cancer, right? Cancers are four types: papillary, follicular, medullary, and aplastic. And blood cancer, all leukemia, but never CLL, right? Mechanism. You have to tell me for both of them. What is the mechanism here? The mechanism is pyrimidine, pyrimidine dimer formation, which leads to mutation. Here, the mechanism is formation of free radical, which leads to mutation. Say yes. So, you get many MCQs based on the physical carcinogenesis. Answers. We are done with physical. Let's start chemical. Can we? Can we? Okay. So, there are many chemicals which can cause cancer. There are two type of chemicals: direct, indirect. We are surrounded with chemicals in the air, in whatever we eat, whatever we drink, it contains many pesticides, many chemicals, you know. So, pollution contains the chemicals, and some of the chemicals causes cancer. The best example you can take, not only like this, you can take the smoking. What does the smoke contain? We all know. We all know smoking leads to lung cancer. What does the smoke contain? Smoke contains tar, and tar leads to cancer. So, tar is the chemical present inside the smoke that leads to lung cancer. So, there are two types of chemicals: the direct and the indirect. Direct carcinogens and indirect carcinogens. Two types of chemicals are present: direct and indirect carcinogens, okay? What do you mean by direct? They are directly going in the body and they induce mutation. They go to the target organ and induce mutation. Indirect ones are inactive ones. Once they go in the liver, they become activated inside human body. After that, they go to the target organ and they cause the cancer, right? Now, what are the steps? How does the chemical induce cancer? Like, what are the stages in chemical carcinogenesis? So, there are three stages. What are the three stages? You can see its initiation, promotion, and progression. In the initiation itself, there are four steps: metabolic activation, reactive electrophile, mutation, and initiated itself. I will show you. Rather, I will draw it for you, okay? Let me draw a rough diagram of human body. So, I'm drawing a rough sketch diagram. So, don't laugh, okay? It's a rough sketch diagram just to explain you. Imagine this person is exposed to some chemical, right? Now, the chemical is present in the blood. Let me draw the blood vessel, okay? Let me draw the liver. Let me draw the target organ, let's say the target organ is lung. It can be anyone, right? The chemical is present in the blood. So, if the chemical is direct, it will go directly to the target organ. But if the chemical is indirect, first it will go to the liver. In the liver, hepatocytes are present. Inside the hepatocytes, there is an enzyme known as cytochrome P450. Then cytochrome P450 converts the inactive to active, inactive chemical to active chemical. That is the first step. So, let's start initiation. In the initiation, the first step is metabolic activation. The metabolic activation takes place in liver. So, indirect chemical goes in the liver. The liver converts it from indirect to direct, inactive to active, and again it will go in the blood. After becoming active, it will go in the blood. So, first step is over, the metabolic activation. Say yes. After that, after that, we are going to the target cell. We are going to the target cell. I mean, the chemical will go to the target cell. In the target cell, imagine the target cell. This is the nucleus of the target cell. Imagine it is a cell. So, in the cytoplasm, it will lose electron. Let me draw a target cell. This is a target cell. The nucleus of the target cell. The DNA of the target cell. This is the chemical which is already active. Which is already active. If it is direct, it is directly coming here. Indirect, first go in the liver and then come here, okay? Now, this chemical will lose electron and form the electrophile. Electrophile here, lose the electron and become positively charged. It will in the cytoplasm of the target cell. Now, nucleus is negatively charged. We all know nucleus is negatively charged. And by losing electron, it becomes positively charged. So, negative attracts positive. So, because of that, it will go in the nucleus and hit the DNA. I'm using the word hit. It will hit the DNA. It will hit the DNA, right? Because of which, it will produce the cancer, right? So, first electrophile formation, then it hits the nucleus and causes mutation, and because of the mutation, the cell will divide and form the initiated cell. So, these are the steps of initiation. You got it? So, in initiation, there are four steps. I have explained you. So, first, the metabolic activation, only the indirect chemical, first go in the liver, and by cytochrome P450, it will be activated. Then it will form reactive electrophiles. It will lose the electron and form positively charged ions, which are known as electrophiles, and it will hit the DNA, produce the mutations, and finally, the initiated cell is formed. Say yes. Can we go ahead? Can we go ahead? The initiated cell is formed. Now, the initiated cell, the mutated cell, is the initiated cell, okay? The mutated or initiated cell is present, but it will not cause the cancer. This is the mutated cell. It is already having the mutation by the chemical. The mutation is already there, but it cannot cause the cancer unless until it is having, um, uncontrolled proliferation. For that, another chemical is required. The name of that chemical is promoter. Promoter will cause the proliferation of the mutated cell. So, this cell goes on dividing, goes on dividing, from one to two, two to four, or two eight, eight to sixteen, sixteen to thirty-two, thirty-two to sixty-four, likewise, and it will form a bunch of cells known as cancer. So, this is known as promotion. So, initiation, different chemical is required. Promotion, different chemical is required. The chemical required for initiation is initiator. The chemical required for promotion is promoter. Right? And for a cancer, both are required, right? Initiator causes mutation. It is mutagenic. And promoter causes proliferation of already mutated cell. Please appreciate my efforts. Come on. You got it? So, initiator chemical causes the mutation, and promoter chemical causes the proliferation of the mutated itself. And finally, the cancer occurs, right? This is known as progression. You got it? The promoter is required. It does not damage the DNA. It does not produce the mutation. It causes proliferation of the mutated itself, okay? So, initiator should be followed by promoter. Promoter should not be followed by initiator. Then only cancer will occur. If only initiator is present, there is no cancer. If only promoter is present, see the triangles are the promoter. Green triangles. Then also no cancer is present. If initiator, if promoter is followed by initiator, again no cancer is present. Cancer occurs only if initiator is followed by promoter, whether in continuity or whether after a gap. Say yes. So, it is a diagram from Robbins, and I hope you all can understand it very well now, okay? So, initiator should be followed by promoter. Promoter should not follow the initiator. Promoter what does the promoter will do? Mutated. First, initiators should come, cause the mutation. Then promoter should come, and it should cause the proliferation of the mutated itself, okay? And finally, just suppose we are talking of the lung cancer. The initiator is the tar. It will produce the cancer. The promoter is also tar. Sometimes the same chemical acts as both, okay? It is also causing the front. But the patient don't have cough. Patients don't have dyspnea. So, genotypically, the patient have cancer. But we know typically, you know, phenotype. Phenotype is the expression. When the cancer is expressing, it is known as progression. The progression is the phenotypic expression of the malignancy. You got it? So, these are the steps: initiation, promotion, progression. In the initiation, there are four steps. Say yes. How does a chemical carcinogenesis occurs? Who will tell me? How does the chemical carcinogenesis occurs? There are three steps. First, initiation is required. Then promotion is required. And then progression, that is phenotypic expression. In the initiation, there are four steps. First, metabolic activation. It occurs in liver. It is required only by indirect chemical, not direct chemical. Then, electrophile formation. Electrophile formation takes place in the target organ cells, in its cytoplasm. Then, mutation. Mutation, mutated cell is formed, and initiated cell is formed. Then, promoter is required. That causes clonal proliferation of the mutated itself. And then progression is the phenotypic expression of the cancer. Say yes. So, I hope you got it, right? So, is there any test to prove the chemical carcinogenesis? I explained you the chemical carcinogenesis. You should not believe me. You should ask me, ma'am, is there is any proof that whatever you are saying is right? Chemical causes cancer. There are some tests which can prove that chemical causes cancer. Yes, there is the test. So, the name of the test is Ames test. Very important pyq. Ames test. First, learn Ames test is proving that chemical can cause cancer. Let me explain the test. It's a very easy test. To take a bacteria in a test tube. Take the bacterial suspension. The name of the bacteria is Salmonella typhimurium. What is the name of the bacteria? It's Salmonella typhimurium. It's the name of the bacteria. Salmonella typhimurium. It is already mutated. We are taking already mutated strain. You know, what is the mutation? Salmonella typhimurium cannot grow without histidine. Histidine is given, then only it will do banner efficient. Otherwise, it will not grow. It's a unique property. This is the mutated strain that cannot synthesize histidine. In the body, so if you give from outside, then only the bacteria will grow, otherwise it will not grow because it is a mutated strain. It cannot synthesize histidine. Okay? Now, you put one drop of this bacteria, bacterial suspension, mix it with the chemicals, mix it with chemicals in a jar, right? Now, if the chemical is carcinogenic, the chemical will cause the mutation in this bacteria. But you will see them. It's already mutated. It's already. So, basically, they will reverse the mutation. You got my point? The bacteria is already mutated, right? And the chemical will cause the mutation. So, you know, minus minus is equal to plus in mathematics. So, basically, the mutation will reverse. It will cause mutation over mutation to reverse the mutation. I mean to say, now, if you try to grow this bacteria on histidine-free media, the bacterial colonies can be seen. This is only occurring when the mutation is reversed. Say yes. Say yes. Can we go ahead? Can we go ahead? Okay? So, this is Ames test. This is Ames test. You can see the list of the chemicals and the corresponding cancers they cause. I request all my dear students, I will provide the notes. Please have a look on this list. Like alkylating agents cause AML, androgens cause prostate cancer, dyes cause bladder cancer, arsenic causes cancer of the lung and the skin, asbestos causes cancer of lung, pleura, mesothelium. Like this. Or there is an already asked question pyq on the vinyl chloride, on benzene, on aflatoxin. Vinyl chloride causes angiosarcoma of the liver. Benzene, benzene causes leukemia. And aflatoxin causes liver cancer. Please learn this list. It's very important. We are done. We are done with the chemical carcinogenesis also. Can you tell me the answer? The question is in front of you. A simple bacterial test for mutagenic carcinogenesis is it Ames test, redox, just bacteriophage, or genes pricing? What is the correct answer? The simple bacterial test for mutagenic carcinogenesis for mutagenic carcinogens. One test, single bacterial test to prove that. Here's the correct answer is Ames test. Just now I told you for mutagenic carcinogens, okay? So, correct answer is A. You all are right. Okay. Uh, rest questions you can see by yourself. The last thing here in neoplasia, I would like to tell you is the biological carcinogenesis. So, let's start biological carcinogenesis. So, in biological carcinogenesis, I would like to tell you three type of carcinogenesis: viral, bacterial, and parasitic. What do you mean by biological carcinogenesis? Some biological agent is causing the cancer. So, how many viruses? There are six viruses. There is one bacteria and four parasites. Total 11 organisms in this world are carcinogenic. They can cause cancer. So, you should know the first thing, you should know the list with six viruses. How many of them are DNA viruses? How many of them are RNA viruses? So, you should know the list of the viruses. You should know the list of the bacteria and list of the parasite, okay? So, let's start with the viruses, okay? So, you can see the list. These are the six viruses. I'm telling you, they are carcinogenic. You can read HPV, Human Papilloma Virus, Epstein-Barr Virus, Hepatitis B, Hepatitis C Virus, HIV, HTLV, and HHV. So, you know these. So, you should know which cancer each of them is causing. Which cancer? Only one bacteria is carcinogenic, which can cause cancer. If the name of the bacteria is Helicobacter pylori, it causes two, two stomach cancer: the gastric cancer, the adenocarcinoma of the stomach, and MALToma, the lymphoma or the MALToma of the stomach. Both are of the stomach only. One is adenocarcinoma, one is MALToma. And there are four parasites which causes cancer: Schistosoma, Clonorchis, Opisthorchis, and Fasciola hepatica. Very important pyq. Learn the list. Learn the name of the six viruses, one bacteria, and four parasites which are oncogenic. You are 90% job is done. Then the most important among them, I will explain in detail, okay? So, the six viruses. Out of the six viruses, you can see how many of them are DNA? The four of them are DNA, and the two of them are RNA. Which four are DNA? It is Hepatitis B virus, A, I'm really sorry, Human Herpes Virus 8, Human Papilloma Virus, Epstein-Barr Virus. And which are RNA viruses? HTLV and HCV. So, please learn them differently. Among them, I will give you details of only two. Which two? So, I will give you detail of, I guess, HPV and EBV. Now, they cause cancer. I cannot give you the detail of all of them now. How they cause cancer? The most important which are important from at some point of view, we will see. So, how does HPV causes cancer? HPV, there are many types of HPV. Some causes benign cancer, some causes malignant. So, 16 and 18 most commonly cause malignant cancer. They are high risk, okay? In the HPV, there are two proteins: E6 and E7. E6 causes mutation of p53, and E7 causes mutation of retinoblastoma gene. And because of which, the person had cancer. HPV causes genital cancer. By genital cancer, I mean cervix cancer in females, and I mean penis cancer in males. Let me draw it for you instead of reading. We will draw it. So, you can see here, I am drawing any cell, like either the skin cell or the genital cell of human. You can see I am drawing the nucleus. I am drawing the DNA, okay? This is HPV virus. HPV virus enters inside the cell, and here it forms two proteins: E6 and E7. Among them, both of them will go in the nucleus. E6 causes mutation of p53, and E7 causes mutation of retinoblastoma gene. And because of which, this cell become immortal, and it will lead to cancer. Various types of cancer. This is the mechanism. So, E6 and E7, you have to learn. And Epstein-Barr Virus, most commonly, it causes Burkitt lymphoma. It causes other cancers also, but most commonly, it causes Burkitt lymphoma. So, that's all about it. That's all. So, please read the list. The viruses, the bacteria, and parasite. Bacteria and parasite, there is no mechanism. You have to learn the list. So, that's all about it. I guess we are done with the general pathology. We should start the hematology. I would like to take a small break for, say, 10 minutes only, and we will start the hematology. I will take one hour session for hematology, right? Now, so, let me continue with hematology. So, we have done the most important topics in general pathology. And let's start with hematology. In hematology, we will start with anemias. So,

What is the definition of anemia? How can you define anemia? Do you know what is anemia? Can you define anemia for me? What is anemia basically?

So, anemia. How many RBCs do humans have? Humans have RBCs, WBCs, and platelets in the blood. The normal count of RBC is 4.5 to 5.5 million per deciliter. This is the normal count, right? So, anemia is a reduction in RBC mass. Reduction in RBC mass. But measuring RBCs is difficult. And all the RBCs contain hemoglobin inside them. We know how, what is the RBC? RBC is a cell which is non-nucleated. It doesn't have the nucleus. At the periphery, hemoglobin is present. So, RBC is a non-nucleated cell which contains hemoglobin. All the RBCs contain hemoglobin. So, whenever the RBCs reduce in number, the hemoglobin also reduces in number because RBC is directly proportional to hemoglobin. So, indirectly, instead of measuring RBCs, we can measure the hemoglobin.

So, basically, anemia is a reduction in total RBC mass. But in practice, measurement of RBC mass is difficult. That's why instead of measuring RBC mass, we measure the hemoglobin. So, nowadays, we define anemia as a reduction of hemoglobin below what? Reduction of hemoglobin below what? Below the normal. Normal limit. Normal lower limit of hemoglobin for that individual.

So, what is the normal limit for hemoglobin for individuals defined by the WHO? For males, it's 13.6 grams per deciliter. If any male having hemoglobin less than 13.5 grams per deciliter, it is anemic. The male is anemic. In females, it's 12 grams per deciliter. And in newborns, it's 15 grams per deciliter. So, it depends on the age of the person. It depends on the gender of the person.

Let me ask a question. Let me ask a question. The question is, a person is having hemoglobin, uh, 12.5. Is the person anemic or not? Is the person anemic or not? My question to you is, is the person anemic or not? Do you know? Can you answer it? You should not answer it. You should ask me the age and you should ask me the gender. If I say the age is adult and if I say the gender is male, the male is anemic because for males, the cutoff is 13.6, and it is less. So, the male is anemic. But if I say the female, the female is non-anemic because for females, the cutoff is 12.00, and it is more than that. It is more than that. You got it? So, male and female. For male, it's anemic. The male is normal. For female, it's anemic. You got my point? I'm sorry. For male, it's anemic. For female, it's normal. So, the age and the gender is important to define anemia. That is my point.

Oh, so let me come on the classification of anemia. For understanding classification of anemia, you should understand the morphology of the RBC. In the RBC, see two things. Number one, okay, see the shape of the RBC. What is the shape of the RBC? RBC, if you see from front, it's circular. It's circular like a coin. And if you see it from the side, it's biconcave. If you see it from the side, it's biconcave. If you see from the front, from the top, it's circular. And if you see from the side, it's biconcave, right? The diameter of the RBC is 7.5 micrometers. The diameter of the RBC is 7.5 micrometers. Please learn this dimension, 7.5 micrometers. It's a circle. So, the diameter. You have to learn this. This is normal RBC. You have seen the shape. Now, is it nucleated? No. RBC is a non-nucleated cell. It contains hemoglobin. And wherever it contains hemoglobin, it is having the pink color. So, the hemoglobin is present at the periphery. See, I'm marking it. It is present at the periphery, not at the center. The central one-third is empty. The central one-third is empty. It is known as pallor. It is known as central one-third pallor. So, please learn two things for the RBC. Number one, its size. Number two, its color. Size and color. See the size from the top. Say, man, size is 7.5 micrometers. Please learn that. And what's the color? If you ask me about the color, the color is present at the peripheral two-thirds, not at the central one-third. The peripheral two-thirds is colored. But central one-third is empty. It's pallor. It's pink color. Okay. So, this is the color. Learn. Central one-third is pallor. Empty portion is. So, this is normal size, normal color. If you know the normal size, normal color, you can understand now ahead like the classification of the anemia.

So, normal size is 7.5 micrometers and central one-third pallor. The lifespan of RBC is 120 days. Everyone knows that. Now, based on the size, RBCs are of three types. Based on the color, RBCs are of three types. First, talk about size. In pathology, size is known as cytic. Please learn the word cytic. So, tick is size. The tick is size. Okay. So, normal size is 7.5 micrometers. Okay, right. RBCs can be normal size, can be larger size, can be smaller size. Okay, normal, larger, smaller. The size. Okay. So, this one is known as normocytic. This one is known as macrocytic. And this one is known as microcytic. Okay. This is static. It's a tick. City. So, that is cytic. Cytic means size. Please learn that. Based on the size, RBCs are of three types. So, they are in front of you: normocytic, macrocytic, microcytic. See the suffix. Suffix acidic. Normocyte, macrocyte, microcyte. Based on know how you measure the size. Okay, let me tell you color also. Okay, first finish size. How you measure the size? Just suppose I'm giving a slide in front of you. There are three slides. Now, you measure the size of the RBC. You don't have a scale in the microscope, right? You don't use a scale to measure whether the RBCs are 7.5 micrometers, smaller than that, bigger than that. How you measure? We don't use a scale. Now, so there is a way. You know, in the slide, we have WBCs also. One of the WBCs is lymphocyte. The size of lymphocyte is also 7.5 micrometers, and it is fixed. RBC can be smaller, can be larger. But the lymphocyte is always 7.5 micrometers. So, we compare the size of the RBC on a peripheral smear with a lymphocyte. See here, the RBCs are the same size as that of lymphocyte. That's where it is normocytic. See in the second slide, the RBCs are smaller as compared to lymphocyte. These are microcytes. And in the third size, in the third slide, the RBCs are larger. The RBCs are larger than the lymphocyte. It is macrocytes. So, normal size, it's microcyte and macrocyte. Based on the size, you can divide the RBC into three categories. Yes, we have to compare it with a small lymphocyte. So, that is the thing.

Based on the color, RBCs are of two types only, right? Not three types. Color in pathology is known as chromic. Color, color is known as chroma. Chroma means color. If the RBC is there, in the RBC, if the peripheral two-thirds is colored, you can see peripheral two-thirds color. Central one-third is an empty. It is known as normochromic. Normochromic. Okay. But if the color is present only at the periphery, central one-third pallor is more, and peripheral two-thirds ring is less. It's like this. Hardly any color is present at the periphery. It is known as hypochromic. Hypo means less. There is no condition like hyperchromic. Hyperchromic, it doesn't exist. So, basically, normochromic, the central one-third pallor is there. And here, the pallor is more than one-third. The pallor is more than one-third. The color is less. So, this is based on the color.

So, what we have learned? What we have learned? Can you please summarize? Based on the size, how many types of RBC? Based on the color, how many types of RBC? Based on the size, that is known as cytic. How many types of RBC? Based on the color, that is chroma. How many types of RBC? Can you please tell me? Based on the size, three types of RBCs. Normal. Okay. Based on the color, there are two types of RBCs. Normal. Normochromic. The suffix is important. The suffix is cytic and chromic. Say that. And hypo. Hypochromic. Hypo. There is no hyperchromic.

Now, let me classify anemia. Everyone with me? Everyone? So, first type of anemia is normocytic, normochromic. The size is normal, the color is normal. Still, the person has anemia. Such anemia is normochromic. The second type of anemia is microcytic, hypochromic. In which RBCs are less than size, less than color, and the patient has anemia. It is known as microcytic, hypochromic anemia. And the third type of anemia, macrocytic. But there is no hyperchromic. No. There is no corresponding. So, macrocytic, normochromic. So, tell me the three types of anemia. What are the three types of anemia? Normocytic, normochromic. Microcytic, hypochromic. Macrocytic, normochromic. You got it? So, based on the size, based on the color, we have three types of anemia: normocytic, normochromic. Microcytic, hypochromic. Macrocytic, normochromic. Everyone give me a thumbs up if you got this basic concept. This is the basic classification of anemia, known as morphological classification of anemia. For measuring the size, you require a lymphocyte on the smear. For color, you don't require any lymphocyte. Give me a thumbs up, everyone. Are you people there? You got it? It's a normochromic and hypochromic. We got it. Can you see the RBCs here in the slide? In the slide, they are normal chromic. See the central one-third pallor. See the central one-third pallor is there in all of them. Central one-third is pallor, right? See the second slide. In the second slide, you can hardly see any color. Maximum slide is pallor only. Hardly any color is present. Maximum is pallor. So, this is normal chromic. This is hypochromic. Granted. Can we go ahead?

Two more terminologies you have to learn here. Two more terminologies. I want to tell you anisocytosis and poikilocytosis. Now, can you see here? Some RBCs are small, some are normal, some are large. So, variation in size is known as anisocytosis. Some are small, some are normal, some are large. But variation in shape. Can you see this is tear shape, this is helmet shape, this is oval, this is circular. So, variation in shape is known as poikilocytosis. Poikilocytosis. So, variation in size is anisocytosis, and variation in shape is poikilocytosis. These are the basics. If you learn, okay, if you know the basics, learning the concepts are very easy. So, let's classify anemia now. You can very easily understand the classification of the anemia. There are two important anemias. More for two important classifications of anemia: morphological and etiological. Okay, morphological and etiological. So, morphology classification I already told you: normocytic, normochromic. Microcytic, hypochromic. Macrocytic, normochromic. That is the three types of anemia, the morphological classification. And okay, coming on the etiological classification. Now, in etiological classification, what is the cause of the anemia? You have to learn the cause of the anemia. Okay, what is the cause of the anemia? So, the anemia can be due to three causes. Number one, blood loss. Like someone is having surgery, someone is having an accident, acute blood loss. Or someone is having hemorrhoids, peptic ulcer, menstruation, menorrhagia, chronic blood loss can be there. So, blood loss can lead to anemia.

The two more important causes of anemia. Where does the RBC produced? The RBCs are produced in the bone marrow. This is the bone marrow. This is the blood vessel. The RBCs are produced in the bone marrow from the cell, hematopoietic stem cell, which is the precursor of all cells. It gave rise to the RBC, and RBC finally formation, it comes in the blood like this. This is the RBC. RBC comes in the blood after formation. Okay, after formation in the bone marrow from the precursors, the normoblast, early, intermediate, late, right? Now, for anemia, there are two causes. Either there is a problem in the bone marrow, and there is decreased production of RBC. Or the production is normal. There is a problem in the peripheral blood vessel, there is increased destruction of RBC. So, these are the two main causes of the anemia. Please understand. Decreased production. So, the problem is in the bone marrow. Or increased destruction. The problem is in the peripheral blood vessel. What is the problem? Okay. So, either there is decreased production or there is increased destruction. The two causes. The anemia due to increased destruction is known as hemolytic anemia. Hemolytic anemia. Hemolytic anemia is the anemia due to increased destruction of RBC. That's it.

So, there are two main types of anemia: decreased production, increased destruction. So, what is the cause of decreased production? Now, why the production is less? The production can be less, you know, in the bone marrow. How does the production takes place? What is erythropoiesis? How does the precursors of the RBC are there? The first cell is hematopoietic stem cell, then pronormoblast, early normoblast, intermediate normoblast, late normoblast, reticulocyte, and finally RBC is formed. After formation, it comes in the blood vessel. Okay. Now, in all these precursors, let me draw the precursors. These all are there. They all are there. Now, the cytoplasm contains the hemoglobin. They all have hemoglobin in the cytoplasm. And they all have nucleus. Nucleus. But nucleus is extruded at the late normoblast stage. The last reticulocyte and RBC don't have nucleus. They are non-nucleated cells. The nucleus is extruded at the late normoblast stage. You got my point? So, basically, decreased production can be due to two reasons. Either there is a problem in the cytoplasm or there is a problem in the nucleus. The problem in the cytoplasm means hemoglobin is not there. Either heme is not there or globin is not there. Heme is not there, it is iron deficiency anemia, cytoplasmic anemia, anemia of chronic disease. And globin is not there, it is thalassemia or sickle cell anemia. Or else, there is a problem in the nucleus. For the synthesis of nucleus, vitamin B12 and folic acid are required. It is megaloblastic anemia. Or there is a problem in the stem cell, that is aplastic anemia. So, these all are the various classifications of the anemia. You must understand. You got it? Give me a thumbs up if you got it. Give me a thumbs up.

So, can we continue? Okay. So, let's start hemolytic anemia. In the hemolytic anemia, I will be discussing. So, we will be discussing one more topic, hemolytic anemia. After that, I will end the session. The remaining RBC, few more anemias are important. Remaining and all WBCs, I mean all the leukemias, I will be discussing tomorrow along with the systemic. Tomorrow also, we are having the same session. The session tomorrow. Okay. So, let me finish it now only because it is a fresh topic. If I start now and leave it in the between and tomorrow, so there will not be a link of continuity. So, let me end the session now. Tomorrow, 9:00 AM in the morning, till again 4:00 or 4:30, we will be having the session. We will be having a lunch break in between. That's it. So, we are having the session. I request all of you, don't miss tomorrow's session. Tomorrow, I will first start with systemic. In the systemic, I am going to cover 10 important systems. I have enumerated the 10 systems. You can see in tomorrow's link. So, we will start with blood vessels, then we will move on CVS, then CNS, then, you know, one by one, we will take the systems like GIT, hepatobiliary, endocrine, and which else? Respiratory, musculoskeletal. So, we are going to take all these systems one by one. Tomorrow's session, the most important topics in them, not the complete systems, of course. Then blood vessels, I'm going to teach you the important atherosclerosis, aneurysm, aortic dissection. In CVS, I will teach you MI, endocarditis. In CNS, I will teach you meningitis. In GIT, I will teach you practical sir. I will teach you gastric. Just like the important, important topics we are going to cover in the entire systemic pathology. Right? And after that, so I will try to finish it till 2:00 o'clock. And after lunch, I will take hematology tomorrow directly. Hematology. So, the remaining anemias and WBCs, I will cover it tomorrow. Will it work for you? Will it work for you? So, tomorrow, it's already today, it's already late now. So, tomorrow we can continue. So, I will start the systemic pathology today. So, in today's session, in non-stop marathon of seven to eight hours, we are going to complete entire systemic pathology in a super simplified manner. Okay. So, entire systemic pathology, I am going to cover today. So, basically, in the entire systemic pathology, I will cover all these systems one by one. The most important topics from these systems. So, I will start with blood vessels, followed by CVS, followed by CNS, then GI, then I guess endocrine, then GIT, then renal, then respiratory, liver, male and female genital will be in the end. So, I will cover all these systems one by one. Okay. So, without wasting any further time, let's start with the first system. I will take all these 12 systems today. Okay. But the important topics, not all the topics, which are most important, ultra-important, repeatedly asked topics. Because in the six to eight hours, we can cover the important topics only. Okay. So, the high-yielding topics. Let's start with the blood vessel. In the blood vessel, I'm going to teach you aneurysm and aortic dissection. So, let's start with aneurysm. Okay. What is aneurysm? What is aneurysm? Can you tell me? What is aneurysm? So, you know, the wall of the blood vessel has three layers: intima, media, externa. This is the wall of a blood vessel. The arteries or the blood vessels have three walls: tunica intima, tunica media, and tunica externa. If there is focal weakness at any point in the wall of the blood vessel, there is protrusion, outpouching, or protrusion is produced. This is outpouching or protrusion. Outpouching or protrusion is produced at a focal one point because of weakness of the wall at that particular point. And this is known as aneurysm. So, what is aneurysm? Can you tell me? What is aneurysm? Aneurysm is abnormal dilatation of the wall of the blood vessel because of focal weakening. The weakening can be congenital, can be acquired. So, because of the weakness of the wall, focal weakness, there is an outpouching. And that outpouching is known as aneurysm. So, you all can see here, we have drawn aneurysm because of focal weakness of the wall of the blood vessel at one particular point. It can be congenital, it can be acquired. The weakness, right?

Now, what are the clinical features? If someone is having this outpouching, is it bothersome? Does it produce any symptoms? Now, when the blood is flowing through this blood vessel, you can imagine the blood will have stasis here. Normally, blood keeps on flowing, keeps on flowing, keeps on flowing. But here, the blood will have stasis because it is the outpouching. Stasis. Yesterday, I taught you general pathology. In Virchow's triad, stasis was one of the risk factors. And it will lead to thrombus formation. So, it will lead to thrombosis. It will lead to thrombosis. Thrombosis till it is attached to the wall, it is thrombus. Once it gets detached, it is embolism. Yesterday, I taught you that also. So, thrombosis is the clinical feature. Embolism is the clinical feature. You can see here, the blood is showing the stasis. That's why it is showing thrombus formation. Once the thrombus gets detached, it is embolism, right? Sometimes, it can get ruptured. It is a medical emergency. The aneurysm can rupture at any of the blood vessel. The major blood vessels start bleeding. Internal bleeding. It's a very emergency condition. And sometimes, it can cause compression of the surrounding neighboring structure. Can you see there is an aneurysm here? See the aneurysm. And can you appreciate this is a nerve? If you can appreciate, the aneurysm is compressing the nerve. So, the patient will have neuropathological symptoms. So, these can be the clinical features. Yes, the PDF will be available after the session. Yesterday also, I put the PDF on the Pro CM Telegram channel. Today also, Dr. Bhanu Prakash Prosum Telegram channel, I will put the PDF just after the session. So, please concentrate on the session. And if you don't write, it's okay. I will provide the PDF. The exact PDF. Can we go ahead now? Can we go ahead?

So, this is the clinical feature. You understood what is aneurysm? You understood the four clinical features. Number one, thrombus formation. Number two, embolism. Number three, rupture. Number four, compression of the surrounding structure. These are the four clinical features of the aneurysm. Now, let me tell you three types of classification of aneurysm. How to classify it? The first classification based on the composition of the wall. It is of two types. What are the two types? True aneurysm and false aneurysm. False aneurysm also known as pseudoaneurysm. The false one also known as pseudoaneurysm. What do you mean by true and false? Okay, I told you the wall of the blood vessel has three layers: intima, media, externa. So, media, tunica intima, media, externa. If all three are protruding out, intima, media, and externa. If all three protruding out, so the wall of the blood vessel is made up of all three layers. It is a true aneurysm. You can see the wall. Please appreciate the wall here. You can see the wall contains all three layers: tunica intima, tunica media, tunica externa. It is a true aneurysm. True means real, real aneurysm. This is the meaning of the true. The true contains all the three layers: intima, media, externa. Can you see a normal blood vessel here? See the tunica intima, this is media, this is externa. Here also, intima, media, externa. See all three are protruding out. Intima, media, externa. All three are protruding out. This one is a true aneurysm. You all can appreciate, I guess. Okay.

See the second possibility. There is a defect here. There is a hole or defect. Or there is an injury in the wall of the blood vessel. So, what will happen? The person will start bleeding. This is the bleeding. To constrict the bleeding, the body has a protective mechanism. The body will form a connective tissue covering. I am using the word connective tissue covering. A connective tissue covering to constrict the bleeding. Now, it is looking like aneurysm. But it is not aneurysm actually. It is a hematoma. Now, the wall is made up of connective tissue. The wall is not made up of the three layers: tunica intima, media, externa. No. The wall is made up of connective tissue. It is looking like aneurysm, but not aneurysm. That's why it is known as pseudoaneurysm or false aneurysm. Give me a thumbs up now, please. Give me a thumbs up. Got it? So, this is the two types of the aneurysm. We have learned the true aneurysm, the false or pseudoaneurysm. You can understand. So, based on the composition of the wall, if the wall of the aneurysm contains all three layers, it's true. If the wall contains fibrous thickening and connective tissue, it is a hematoma. It is known as false aneurysm. This is the first classification.

The second classification based on the shape. There are five types of aneurysm. See the first one is the saccular. Saccular means unilateral protrusion. Unilateral, in one of the side. Unilateral. That is saccular. The second is the fusiform. Fusiform is completely circular. All around protrusion is all around, not in one direction. It is all around. So, this one is fusiform. You can say it's like this. But this one is I'm sorry, the first one is the saccular. And this one is the fusiform. I hope you can understand the difference between saccular and fusiform. The third is the cylindrical. In which a long, parallel, you can see the parallel, parallel aneurysm is formed. The two walls are parallel to each other, like a cylinder. Cylindrical. The next is the serpentine. In which multiple small, small aneurysms are formed in continuity. It's serpentine. It's serpentine. And last one is the recemos. In which multiple blood vessels are interconnected with each other, forming a recemos. So, these are the five types based on the shape: fusiform, saccular, cylindrical, serpentine, and recemos. Please see.

The third classification based on the pathological mechanism. Who is causing the weakness? I told you, this is the blood vessel. In the wall of the blood vessel, there is a focal weakness at one point. At that point, the wall of the blood vessel protrude out. So, you should ask me a question, ma'am, who is causing this weakness? What is the cause of the weakness that is leading to the protrusion? The cause of weakness can be three. Based on which, three types of aneurysm are there. The first reason for the cause of the weakness can be atherosclerosis. Most important, 90% cause. 90% time, the cause is atherosclerosis. The focal area, there is atherosclerosis because of which the wall got weakened and there is focal protrusion of the wall, producing the aneurysm. Number one. Number two, there can be syphilis. You know syphilis, there are three types of syphilis: primary, secondary, tertiary. In tertiary syphilis, the wall of the blood vessels can be involved, producing an arteritis in the wall of the blood vessel that is producing this weakness and that is causing the focal protrusion. So, such aneurysm which is caused by syphilis, the weakness is caused by syphilis, it is known as luetic aneurysm. Luetic aneurysm is due to weakness produced by syphilis. It's a very important PYQ. And atherosclerosis, the aneurysm also known as atherosclerotic aneurysm. Atherosclerotic aneurysm is due to atherosclerosis. Luetic aneurysm is due to syphilis. And third, third cause is infection. Imagine if any infection occurs, it can be bacterial, viral, fungal, parasitic, any infection is caused in the wall of the blood vessel, producing vasculitis. Any infection that causes weakness and that is producing the aneurysm. So, such aneurysm which is caused by the infection, any infection, it is known as mycotic aneurysm. So, there are three types of aneurysm: atherosclerotic aneurysm due to atherosclerosis, luetic aneurysm due to syphilis, and mycotic aneurysm due to infection. So, basically, who is producing the weakness? There are three types of aneurysm. Give me a thumbs up. Got it? You can read the three names. The three types of aneurysm: atherosclerotic, as the name clarified, it is due to atherosclerosis. 20% is this. This type only. So, second is luetic. Luetic is due to syphilis. It's very important PYQ. And third is mycotic. Mycotic is due to microbial infection. Now, it's a misnomer. Looking at the word mycotic, you may think it's fungus only. It is not only fungus. It can be bacteria, virus, parasite, or fungus, anything. You got it? Can we go ahead?

Say yes. So, let me describe that this atherosclerotic and syphilitic a little bit detailed. Atherosclerotic is the most common, as I told you. Okay, as I told you, it is the most common one. Let me tell you, uh, okay, let me tell you the location of atherosclerotic and syphilitic aneurysm. They mostly occur in the aorta. Do you know what are the parts of the aorta? This is a rough diagram of the heart. This is the right side of the heart. This is the left side of the heart. From the left ventricle, the aorta comes out like this. This is the aorta. We all know that. From the left ventricle, this is the aorta. So, aorta, what parts aorta have? This is ascending aorta. This is arch of aorta. And this one is descending aorta. Completely, right? Now, descending aorta is divided into two portions by the diaphragm. By the diaphragm. So, above the diaphragm, it's thoracic. The descending aorta is known as thoracic. And below the diaphragm, it is known as abdominal aorta. We all know that. Just revising. Okay. Now, the abdominal aorta again divided into two portions. Uh, above the renal artery. So, you can see from the aorta, the renal arteries are coming out. These are the two renal arteries supplying the two kidneys. So, suprarenal and infrarenal. You can say this portion is suprarenal. And this portion is infrarenal. So, tell me the two aneurysm I told you, three important causes of the aneurysm: atherosclerotic aneurysm, luetic aneurysm is due to syphilis, and mycotic. So, tell me their most common site in the aorta. Right? Most important PYQ. Let me draw atherosclerotic. The atherosclerotic one is in the infrarenal portion. To be very specific, it is not in the ascending aorta. It is not in the arch of aorta. It is in the descending. It is not in the thoracic. It is in the abdominal. In the abdominal, it is not in the suprarenal. It is infrarenal. To be specific, this is the most common site of atherosclerotic aneurysm. Please pay attention. Okay. In the luetic, the most common site is the thoracic. The thoracic aorta, followed by ascending aorta. Sometime it can occur in the ascending aorta also. So, you can see I have marked the location of the atherosclerotic aneurysm as well as luetic aneurysm. Let me highlight. Atherosclerotic aneurysm occurs in infrarenal, infrarenal portion of the abdominal aorta, descending aorta. And let me highlight the position of luetic aneurysm. Luetic aneurysm occurs in the thoracic, followed by ascending aorta. Everyone give me a thumbs up, please learn that. It's a very important confusing questions are there. So, let's go ahead. Atherosclerotic aneurysm is the most common type. It occurs in infrarenal portion of the abdominal aorta. You can see these are the renal arteries. So, it is infrarenal. Appreciate infrarenal. Infrarenal location. It is fusiform. And luetic one, it occurs in tertiary stage of syphilis. It occurs in thoracic. You can see it occurs in either thoracic or ascending aorta. Okay. And, um, it is saccular in nature. Okay. Yeah. Two more things I would like to tell you here regarding the luetic one. Whenever you take one, let me draw it. Okay, let me draw the heart once again. From the left ventricle, let me draw the aorta. This is the aorta. So, I am interested in luetic one now. Luetic syphilitic one. So, I told you, sometime it occurs here in the ascending aorta, here. So, just what is there? The structure? This is the aortic wall. So, because of the aneurysm, the two walls, the semilunar walls get opened up, you know, and it will lead to aortic regurgitation. Because of the, this thing, aneurysm, because of the syphilitic aneurysm, you can see this is syphilitic aneurysm producing the dilatation here in the ascending aorta, just near the aortic wall. So, because of which, this aortic wall gets, aortic regurgitation. Because of this, there is more and more and more blood in the left ventricle. Because of which, to compensate, what it will do? To compensate, the wall of the left ventricle goes on thickening, goes on thickening, goes on thickening. It will produce left ventricular hypertrophy. Because of which, the heart size is very big. And it is known as cor bovinum. What is it known as? Cor bovinum. What do you mean by? I'm sorry. Cor means big size. And what do you mean by bovinum? It is looking like heart of a cow. It's human heart looking like a big cow heart. Cow heart is big in size. That's why it is looking like that. That is known as cor bovinum. Okay. So, you should learn the word cor bovinum. Luetic aneurysm, number one. Number two, if you cut it, if you cut and open it, inside there is wrinkling and calcification. The wrinkling is looking like the tree bark. Can you see the bark of a tree? This is the bark of the tree. Appreciate the aneurysm inside. It is wrinkled. The wrinkling is looking like tree bark appearance. I'm talking about syphilitic aneurysm. And it is having calcification also. So, plant three points. Three important points regarding the luetic aneurysm. Tree bark appearance, calcification. Everyone give me a thumbs up. Everyone give me a thumbs up. Everyone, you got it? Learn the three. All three are PYQs. Okay. So, we are done with aneurysm. Do you have any doubt in that? Shall I move to the next topic? The next topic is the aortic dissection. You have to be interactive, huh? If I'm asking something, please respond. If you have any doubt, please write down. So, let's start aortic dissection. We are done with aortic aneurysm. Now, coming on aortic dissection. What is aortic dissection? As I told you, in the wall of the blood vessel, there are three vessels. There are three layers: intima, media, externa. Imagine in the intima, if there is a tear. If there is a tear. Can you see there is a tear? So, what will happen? Only in intima, the blood from the main lumen, it will go in the intima. It will go in the tear of the intima. And blood is dissecting the media. The media is very thick. Intima is very small. The adventitia is also very thin. But media is a thick layer, you know. So, blood is entering from the intimal tear and dissecting the media. Dissecting the layers of the media into various fragments and forming a channel in the media. So, you can see two blood channels. This is true blood channel. This is false blood channel. True and false run parallel. True lumen is true lumen. Okay. And from the two lumen, blood is going in the media and forming one more channel parallel to the main lumen. So, pseudo lumen can be there. So, this is the cross-section of the same diagram. If you cut it from here and look from above, it looks like this. Can you see here? It looks like this. So, please appreciate the tear in the intima. The blood is entering from the intima and dissecting the media. So, it is a very painful condition. The patients say inside the chest, it usually occurs in the aorta. Inside the chest. Patient is feeling like a stabbing pain. Stabbing. Someone is dissecting with a knife. Someone is cutting with a knife. It is that painful condition because who's doing the dissection? The blood is doing the dissection. That's why it is known as aortic dissection. Dissection like a with a knife, with a scalpel, someone is cutting the aorta. The pain is that excruciating pain, severe pain. Say yes, you got it. Okay. So, when blood separates the plane of the media to form one more blood-filled channel which is parallel to the main channel. So, this is aortic dissection. So, you should ask me, ma'am, why there is a tear? Why there is a tear? You are seeing from this tear, the blood is entering now. So, what is the reason for this tear? The reason for this tear, 90% time, the reason for this tear is hypertension. If someone is having high BP, more than 120 by 80, long time, and the person is not taking treatment, because of that high blood pressure, there is a tear. There is a tear. And the blood is going in the media and dissecting it. Because of that, this is hypertension. 90%. But non-hypertensive causes are also there. 90% it is hypertension. But among the non-hypertensive causes, it is Marfan syndrome. The most common cause is Marfan syndrome, in which cystic medial degeneration is seen. Because of which, there is a tear in the intima. Say yes, if you got it. Say yes, got it. So, this is the thing. You can see morphologically. Can you appreciate a tear here, everyone? Say yes. Can you appreciate a tear here? Here? So, from this tear, the blood is entering and dissecting the media. Dissecting. You can see two channels. One is my main channel, main lumen. And one is pseudo. Sometimes, what happens now? From this point, the blood is entering. And you can see this is the tear. The blood is entering from here. And after traveling inside the media, after certain distance, there is one more tear. And blood is coming out. So, a small channel is formed from here to here. Blood is entering from one point and exiting from other point. I must say, the blood is entering from the proximal and proximal tear. And blood is exiting from the distal tear. So, two tears. This is known as double barrel aorta. What is it known as? Double barrel aorta. If you cut it from here, you can see the two lumens. This is the true lumen. And this is the false lumen. True lumen, false lumen. Double barrel aorta. Learn the term. Double barrel aorta having two lumens. Okay, everyone got it? Can we go ahead? This is double barrel. It's very important. What is double barrel aorta? So, double barrel aorta is the aorta in which two lumens are seen. One is true lumen, one is false lumen. It is seen in aortic dissection. The most common cause of aortic dissection is a tear. The tear is caused by the hypertension, most commonly 90%. And among the non-hypertensive causes, the most common cause is the cystic fiber, Marfan syndrome, cystic medial degeneration. Am I fast or is it good to go? You got it? Can we go ahead?

Let me do the classification of aortic dissection. How to classify aortic dissection? There are two schemes for classification: Stanford classification, DeBakey classification. Let me explain you both. Okay? Can you see this diagram? In this diagram only, I will do both the classification. That's DeBakey as well as Stanford. Okay? Please everyone have a look on this diagram. Let's do DeBakey classification. DeBakey classified the aortic dissection in three, three categories: DeBakey category 1, DeBakey category 2, DeBakey category 3. If the dissection involves complete aorta, you can see the dissection is involving complete aorta. The ascending also, arch also, descending also. It is known as type 1. If only ascending aorta is involved, it's type 2. And if only descending aorta is involved, it's type 3. It's very easy to learn. Complete, ascending, descending. Type 1, type 2, type 3. DeBakey is very easy to learn. Let's come on Stanford classification. So, please everyone here, listen. Stanford classification. DeBakey type 1 and 2 is Stanford A. Stanford A includes both. Stanford A includes complete also, ascending also. And Stanford B is only descending. Say yes, if you wanted. Say yes. To DeBakey, it's type 1, type 2, type 3. This is DeBakey classification. Okay? In type 1, it's the complete aorta involvement. In type 2, only ascending is involved. And in type 3, only descending is involved. And what about the Stanford classification? DeBakey type 1 and 2, Stanford type A. And DeBakey type 3 is Stanford type B. So, in Stanford classification, we have only type A and B, not C. Say yes. This is Stanford. Stanford. So, this is important. Although in surgery, but I have covered the classification here. So, that any MCQ coming, you can solve. So, that is all about the Stanford classification and DeBakey classification. You can read the theory. We have done the classification also. We are done with two topics till now on blood vessel. I have covered aneurysm and I have covered aortic dissection. Does anyone have any doubt till now? Shall I move to the next system? We are done with blood vessel. Let's start the next system, CVS. After doing the MCQ and I will start with ischemic heart disease and MI. Okay? So, this is the first question in front of you. I want each one of you to answer it. Can you tell me the most common one cause of abdominal aortic aneurysm? Abdominal aortic aneurysm. The most common cause is it atherosclerosis? Is it syphilis? Is it trauma? Is it congenital? I told you 90% time, what is the cause? Can you please tell me the answer? Yes. Can you please tell me the answer? I am waiting for it. Let's see who is giving the answer. I'm waiting. Yes. Yes, absolutely right. Absolutely right. So, what is the correct answer here? Yes. Yes, Vishnu. The correct answer here is the atherosclerosis. So, I told you three causes of the weakness: atherosclerosis, syphilis, infection. Sometimes it can be trauma also, congenital also. But most common cause, 90% time, it is atherosclerosis. So, and I told you the location also. It's infrarenal. So, correct answer here is A. The next question is in front of you. Most common site of atherosclerotic aneurysm. Can you tell me the site? Don't go on these years. These are for the university exam years. But it is a recent question also, right? Don't go on these years. Can you tell me the answer? Most common site of atherosclerotic aneurysm. Most common site of atherosclerotic aneurysm. Is it coronary artery? Renal artery? Yes, you all are right. Very good. The most common site of atherosclerotic aneurysm is the abdominal aorta. To be specific, in abdominal aorta also, it's infrarenal. Intrarenal. Better was the question if two options were from the abdominal aorta, suprarenal and infrarenal. Right? So, better was the question. But correct answer, you know, it's infrarenal only. It's infrarenal. It's not B. It's not renal artery. The correct answer is D. Okay. You got it. Abdominal aorta. The next question is in front of you. Tree bark like calcification is seen in which aneurysm? The luetic aneurysm, atherosclerotic aneurysm, berry aneurysm, or traumatic aneurysm? Tree bark like calcification. So, the question is very easy, I guess. You all can answer it. So, tree bark like aneurysm. I told you three important features for syphilitic aneurysm. Yes, the answer is syphilitic aneurysm. I told you three important points on which MCQ is there. Number one, if you cut open it, it is wrinkled from inside. That's why it is known as tree bark like appearance. Number two, it is having calcification, linear calcification. Number three, because of which there is aortic regurgitation, leading to left ventricular hypertrophy. The heart size is big. It is known as cor bovinum. All three are PYQs for syphilitic aneurysm, also known as luetic aneurysm. So, if you know the concept, you can answer any question. Okay. So, the correct answer here is A. Can I go ahead? Okay. Let's start the next system. CVS. We are done with blood vessel. Let's start CVS. In CVS, I am going to teach you four or five topics. I will start with ischemic heart disease. In which I will first teach you what is angina. Then I will teach you MI. Everything about MI. Very important topic. Then I will start with endocarditis. I will teach you rheumatic heart disease. I will teach you endocarditis, non-bacterial thrombotic endocarditis, infective endocarditis. So, these are the important, ultra-important, high-yielding topics we are going to cover in CVS. So, in the next hour, I will give five-five minutes to each topic. Not much. So, maybe next 30, 35, 40 minutes, we are going to cover the system. So, in this way, one by one, today we are going to cover 12 systems. Okay. So, let's start with CVS. Let's start with ischemic heart disease. Okay. So, for understanding ischemic heart disease, you have to understand the blood supply of the heart. You can see here, there is a sketch diagram of the heart in front of you. You all have to concentrate here on the left ventricle. Can you all see the left ventricle? I guess all of you can see the left ventricle here. Okay. Now, when the left ventricle is pumping, what happens? We all know, of course. When the left ventricle pumps, the blood is ejected in the aorta. And via aorta, the pure blood is distributed to all the organs of the body. The left ventricle is doing the systole. It is pumping. Whenever it is pumping, whenever it is doing the systole, the blood is ejected in the aorta and distributed to all the organs of the body. But who is giving blood to the heart? Heart is giving blood to everyone, to all the organs of the body. But who is giving blood to the heart? So, from the aorta, for pumping heart, also requires oxygen. Now, heart also requires energy. Energy means ATP. ATP is synthesized or generated from oxygen. And oxygen is present in blood. That's why like every organ, heart also requires blood because heart also wants to generate ATP. From oxygen. So, from where heart, the walls of the heart, the walls of the left ventricle, from where they get the blood? So, answer is coronary artery. So, you can see from the aorta, let me highlight, from the aorta, you can see this purple color artery I'm highlighting, it is coming out of the aorta. So, this is a coronary artery. This is a big coronary artery. It is known as conductance vessel. From which small, small coronary arteries are coming out. These are known as resistance vessels. And these are penetrating in the wall of the left ventricle and supplying the blood to the wall of the left ventricle. So, in the wall of the left ventricle, the cells are cardiocytes. Cardiocyte cells are present. They all get the blood. They all will synthesize the ATP and do the contraction. When they do the contraction, the systole goes on. So, it's a give and take relationship. Not only in heart, in this world, we have give and take relationship. Whatever we give, it comes back. It's nature. It's universe. Okay. It is not a spiritual lecture. Let me concise to the point. Okay. So, whatever blood you are going to the heart via aorta, the same blood, heart will give via aorta. Whatever blood you give to the heart via coronary, the heart will give blood to the aorta. It is known as demand and supply. Whatever you are supplying to the heart, proportion to that only, you should demand. You should demand. So, you are supplying more blood in the coronary. The heart will contract more. When the heart will contract more, more blood will be ejected in the aorta. If you give less blood to the coronary, heart will contract less. If the heart will contract less, less blood will come in the aorta. So, it is a demand-supply relationship.

A give and take, demand and supply balance relationship. Okay, so normally we all have a balance. We all have a balance. So, we give blood to the heart, Maya coronary. We ask the heart to contract, and we receive the blood. I mean, all the organs receive the blood via aorta, right? This is normal till now.

But imagine if the coronary is obstructed, what will happen? Get obstructed, what will happen? The heart will not receive much blood. But so, in that case, the heart will contract less. The heart will not contract vigorously. The heart will contract less because you are giving less blood to the wall of the heart, right? Heart will contract less or heart will stop contracting. So, aorta will not receive the blood, and all organs will compromise. So, that is related, that is known as ischemic heart disease. So, the wall of the heart is suffering from ischemia, you know. So, if you don't supply the blood via coronary, the cardiomyocytes present in the wall, the left ventricular wall, they start dying because they are not receiving the blood. They will have coagulated necrosis. So, it is ischemia, and it is known as ischemic heart disease. So, you understand what is ischemic heart disease? IHD, ischemic heart disease. Ischemia is occurring in the wall of the left ventricle because of less blood supply via the coronary. It is also known as coronary artery disease because ischemia is always due to coronary obstruction. So, I can say IHD is equal to CAD, one and the same thing. Ischemic heart disease, also known as coronary artery disease, because ischemia occurs because of coronary obstruction only. The reason, okay, you got it. So, what is the reason for that? The reason is imbalance between demand and supply. I told you the relationship between the demand and supply. You are giving less, asking for more. It is not a way. Whatever you should give, you should ask for the same. In the universe also, whatever you give, ask for the same. If you give less, ask for more, it will not work, okay? Here also, it is not working. Can we go ahead? Can we go ahead? Are you yes, yes, everyone, okay?

So, for that, you have to understand the coronaries now. I will observe the coronary. So, you have to understand. Now, this is anatomy portion, but I will cover it here. So, there are two types of coronary present in the human body from the aorta. Two types of coronary are coming out from the arch of the aorta: the left coronary artery, the right coronary artery. The main coronary artery has two branches, left and right. Right coronary artery is known as RCA. It doesn't have any further branch. RCA is the final artery. But LCA, left coronary artery, has two branches. The first is left anterior descending, LED, and second is left circumflex, LCX. So, LED and LCX are the branches of LCA. LC is divided into two branches. So, finally, we are having three coronaries: one is RCA, right coronary artery, and two are the branches of the left. What are the two branches of the left? Left anterior descending, the first branch. Left circumflex, the second branch. Now, we are having three, three branches. Let me show you the heart, okay? Can you see this diagram of the heart, everyone on the screen? Please concentrate. If I cut the heart from here and look from above, can I see the section? Let me draw the section. Let me draw the section. I can see I'm cutting from the ventricle, uh, ventricular level. So, I can see two lumens. This is right ventricle, this is left ventricle with the lumen of the ventricle. I am interested in the left ventricle, the walls of the left ventricle. So, in between the two ventricles, there is interventricular septum. I can see the interventricular septum also. So, basically, I'm having four walls. This is anterior wall, this is posterior wall, this is lateral wall, and the medial wall is interventricular septum itself, right? So, we are having four walls to supply. They all should get the blood because because they all have the cardiomyocytes in them. Cardiomyocytes are present everywhere. These are the cells present everywhere. So, all the cells, when they receive the blood, they contract, and in this way, the contraction takes place. The stall takes place. So, all the four walls should receive the blood. So, we are having three coronaries. We are having three coronaries and four walls. So, tell me, which coronary supplies which one? Let's start with LED, okay? LED supplies anterior wall. Please learn that. LED supplies, uh, anterior wall. LCX supplies lateral wall, okay? RCA, right coronary, supplies posterior wall. Please learn that. LED is the main artery, okay? Left anterior descending. It is supplying anterior wall and the apex. Lateral wall is supplied by left circumflex, this branch of the left. And RCA is only one. It is supplying posterior. You will say, ma'am, what about the medial wall? You should ask. Remember, what about the medial wall? Who is supplying the medial wall? We have only three coronaries, not the fourth one. So, the fourth wall, the medial wall, is supplied partially, upper one-third, I mean posterior one-third by RCA, and anterior two-third by LED. The LED supplies the anterior two-third, and posterior one-third is supplied by RCA. Say yes. This is the blood supply in short. I told you. Say yes, everyone. Give me a thumbs up if you got it. Please understand the blood supply of the heart. Now, this portion is from anatomy, but here for understanding MI and ischemic heart disease, angina, you must know the blood supply of the heart. Then only you will have a better understanding, okay? So, these are the types of the coronary.

Now, imagine which coronary is obstructed. What's the most common cause of obstruction of coronary? Again, the most common cause of obstruction of coronary is atherosclerosis. Ninety percent of the time, there can be atherosclerosis in any of the coronary. Sometimes, atherosclerosis most commonly occurs in LED. So, LED is the most common coronary artery in which atherosclerosis occurs. Just a second. The most common coronary is LED, followed by RCA, and followed by LCX, right? So, whatever coronary is obstructed, the person, the patient will have ischemia in that corresponding wall. Ischemia in that corresponding wall. It is not necessarily ischemia occurs in order. If all the three coronary get obstructed, ischemia will be there in all the walls. So, the type of the MI, MI is ischemia, depends which coronary is obstructed. If LED is obstructed, ischemia in the anterior wall. If RCA is obstructed, posterior wall. And if LCX is obstructed, so extreme, anterior wall. So, you must ask me the next question, ma'am, what is the sequence? Most common. The most common, I told you, it's LED, followed by RCA, followed by LCX. The two left are at the extremes, and right is in the middle. Please learn like that. So, you tell me the sequence of the wall involvement. LED supplies anterior. Anterior most commonly undergo ischemia or MI, followed by posterior. Lateral is least common. Lateral is least common, right? So, please learn the basic concepts. If you know the basic concepts, understanding the disease is fun for you. Can we go ahead? Please interact. Right, please interact. Give me a thumbs up in between that you are getting it, okay? So, this is the blood supply. The same diagram is shown to you. So, we are cutting the heart at this level and we are looking from above, and you can see the two, uh, lumens. You can see the lumen of the right ventricle. This is the lumen of the left ventricle. We are interested in left ventricle walls. So, please appreciate the anterior is the anterior wall supplied by LED. Posterior wall is supplied by RCA. Lateral wall is supplied by LCX. Appreciate the medial wall, the interventricular septum. The upper half, I'm sorry, the posterior half is supplied by RCA, and the anterior, uh, two-third is supplied by LCL, LED. So, give me a thumbs up, everyone. You got it? Can we go ahead? Let's come on the disease. If you understood it, let's come on the disease.

So, I am teaching you coronary artery disease. There can be four presentations. Either the patient has angina because of coronary obstruction, or the patient has MI, or the patient has chronic ischemic heart disease, CIHD, or the patient has sudden cardiac death. One of the four things can occur. All four will not occur together. One of the four things will occur because of obstruction of coronary. If coronary got obstructed, the patient can have one of the four presentations. So, out of the four, I will be discussing two in detail: angina and MI. Let's start with angina.

What is angina? The angina's angina pectoralis. What is it? It is a chest pain. The patient will come to you with substantial discomfort. I use the word substernal discomfort. It's not actual pain, it is only discomfort. The patient will say, "I'm not having pain, doctor. On the little bit left side, a stop externally, just below the sternum, a little bit left side, I am having heaviness. I am having a squeezing feeling. I am having a pressure or choking feeling." It can be pain. It is not pain, but heaviness is there. So, I will use the word discomfort. So, use the word substantial discomfort. So, what is angina? What is angina? Angina is not continuous. The patient has the pain between two episodes. Patient is absolutely normal, like asthma. So, between the episodes, patient is absolutely normal. When the patient has the episode, the attack of the angina, at that time, the patient has substantial discomfort, and between two episodes, patient is absolutely normal. So, it is not a continuous disease. It comes in attacks. This disease, angina, comes in attacks. Attacks. And between two attacks, patients is normal. Anything coming in attacks in pathology is known as paroxysmal. What it is known as? What it is known as? Come on, what it is known as? Use the word paroxysmal. So, please understand the pathology is not a subject, more of a subject, it is a language. If you understand the language of the pathology, pathology is a very beautiful subject, okay? So, it is the disease is coming in the attack. It is recurrent again and again. The attack comes, and it is what is the disease? It's substantial discomfort. It is not pain, it is discomfort, and it is transient. MI, the ischemia is transient. The word transient is very important here. I will tell you the meaning of transient, okay? The patient comes to you, "Doctor, I am having substantial pain or discomfort. It comes, it goes. It comes, it goes." Okay? So, what is the main problem? The main problem is demand versus supply. There is an imbalance between them. What is the supply? Whatever you are supplying, the heart is your supply. Your supply, the heart, via coronary. You apply supply the heart via coronary, via coronary artery. You give blood to the heart. So, you are supplying the heart. Whatever you are demanding from the heart is from aorta. You want the heart to pump and give you blood via aorta, so that all the organs should receive the blood. There should be a balance, right? It is I'm not saying exact equal, equal is not the word, balance is the word. So, whatever blood you are supplying via coronary, the proportionate blood you should get in the aorta. If your supply less, if you ask for more, there's an imbalance leading to this. So, the reason for the angina is this. You got my point, okay?

Okay, so can we go ahead? Ah, so give me a minute, one more minute, okay? There are three types of angina. They are in front of you: stable, unstable, Prinzmetal. Learn their other name. Stable also known as classical, okay? Unstable also known as crescendo, and Prinzmetal also known as variant. There are three types of angina. Please learn their two, two names. Well, I will let you know the meaning. Why it is important to know the three types of angina? If you say, "Man, with the patient is coming to me with a chest discomfort, it's angina." Why we have to divide it into three types? Because the treatment of all three is different. The prognosis of all three is different, okay? You cannot say it's angina, treated same. You have to find out the type of the angina and treat it accordingly. Let me explain you the reason for all three. Let me come on the first angina, the classical angina or stable angina. Among the three, this one is the most common. The stable and the classical, it's the most common among the three. This is the most common. Now, what's the reason? I have not drawn the diagram. Uh, okay, let me show you all three in this diagram. Please have a look, everyone. Can you zoom it out? Please see here, the three types of angina I'm showing you in this diagram, okay? Let me highlight the coronary. Where is the coronary? This is the coronary. This is the coronary artery supplying the blood to the left ventricular wall, okay? I will do three things one by one. First, producing atherosclerosis in this coronary because of this atherosclerosis, the blood reduction will be there. The blood supply will be reduced in the coronary, and because of which the angina occurs. It is known as stable angina. Stable or classical. So, stable or classical is due to atherosclerosis. But atherosclerosis never completely obstructs the coronary. It only partially obstructs. It is blood. No, it's not that it is getting partial blood, you know. So, if someone is having atherosclerosis in one of the coronary artery, and the atherosclerotic plaque is partially obstructing the lumen, partially, partially obstructing the lumen of the coronary, so heart wall is still getting the blood, and that blood is sufficient for basal metabolism. You are giving less blood via coronary. Heart will say, "Okay, you give me less blood, I will also give you less blood." Give and take. You give me less, partially, I will also contract partially and give, eject less blood to the aorta. But that less blood is sufficient to all the organs for basal metabolism. If I do nothing, just sitting down, that blood is sufficient for my body. But if I start running, jogging, doing any physical activity, my demand of the blood is increased, you know? At that time, my organs are asking for more blood to the aorta. Aorta will say, "Okay, let me ask more blood to the heart." So, heart is saying, "No, you are giving me less blood, I will give you less blood." So, basically, the patient has pain only at the time of exertion. Whenever the patient is running, jogging, patient has chest pain. Whenever the patients sit down, the pain disappeared. This is a classical angina, the stable angina, and I hope you got the reason. The blood supply is sufficient for the basal metabolism, but it is not sufficient for the exertion or increased physical activity. So, at the time of the physical activity, patients have chest discomfort. At rest, it disappears. Give me a thumbs up, you got it. This is classical angina, classical angina, also known as stable angina. You got it? This is the first type of angina.

Let me come on the second type. In the second type, the obstruction of the coronary is still there, but it is not the atherosclerosis. It is some non-atherosclerotic cause. It can be thrombus, it can be calcification, it can be plaque, it can be something else, but it is a non-atherosclerotic cause, and it usually sometimes it can cause complete obstruction of the coronary. The complete obstruction can be there. So, patient can have pain every time, at the exertion also, and at rest also. So, this differentiates the unstable angina from stable angina. In stable angina, patients have pain or discomfort only at the time of exertion, but at rest, it disappear. But in unstable angina or crescendo angina, patients have pain all the time. At rest also, it doesn't disappear. At rest also, at activity also. You got it? Kindly say yes if you got it, okay? So, that is, uh, that is the thing.

Okay, so coming on the third type of angina, the variant angina, the Prinzmetal angina. The cause of the obstruction is not atherosclerosis. The cause of the obstruction is not thrombosis. The cause of the atherosclerosis is vessel spasm. So, the third type of angina, the cause of the obstruction is vessel spasm in the wall of the coronary, and basal spasm is sudden. Anytime it can come, anytime it can go. So, these are the three types of angina. What are the three types of angina? What's the reason for stable angina? It's atherosclerosis. What's the reason for unstable angina? It's non-atherosclerotic obstruction, like thrombosis, like thrombosis. And what's the reason for Prinzmetal or variant angina? It's vessel spasm. So, tell me the treatment of all three. Can you tell me common sense treatment of all three? For stable angina, there is atherosclerosis. Now, you will give statins, or you will do the stenting. There is no drug which can dissolve the already formed atherosclerosis. For that, you have to disclose and do the stenting. For thrombosis, you have to give antithrombotic drugs. And for vasospasm, you have to give vasodilator, arterio dilator, especially because coronary is the artery. So, treatment of all of them. Here we give statins. Here we give antithrombotic drugs. And here we give the vasodilators. Here, statins is for prevention, but for treatment, we have to do the stenting, the surgery, the stenting. Say yes if you got it. Can we go ahead? Can we go ahead? Yes, yes, very good. Okay, so that is the three type of angina. Not read theory. I have already explained you the classical angina, stable angina is the most common type of angina. Your reduction in coronary due to atherosclerosis is there. So, atherosclerosis is the main reason. Patients have chest discomfort, not the pain, please mind. It's not pain, it's chest discomfort. Patient will say, "I'm having heaviness in the chest. I'm having pressure feeling, choking feeling, squeezing feeling, smothering feeling in the chest. Someone is compressing my chest." It is feeling like that. A heaviness is there. It's not pain. Patients have this feeling only at exertion. This feeling disappears at rest. Okay? If you ask the patient, patient to localize where it is. So, patient will put the hand on the chest like this, and you know the fist. The patient will hold the fist like this. "I am having like this pain." It is known as Levine sign. The pain lasts only for two to five minutes, that's it. The unstable angina, the reason is not atherosclerosis, it's thrombosis. It's thrombosis. Here, patient have discomfort at rest also, at exertion also, right? And the third one is the Prinzmetal. Here, the reason is the vessel spasm. Here also, patients have pain at rest also. So, that is the three type of angina. We are done. Are you people awaken or sleeping? Or who are you? Awakened? Are you people still there? Okay, can we go ahead? Can we go ahead?

So, let's come on MI. The next topic is MI. The next topic, atherosclerosis and thrombosis are entirely different things. Siri, atherosclerosis is a plaque made up of cholesterol. Thrombus is the clot without injury. If you have watched my yesterday's lecture, you may know what is thrombus. You can watch it. It's available on the YouTube. Yesterday, in general pathology, I taught you what is thrombosis. Atherosclerosis, I will later come on. Okay, let's start the next topic that is MI. Can I come on the MI? The next topic is myocardial infarction. So, let's start myocardial infarction. Here also, the reason is same. Here also, the three same three reasons are there: it can be atherosclerotic plaque, it can be thrombosis, it can be vasospasm. So, basically, there is obstruction in the coronary. Whatever is the reason, let's say atherosclerosis, let's say thrombosis, let's say vasospasm. Whatever is the reason, the point is that the ultimate point is that the coronary is obstructed, either partially or completely. The coronary is obstructed. If the coronary is obstructed, there is less blood supply to the heart. What is the difference then? You must ask also. Here in MI, what is different? In angina, it was occurring and going. It was partial, right? So, it was coming at the time of exertion and going at the time of rest, or else vasospasm was coming and going spontaneously for few seconds. It is coming and going. So, here the ischemia was transient. Here, once it was occurring, it is not going back. Here, it is persistent, and that is leading to permanent ischemia, not transient. So, ischemia occurs in both. In angina, yesterday I taught you five types of necrosis. If you remember my yesterday's lecture, the most common cause of necrosis is coagulative necrosis. So, ischemia of all organs except brain, yesterday I taught you, is all organs except brain have coagulative necrosis. So, here also, in heart, there is coagulative necrosis. So, in MI, there is coagulative necrosis. You can see, let me draw. You can see the cells. I'm drawing the cells in the left ventricle. Can you see? I'm drawing the cells in the left ventricle. These all cells receive blood from the coronary. Now, imagine the coronary is obstructed. You are saying, "Ma'am, the coronary is obstructed, atherosclerosis or whatever." So, there is less blood supply to all these cells. All these cells will not receive blood. Now, will not receive blood, so they will start dying. They will start dying, and the death of the cell is necrosis. It's coagulative necrosis. It's an infarcted area. So, that is MI. That is MI. It's the infarction or coagulative necrosis of the myocardium of the left ventricle due to decreased blood supply because there is no obstruction in the coronary. The reason for obstruction can be atherosclerosis, can be thrombosis, can be vasospasm. Doesn't matter, but it is persistent. It will not come and go like angina. It is not transient. It's persistent. The same three reasons: atherosclerosis, thrombosis, vasospasm. The same three reasons.

Now, let me come on the type of MI. There are two types of MI. Do you know what are the two types of MI? Can anyone tell me what are the two types of MI? Let me explain you the two types of the MI, okay? I'm zooming out this portion. Can you see here? I am zooming out the wall of the left ventricle. Please see. So, let's zoom the wall of the left ventricle like this. This is the thickness of the wall of the left ventricle. This is lumen of left ventricle, left ventricular lumen, and you can see the thickness. Can you tell me where is the coronary? This is the bigger coronary, the conductance vessel, and this is the smaller coronary coming inside, supplying the wall of the left ventricle like this. Everyone, give me a thumbs up if you got this diagram. Let me explain you two types of MI here. Everyone, give me a thumbs up. You got it? You got it? This is the bigger coronary. From a small, small coronaries are coming out, and they are going inside. Can you see the coronaries are coming from outer to inner? The coronary, see the direction. The coronary is coming from outer portion to inner portion. This is inner, this is inner portion having the lumen, and this is outer portion of the lumen, right? Okay, the wall of the left ventricle, I mean. So, you can see the blood supply of the via coronary. Now, imagine here is the atherosclerosis. So, no blood is coming here. So, all these coronaries which were normally receiving the blood, they are receiving less blood. All these coronaries. So, you tell me, apply your common sense and tell me that ischemia or necrosis occurs at which portion? Let me give you two options. Occurs in inner half or outer half? First, where it occurs? Is it occurring inner half of the myocardium or outer half of the myocardium? It starts from what point? Common sense, can you apply your common sense and tell me the answer? If the blood supply is obstructed, if the blood supply is obstructed in all these small coronaries, they have less blood or no blood. All these small coronaries have no blood. Imagine it's complete obstruction. None of the smaller coronary have the blood. So, ischemia starts from the inner half or outer half? I'm asking you. So, bubbly, Ramdas, everyone, I cannot read your names. Come on, can you please answer it? Outer? Why outer? Ramdas, why outer? Osama is saying inner. Let me tell you, inner is the correct answer. It's not prominent. You can see now, listen, listen, listen. So, there is no blood supply in the smaller coronary. So, Pele, whenever we are going inside, inside, these are the end arteries. So, here the inner portion is already having compromised blood because it is having less blood. These are the end arteries, you know? So, the inner, inner half is already having compromised blood. The outer half. Now, when the blood goes from outer to inner side, the outer have more supply, and as we go deeper, deeper, inner, inner, inner, the blood supply go on reducing, reducing, reducing, right? The inner already have less supply, and on that, on top of that, you are obstructing the coronary. So, inner will have zero supply. So, always remember, always remember, the ischemia starts from the inner half. The ischemia starts from the inner half, like this, like this, and it go on progressing, progressing, progressing, progressing, progressing, and in 24 hours, it involves throughout the thickness. So, this is the two types of MI in front of you. The two, two types of the MI. So, this MI is known as subendocardial. Only inner half is involved. It is known as subendocardial MI. And this MI is known as transmural. Transmural means full thickness. Full thickness is involved. So, these are the two types of MI. Everyone, give me a thumbs up. What are the two types of MI? It is subendocardial and transmural. Yes, based on the ECG, it is STMI and non-STMI, but that portion will be dealt in medicine, I guess, not in pathology. Pathological point of view, the MI is of two types, you know. You got it? Can we go ahead? Say yes. Okay, so inner half is involved, it's subendocardial. Outer half is involved, it's trans, but it's known as the endocardial. Heart has three layers: endocardium, myocardium, pericardium. Where is the endocardium? I guess here is the endocardium. This is endocardial layer. After that, myocardium, I have drawn the thick layer, and there is pericardium outside. So, this, the inner half is near the endocardium, just below the endocardium, that's why it is known as subendocardial. I hope everything is clear. So, what are the two types of MI? Can you please tell me the two types of the MI? Now, the two types of the MI is the subendocardial, in which only inner half is involved, and second is transmural, in which entire thickness is involved. I hope everyone got it. The same you can appreciate here. I guess everyone can see here. This is the right ventricle, your lumen. This is left ventricle. This is right ventricle. This is left ventricle. I am interested in left ventricle. In the left ventricle, see here, see the MI. Where is the MI? Where is the infarct? I mean, here only inner half is involved. Here, the full thickness is involved. You yourself decide. Here it is subendocardial. It progresses, progresses, and subendocardial converts into transmural. Transmural, okay? Can we go ahead? Okay, so here also you can see the diagram. Let me explain you this beautiful diagram. Everyone, here on the screen, can you see the three diagrams in front of you? These three, I'm talking, okay? See the three diagrams. The three diagrams have the wall of the left ventricle. See the coronary. Appreciate the coronary. It's currently, it's not obstructed. Just obstruction have occurred at 0R. It's 0R means the obstruction have started. Till now, there is no impact. Now, within the two hours, the impact is starting from inner side. So, it's the endocardial. And within 24 hours, it progresses, progresses, progresses, and full thickness, it converted into full thickness and part. So, everyone, appreciate this diagram if you got it. So, subendocardial converts into full thickness within 24 hours. It starts from the inner side. I hope you got it. I hope you got it. So, what is the location of the infarct? It depends on the type of the coronary. I told you, there are three coronaries: LED supplying anterior wall, LCX supplying lateral wall, and RCA supplying posterior wall. I told you already, right? Now, please again see this beautiful diagram from the Robbins. Let me explain or decode this diagram. It's very easy. See everyone, the central diagram is the normal. The central diagram is the normal. You have to give me one minute. Um, there is power cut off. So, the sound is there of the inverter. Let me switch off this invert. I mean, the sound of this inverter. Give me one minute, otherwise it will distract us. Still it's coming, I guess. Let me wait. I guess it's gone. Okay, no, it's still coming. Give me a minute. Yeah, I'm sorry. So, can you see the central diagram? It's normal. The central diagram is normal. You can see the right ventricle, you can see the left ventricle. You can see this is anterior wall. So, this artery is LED. You can see this is posterior wall. So, this artery is RCA. You can see this is lateral wall. So, this artery is LCX. You can see the three coronaries supplying the three walls, right? Now, on this side, we are obstructing the three coronaries one by one. You can see here, LED is completely obstructed. Here, LCX is completely obstructed. And here, RCA is completely obstructed. I guess you, RCA is completely obstructed. You can see the corresponding, please appreciate the corresponding, um, uh, impact. So, when LED is obstructed, you can see the anterior wall is showing transmural thick, transmural impact. If LCX is obstructed, the lateral wall is showing. That RC has obstructed, the posterior wall is showing. That you can see it is completely obstructed. The full thickness obstruction is there. Whenever the corresponding coronary is obstructed, the full thickness obstruction is there. Now, the same, you can see if partially they are obstructed. Now, see the coronary. It is partially obstructed. This one is partially obstructed. This one. So, it is transmural in part. So, when the coronary is partially obstructed, it is transmural in part. And when the coronary is completely obstructed, I am sorry, when it is partially obstructed, it is the endocardial impact. And when it is completely obstructed, it is transmural in fact. I hope you got it. So, there are six types of infarct. Three are transmural, the three are subendocardial. Now, depending which wall is obstructed, is it anterior? Is it lateral? Is it posterior? Depending on the coronary, which coronary is it? So, the six types of infarcts are there. So, can we go ahead? Now, the most important thing I would like to explain here is the gross and microscopy of the infarct. Imagine, imagine there is a person. This person is dead. Okay? There is a person. All of a sudden, this person is dead. He was healthy, he was normal, and all of a sudden he's dead. He's having chest pain, and they are dead. So, police is suspecting some foul play. So, the dead body came for the postmortem, for the autopsy. So, I'm the doctor. Just imagine I am performing postmortem on this dead body. So, what I should do? What I'm supposed to do? What I'm supposed to do? I am supposed to take the heart out of this patient and look for the infarct. Whether the patient have MI or no? And what is the timing of the MI? You know, the timing of the MI is the age of MI. If the timing of the MI is correlating with the death of the patient, I will say that the cause of the death is MI. If it is the same time, and maybe this patient have MI 10 years back, but now the cause of death is something else. So, the first thing, MI present or absent? And if it is present, what is the age of the MI? What is the timing of the MI? Age of the MI is it for our, poor, old? Is it, um, 24 hours old? It is five days, seven days, one month, or more than one month old? So, I will write that in the, uh, my postmortem report, and police will correlate that with the timing of the death, right? So, that is the thing we want to do. That. So, for that, first we will take the heart out and look for the gross. So, just suppose this is the heart of the patient, not patient, the dead body. We have taken it out. Now, what I will do? I will cut in slices, multiple slices. Each slice, I will cut at 0.5 centimeter or 0.1 centimeter. I am having hundreds of slides with me. I will take all the slides in this, in this container, all the slices. Now, I will take each of the slide, each of the slides have two lumens, each of the slice have two lumens, the right ventricle, the left ventricle. In the wall of the left ventricle, I will look for infarct in all the slices, in all the. You will say, "Ma'am, it's a tedious exercise." You have hundreds of slides. You will take each of them and with a magnifying glass, search for the infarct. It can be a very small area, a small yellowish area, you can see. So, you can see, "Ma'am, you can miss it sometimes." Yes, if it is very small, sometimes we can miss it. Of course, it can happen with us. So, we can give a false report in the postmortem. We do not want that. So, for for that, there is a dye. It is a dye. There is a dye. The name of that dye, the red color dye is TTC. What is the full form of TTC? It's triphenyl tetrazolium chloride. Triphenyl tetrazolium chloride. TTC. Please imagine this is a container. Will this container with TTC, tetraphenyl tetrazolium chloride? Fill it with TTC. Take your all slices of the heart. I'm taking only one, but you take all of them. Put all the slices here. Right ventricle, left ventricle, all the slices in this container. Okay? Now, there is a rule. There is a rule. The rule is that TTC gives, I'm sorry, red color to the viable area, and TTC gave no color, I mean, yellow color, no color or pale color to the dead area, the non-viable area, non-viable area. So, this is the rule. This is a rule. TTC. So, all these slices become red color, except the infarcted area, which will be yellow. So, one of the slice will be like this, having the infarct, right? Few slices will be like this. You can see the complete slices red, it is viable. But you can see this portion is yellow. This portion is yellow. So, this is infarcted area. So, this is how you can highlight the infarcted area on the viable area. This is TTC. Say yes. Say yes. You got my point, okay? You got my point. This is TTC. Very good, very good. Okay, everyone, give me a thumbs up. So, please learn TTC is very important. So, you should ask me, "Ma'am, why the viable area is red and non-viable area is white?" You know? So, uh, whenever there is ischemia, the cell bursts. This is a cardiac cell. This is the nucleus of the cardiac cell. The cytoplasm of the cardiac cell have an enzyme, dehydrogenase. Dehydrogenase enzyme is present, and during ischemia, it bursts. It bursts. So, dehydrogenase enzyme is lost in the blood. So, the dead cell do not have dehydrogenase. The viable cell have dehydrogenase, and TTC binds with the dehydrogenase. This is the principle. TTC binds with dehydrogenase. So, it will bind only on the viable area, not on the dead area. Viable area have dehydrogenase, they become red in color. That area do not have dehydrogenase, they are burst. Dehydrogenase is lost. So, they will remain pale. They will not take the dye. Say yes if you are getting all the concepts. Am I too fast, or you are getting the concepts? Can they appreciate? Come on, say yes. So, this is the diagram. Can you see here? Here also you can see. This is the dead area which is pale, and complete other slices red. So, it is having the dehydrogenase, okay?

Now, coming on the microscopy. So, even you come to know with the help of TTC, you come to know its MI. Make your postmortem report and submit it to the police. So, it is having MI. No, half job is done. MI is present. I came to know. I can see the MI. This is the MI. This is the MI. But I don't know the age of this MI. Is this MI four hours or is it eight hours ago? Is it 20 hours ago? Is it one day ago? Three days ago? I want to know that also. For knowing the age, you have to make a slide. You have to make a slide. The histopathological slide. You have to do the microscopy on gross. We can say MI present or absent. But if you want to know the exact age of the MI, you have to do the microscopy. Say yes if you got it. Say yes if you got it. Can we go ahead? Yes, okay. So, in the microscopy, I divide it into 10 time zones. This is the ultra important topic. Please mind my words, and this is the most difficult topic of MI, I must say, as per my opinion. It's very difficult, right? I'm trying to super duper simplify it, okay? So, please pay attention. So, I'm dividing in 10 time zones, okay? Now, make a slide of this area. Cut this area. Make a slide. Look the slide. In the slide, what you are seeing? Based on that, decide your time zone. So, I will show you 10 diagrams right now. 10 diagrams, okay? For 10 time zones. First, learn the time zones. First, learn the time zones. Zero to half hour, half to four hours, four to 12 hours. So, it was R, R, R, okay? And 12 to 24 hours. I'm sorry. So, four times it is R, R. Zero to half, half to four, four to 12, 12 to 24. 24 hours means one day. So, one to three days, three to seven days, seven to ten days, 10 to 14 days. So, four times it is days, days, days, days, okay? Now, 14 days is too big. So, two to eight weeks, more than two months. So, one week, one month, to learn like this. How I learn? Let me tell you. So, it's R, R, R, R, R, then it is day, day, day, day, then it's a week, and then it is month. Now, let me fill. Let me fill. I will try, huh? So, it's zero to half hour, half to four hours, four to 12 hours, 12 to 24 hours, 24 hours, one day. So, say one to three days, three to seven days, seven to ten days, and 10 to 14 days. 14 days means two weeks. So, two to eight weeks, and eight weeks means two months. So, more than two months. Everything is same. Now, I am going to give you 10 diagrams. If you learn the time zone, the first thing was to learn the time zone. If you know the ten time zones, I told you a trick. Four are the R, R, R, R are the days. One is week, one is month. In this way, they are ten. They are ten in number. Now, let me tell you the 10 diagrams. During zero to half hour, no change is seen. The heart will be normal. If you make a slide of this area. Now, within zero to half hour, it's reversible, and you cannot find anything microscopically. You can miss it. You can miss it. After 30 minutes, after 30 minutes, you will see the waviness. Let me show you the waviness. Normally, the heart fibers are straight. They are straight. But here, I can see they are wavy. They are normal, but they are wavy. They are normal, but they are wavy. So, first thing is waviness. They are like wavy. Normally, they are not wavy. They are straight. They are straight. But in MI, they become wavy. So, between zero to half hour, only thing you find is the waviness. Waviness is the earliest feature. It's a PYQ. Say yes. You can see the nucleus is normal. These cells have the nucleus. You can see the striations, you know, the dark and light bands are there. It's normal. Everything else is normal apart from waviness. Waviness is the first thing, right? From four to 12 hours, you will get coagulative necrosis. Coagulative necrosis. See the upper half of this diagram. Can you see? Can you compare the upper half with the lower half? Now, in the upper half, see the cardiac fibers. Again, you can see only pink color strands are there. I cannot see the nucleus. I cannot see the striations. So, it is, you know, yesterday I told you, only shape is maintained, but the cytoplasmic and nuclear details are lost. The tombstone, the ghost appearance. Now, compare the lower half with upper half. The only shape is maintained, but the cytoplasmic detail and nuclear details are lost. It is coagulative necrosis. So, coagulative necrosis occurs only. Coagulative necrosis. Between 12 to 24 hours, along with coagulative necrosis, few neutrophils will also come. See the upper half. Only yes. Can you see all these cells? See the nucleus of all these cells. These are multilobulated. They all are neutrophils. They all are neutrophils. So, the word is few, right? Now, during one to three days, along with coagulated necrosis, abundant neutrophils will come. See the next diagram. Now, here also there is coagulated necrosis. You can see along with the coagulated necrosis, but see the number of the neutrophils. Appreciate the number here. They are few, and appreciate the number here. They are abundant. So, abundant neutrophils are there, okay? Now, three to seven days, neutrophils will decrease, and macrophages will come. Can you see in this diagram? Only let me highlight this cell, this cell, this one, and this one, okay? You can see these cells have one nucleus. These are macrophages, and rest all are neutrophils. The neutrophils will start decreasing, and macrophages will start increasing. What are macrophages? What does they do? What does the macrophage eat the dead muscle? It eats it, engulfs the dead muscle. So, now whatever dead muscle is there, macrophage start eating it. So, that muscle will disappear. The dead muscle will disappear. You can see. So, instead of dead muscle, there is granulation tissue. So, now the granulation tissue will form. Granulation tissue will mature. You can see this is granulation tissue. Can you see dead muscles are present in the lower half, but they are absent in the upper half? In the upper half, macrophages have already eaten it, and instead of it, granulation tissue is formed, right? And finally, this scar is formed. Collagen and scar is formed. Let me, let me draw the diagrams for you. Let me highlight it. Everyone, everyone, can you please help me to say R, R, R, R? Say day, day. Say weeks. Say month. Okay, let me try to write. So, zero to half hour, half to four hours, four to 12 hours, 12 to 24 hours, 24 hours, one day. So, say one to three days, three to seven days, seven to ten days, 10 to 14 days. 14 days means two weeks. So, two to eight weeks, and eight weeks means two months. So, more than two months. So, these are the ten time zones. We all know that. We all know that. Let me tell you the findings. Can you please tell me the findings and sequence? See, zero to half hour, normal. I will miss it. Please learn how to pour out its waviness. I have shown you the diagram of waviness. So, here the fibers will be like this. They are wavy. They are normal, but they are wavy. After that, we find only coagulated necrosis. So, these fibers, the shape is same, but the cytoplasmic and nuclear details are lost. So, it's tombstone appearance. Now, along with the coagulated necrosis, few neutrophils will come. So, the coagulated necrosis is there, but along with that, I am getting few neutrophils. Few. After that, along with the coagulated necrosis, I am getting brisk neutrophils, abundant neutrophils. So, the same diagram. Coagulated necrosis is there, but I am getting abundant, abundant neutrophils. Abundant. These are the rough diagrams, just for the sake of learning and drawing, okay? Now, the next, the next, the neutrophils decrease, and macrophages start appearing, okay? So, some of the neutrophils will decrease, and instead of that, most of the cells are still neutrophils. They are still neutrophils, but some of them are macrophages. Let me draw a few macrophages. Some of them, macro, will start eating the dead muscle. Now, the granulation tissue will form because it is formed, and then it establishes. First, it is formed, then it establishes. The granulation tissue. Finally, collagen and scar is there. Collagen and scar. This is the thing. How you have to learn? Everyone, give me a thumbs up if you got it. I have put my many efforts in making this table, the simplified for you. If

You read it from it. It will be a bouncer for you, but I have super simplified it for you, so you got it. So this is the 10 time frames, and you can see all the diagrams. This is finally scar. Everything will disappear, and scar will form. Finally, scar is formed. You got it. You got it. So this is the microscopy. Now let me come on the diagnosis. How you do the diagnosis of MI? Can you tell me how you diagnose MI? There are two things you can do: the ECG, or you can take the blood sample in a test tube and look for the cardiac markers. Look for the cardiac markers.

In the ECG, you will find three changes. Yes, very good. Some are absolutely right. Great, great efforts. I appreciate it. Listen, in the ECG, there are three findings you can see. Normal ECG has five waves: P, Q, R, S, and T. You can appreciate this is P, this is Q, this is R, this is S, and this is T. You can appreciate the five waves. Now, this is ST elevation. Can you see the ST elevation? This is T, T inversion. Appreciate the T inversion, and this is deep Q. The most common is ST elevation. So these are the three ECG changes. The details will be taught to you in medicine, but this is the basics you can understand here. So these are the three ECG changes. Based on ST elevation, we divide the MI into two categories: STEMI and non-STEMI. We know that. So ST elevation, T wave inversion, and deep Q. One of these findings will be seen in the ECG. That is a spotter that it is a case of MI.

Number two, you can take the blood sample. Imagine this is the patient. It is having MI. A rough sketch diagram I am drawing. The patient is having MI. So this is the heart of the patient, and this is the blood vessel of the patient. Okay, these are the cells of the left ventricle. Imagine these are the cells of the left ventricle, left ventricular wall. These are the cells, these are the cells of the left ventricle wall. So basically, what is happening in MI? They are bursting, they are dead, they are bursting. So group of cells is dead, they are bursting. So they will release, they will release five enzymes in the blood. And if you take the blood sample in a test tube, look for the five enzymes. These are known as cardiac markers. So whenever the patient has MI, these five enzymes are released in blood, and their level in the blood is more. So these are known as cardiac markers. You should understand the basically cardiac marker. So basically, these are the enzymes that leak out from the dead, dead cells, dead myocardial cells. Okay, now what are these? These are five in number. To learn their name first: myoglobin, CK-MB, also known as AST, and LDH, right? Lactate dehydrogenase, right? Myoglobin is the earliest. It is the first marker which leaks out and comes in the blood within two hours. It comes. It is the earliest, right? And last to remain till 10 days is LDH. LDH comes late but goes late. The last to go is 10 days is the LDH. And among them, the most specific and sensitive marker is troponin. So there are three questions. There are three questions in front of you. The first two appear is myoglobin. Last to go is LDH. And more sensitive and specific is troponin. Troponin. You got my point? Okay, okay, okay. So let's solve some questions.

Okay, you can Telegram me if you want some books. If I will be having the soft copy, I can, I can send you the hard copy on the Telegram. Okay, anyways, so let's solve some questions. We are done with MI. We are done with angina. We are done with MI. Everyone on the screen, tell me the answer of this question. During autopsy of a patient of course, we do the autopsy. That the dead person, there is a patient who is dead, and we are doing the autopsy. What is the cause of the death? The suspected cause of the death is MI. So you put the heart in TTC, tetraphenyl tetrazolium tetrachloride, TTC. So what will be the color? What will be the color of the viable myocardium? Tell me the answer. Is it blue? Is it white? Is it red? Is it dark brown? Who will tell me the answer? Who will tell me the answer? Yes, what is the correct answer? Yes, what is the correct answer? Very good. So correct answer is red. So red is the viable. Viable is red because it is having dehydrogenase enzyme, and dehydrogenase enzyme picks up the stain. Instead of viable, if I ask in the same question, non-viable, non-viable answer will be pale or yellow, but it is not given in the option, but I am telling you, it will be pale or yellow.

So the next question is in front of you. You all are right. Yes, the next question is in front of you. Earliest change in MI. I told you the changes. Now, what is the earliest change in MI? Is it macrophage infiltration? Neutrophil infiltration? Or waviness? Or coagulated necrosis? So, yes, you all are right. Absolutely right. The correct answer here is what's the correct answer here? Yes, you all are right. The correct answer here is waviness. Waviness is the earliest histological change you've seen in MI in half to four hours. Zero to half hour, we see nothing. In half to four hours.

Now, in the same question, I'm asking you one more question. Arrange them in sequence in ascending order from earliest to latest. Can you arrange them in a sequence? Is it A, B, C, D? B, C, A, D? C, D, A, B? Like that? Please arrange a sequence from earlier event to later event. Who will arrange it for me? Let me see who is the first fastest finger first. ABC. So let me see who is the first. You know the events now. You know the sequence of the events, time-wise. So kindly let me know. Yes, kindly let me know the sequence. I am waiting for your answer. I want to know the sequence, right? For in ascending order, the earlier event till later event. Yes, so first is the waviness, of course. So C is the first. After that, there is coagulatory necrosis. So D is next. After that, neutrophils come, then B, and last, macrophages come. So A. Yes, you are absolutely right. The correct answer is CD ba in this sequence. You have to learn. Those who are wrong, please correct yourself. So this is the sequence. First waviness, then coagulation necrosis. I told you the entire sequence.

The next question is in front of you. In MI, microscopic picture of coagulated necrosis with neutrophilic infiltration is seen at what? It's a tricky question. So I'm asking coagulated necrosis with neutrophils. It is seen at which time zone? Is it seen as half? 4 to 12 hours? 12 to 24 hours? One to three days? Or three to seven days? You want to see the chart? Shall I show you the chart? The complete chart. What is the correct answer here? Can you tell me what is the correct answer? What's the correct answer here? In which time zone coagulating necrosis with neutrophils? So I guess you can get confused. I guess you can get confused here because I have not mentioned the word few or brisk. If I use the word few, answer is 12 to 24 hours. If I use the word brisk, answer will be one to three days. You got my point? So both are correct. Both are correct. But I'm going with the brisk. I I guess both answers are correct. But if you go with the brisk, answer will be C. So it is a clinch in the question. B and C both are correct. B and C both are correct.

Okay, the next question. The cells which are seen at 48 hours. Can you tell me the answer? What it answers? What it does? It's how many days? It's two days. 48 hours is two days. Yes, 48 hours is two days. So divide the time zone: 0 to half, half to four, four to twelve, twelve to twenty-four, one to three day. So in this time zone, which cells are coming first time? Which cells are present in this time zone? One to three day. What's the correct answer? In one to three days, which cells are present? In one to three days, neutrophils are present, right? And if I change the time zone to 72 hours, three to seven days, answer will be macrophages. You got my point? So depending on the time zone, we have to answer this. So can you tell me the first enzyme to be raised in MI? The first enzyme to be raised in MI. Answer. Can you tell me what is the correct answer? The earliest enzyme which comes in the blood within two hours. You all are right. The correct answer here is myoglobin.

So basically, we are done with this topic. The next topic to be covered here is endocarditis. The next topic to be covered here is endocarditis. Can we go ahead with the endocarditis? Yes, you all are right. Yes. So can we go with the next topic? Endocarditis. Here I have to teach you four types of endocarditis. I will be covering all four endocarditis one by one. So what is endocarditis? Before coming on the topic, you must understand what is endocarditis. In the heart, there are three layers. Can you see the three layers? You should appreciate the three layers of the heart. The innermost layer, the innermost layer is the endocardium, seen by the red color. The middle layer is the myocardium, seen by the black color. And outermost layer is the pericardium, seen by the blue color. You can see the three layers in the heart: endocardium, myocardium, pericardium. The heart is having three layers like the blood vessel. Okay, now endocardium is of two types. Listen here. The heart walls. What about the walls of the heart? Walls of the heart. Heart has walls. In the middle, wall, back, spitball, tracker, spitball, semi-normals. The walls are made up of which endocardium? The heart walls are also made up of endocardium. It is having an only endocardium. So the endocardium which is present on the walls of the heart is valvular endocardium. And the endocardium which is present on the rest of the heart is mural endocardium. So basically, endocardium is of two types. The endocardium which is present on the walls is valvular endocardium. The endocardium which is present on the rest of the heart is mural endocardium. Apart from that, myocardium and pericardium is there. What is endocarditis? Itis and pathology is inflammation of that particular portion, that particular tissue. Endocarditis is inflammation of the endocardium. So as I told you, endocardium is present on the walls. Walls are inflamed. When the walls of the heart are inflamed, on the walls of the heart, vegetations are formed. So basically, in all types of endocarditis, we have vegetations on the heart walls because of endocarditis. You got it? Can we go ahead? So how many types of endocarditis are there? Inflammation of the endocardium is endocarditis. Heart walls are always involved, and that's why vegetations are always there. There are four types of endocarditis in our syllabus. I will be teaching you all four right now. So you have to do a comparative analysis between all four, between the vegetations of all four. First, I will let you know rheumatic fever, the non-bacterial thrombotic endocarditis, endocarditis. Then infective endocarditis. These all are four types of endocarditis. Let's start with rheumatic fever. The most important is the first and the last. So first is rheumatic fever. Let's start with rheumatic fever. Shall I start with rheumatic fever? Are you people there? Can we start with rheumatic fever? What is rheumatic fever? Please see this diagram. What is rheumatic fever? It's explained here. It's like a story. Can you see? It is a child. Rheumatic fever occurs in child, usually. So this is a sketch diagram of a child. Imagine this child has tonsillitis. These are the tonsils of the child, and the child is having tonsillitis by a bacteria. The name of the bacteria is Group A Streptococcus GAS bacteria. Group A Streptococcus bacteria GAS bacteria. So this child is having tonsillitis by Group A Streptococcal GAS bacteria. You will see, Mom, it's very common. This is the bacteria most commonly causing tonsillitis. Maybe I have, you have many times we have tonsillitis. It's very common. What is the problem in that? The problem is not the tonsillitis. It is not the bacteria. Body is forming antibodies. Can you see against the bacteria? Whenever we have bacterial, bacterial infection, the body forms antibodies for that. The body is forming antibodies for that, right? No, there is no problem in that. The antibodies will react with the antigen, kill the antigen, antigen-antibody reaction takes place, and the bacteria is killed. Bacteria is not the problem. The problem is that the antigen present on the bacteria, the epitope present on the bacteria, the same epitope, the same antigen present on human five organs. The same epitope, the same antigen present on human five organs. So I will tell you the name of the organs. Basically, these antibodies will get confused. Actually, they are formed against bacteria, but they think this is also bacteria. So they will cross-react with the five organs. So antibodies, can you see the antibodies are coming and reacting with the five organs, producing five diseases? So it is an autoimmune disease. The antibodies are formed against the cell tissue. It is known as cross-reactivity. Actually, the antibodies are not formed against the cell tissue. The antibodies are formed against the bacteria, but since bacteria have a mimicry, the similar antigen with the five tissues, the antibodies will get confused, and they cross-react with the human five tissues. Name the five tissues. Number one, brain and heart. The two vitals, heart and brain. One is heart, one is brain. Then there is skin. Just below the skin, we have subcutaneous tissue. And just below that, we have joints. We have joints. So heart, brain, skin, subcutaneous tissue, and joints. These are the five organs. Now, name the five diseases. So in the heart, there is rheumatic heart disease. In the brain, it's Sydenham's chorea. In the skin, its erythema marginatum. In the subcutaneous tissue, it's subcutaneous nodules. And in the joints, its migratory polyarthritis. So these are the five diseases. Rheumatic fever is a collection of all five. What is rheumatic fever? It's not one disease. It's a multi-system disease involving five different systems, five different organs: the heart, the brain, the skin, the subcutaneous tissue, and the joints. So these five, that is rheumatic fever. So among them, heart is most important. I will explain heart in detail, but rest of them I will tell you two, three, two, three lines on them. I will start with the heart, that is rheumatic fever. You got it? Shall I say rheumatic fever is a multi-system involvement? Yes. Is always post-streptococcal involving five organs? So that is rheumatic fever. It's an autoimmune disease. Please mind my words. It is not caused by bacteria. It is caused by autoantibodies. So this mechanism is known as molecular mimicry and cross-reactivity. What is it known as? Molecular mimicry and cross-reactivity. What do you mean by that? So basically, the bacteria is doing mimicry with the five organs. That is known as molecular mimicry. So the antibodies will get confused. They are formed against bacteria and they are cross-reacting. The molecular mimicry and cross-reactivity is there. So there is a child. The child is having tonsillitis by GAS bacteria, Group A Streptococcal bacteria. The antibodies are formed. These are autoantibodies, and they cross-react with human five organs. You can see, and the patient has rheumatic fever. So this is rheumatic fever. In the rheumatic fever, we have Jones criteria. Jones criteria. What are Jones criteria? The five major and five minor. The five major criteria is the five diseases. Only the five diseases and five organs is the Jones five major criteria, right? Minor criteria are also there. Um, in the minor criteria, let me tell you, there is, you want me to write it? I will write it. Let me tell you the Jones criteria. Jones criteria, revised Jones criteria. There are three types of criteria: the major criteria, which are five in number; the minor criteria, which are four in number; and there is supportive criteria, which are three in number. So there are five major, four minor, and three supportive. What are the five major? The five diseases. So in the heart, its endocarditis, that is rheumatic heart disease. In the brain, it's Sydenham's chorea. In the skin, its erythema marginatum. On the skin, it's erythema marginatum. In the subcutaneous tissue, it's nodules. And in the joints, it's polyarthritis, migratory polyarthritis. Okay, so these are the five major criteria. Among the minor criteria, here there is arthritis in the joints. There is arthritis, but here in the minor, I will take arthralgia. Arthralgia. There is a difference between arthritis and arthralgia. Arthritis is the inflammation, and arthralgia is the pain. Along with that, the child will have fever. Fever is a minor criteria. Arthralgia is a minor criteria. And increased PR interval on PQRST ECG, it is a minor criteria. And increased ESR, it's a minor criteria. So learn the four minor criteria. In the supportive criteria, listen, these all things are happening after tonsillitis. If these are occurring without tonsillitis, I will not consider it as rheumatic fever. If they are occurring after tonsillitis, then only I will consider as rheumatic fever. So there should be a, there should be a proof. There should be an evidence that the child is having tonsillitis few weeks back before this episode. You got my point? So there are three ways. Number one, you can take the history from the mother. The mother and the child are coming to your clinic. The mother is saying, my child is having multi-system involvement. His skin involved, joint involved, heart involved. So you are having a suspicion, the child is having rheumatic fever. Ask the mother, does the child have a tonsillitis few weeks back? The mother will say yes. Or sometimes it is very mild or subtle, it is not came in notice. So you should take a throat swab, throat swab from the tonsil and culture it. Number one, you should get the GAS bacteria. Number two, you should take the blood sample, the blood sample of that child and look for the autoantibodies. Look for ASO titer, anti-streptolysin O antibodies, and look for anti-DNase, anti-DNase, right? These are the autoantibodies you are looking in the blood. So these are the three supportive criteria. You wanted. So in the revised Jones criteria, two minor should be present, or one major. I'm sorry, two major should be present, or or one major and two minor should be present along with the support. That is the revised Jones criteria. Okay, now let me come on the heart. In the heart, there are three layers. Now endocardium, myocardium, pericardium. In rheumatic heart disease, all three layers are involved. The patient has endocarditis, myocarditis, pericarditis. All three layers of the heart are involved. The patient has pancarditis. Again, I repeat, the patient has pancarditis. All three layers are involved: endocardium, myocardium, pericardium. So this is pancarditis. Okay, this is in rheumatic heart disease. The patient has pancarditis. So we will see the endocardium first, then myocardium, then pericardium. In the endocardium, there are two things. The valvular endocardium and mural endocardium. I guess you know what is valvular endocardium. The endocardium present on the walls. Because of the valvular endocardium involvement, the vegetations are formed. Can you see vegetations are small, multiple, sterile? So small, multiple, sterile vegetations are formed. Okay, so you can see, I will teach you two, four type of endocarditis. This is the first time teaching right now. I will teach you three more. In all of them, are formed here. The vegetations are small. They are multiple. They are sterile. Compare with others. Number one, see the real diagram. These are the vegetations present on the heart wall. Which heart wall is most commonly involved? There are four, four heart walls now. So on the left side, we have two walls. On the right side, we have two walls. Okay, what are the walls? On the red, left side, mitral wall, aortic wall. And here, right side, we have tricuspid ball, pulmonary wall. Okay, so what is the sequence of involvement? They all have vegetations. So the sequence is MUTAP. MUTAP. It is mitral, followed by aortic, followed by tricuspid, followed by pulmonary. The first left side walls are involved, then right side walls are involved. The mnemonic is MUTAP. Please learn that. So M, A, T, P. Most common is mitral, second most common is aortic, third most common tricuspid, lastest pulmonary. It's very important. Say MUTAP. Yes, absolutely right. Osama, absolutely right. Shalini, they've done it. It's MUTAP. What is the location? What is the location of the, of the, this thing, vegetation? Listen, most commonly, you said it's on mitral. Now, this is right side, this is left side. Where is mitral wall? Here is the mitral wall. This one. This is the mitral wall. So here we have left auricle, here we have left ventricle, and these are the two cusps of the mitral wall. It's a bicuspid wall, right? So imagine this is, these are the two cusps. Above it, there is left auricle, and below it, there is left ventricle. Imagine. So when the two cusps open, blood is coming from auricle to ventricle, then they close. They open, they close, they open, they close. Blood is coming from auricle to ventricle. Every time, where is the vegetations formed? Yes, Osama, absolutely right. Where's the vegetation formed? On the upper surface? No. On the lower surface? No. Both surface? No. It is formed at the line of the junction, the line of the junction of the cusps. It is formed at the line of the junction of the cusps. I may not on upper like this, not on lower. It is formed at the line of the junction like this, right? Like this. I hope you are getting it. Like this. So it is formed at the line of the junction of the two cusps. It is known as line of closure. So let me draw the vegetations. I will draw the vegetations here on the line of the junction of the cusps. It's very important to understand the concept here. Got it? See the vegetation at the line of the closure, at the junction, right? Because of which the wall will look like fish mouth. Have you seen a fish? Let me draw a fish for you. Fish. I draw it for my kid. So let me draw a fish for you. So the fish, the mouth of the fish is like this. Can you see? It's spouting out, right? So the wall will look like this. It's known as fish mouth or buttonhole appearance. Fish mouth or buttonhole appearance. Okay, so can you see here? It is looking like a fish mouth. See the two cusps. Appreciate the nodules on the two cusps. The vegetations. It is looking like a fish mouth. Here also, appreciate the two cusps. Appreciate the nodularity. Appreciate the vegetations at the line of the closure. Looking like a fish mouth. Appreciate. First, you got it. This is fish mouth appearance. So we are done with endocarditis, valvular endocarditis. Now coming on mural endocarditis. What happens in the rest of the endocardium? I told you there are two types of endocardium. The endocardium present on the walls. You can see it here. It is having vegetations. Vegetations are present in valvular endocarditis. You know everything about vegetation. The vegetations are small, they are multiple, they are sterile. They are present in all heart walls. The mnemonic is MUTAP. In all of them, they are present on the line of closure or line of junction, and they produce a deformity which is known as fish mouth or buttonhole deformity. Everything regarding the vegetations, I explained you completely. Okay, now coming on the rest of the endocardium. In the rest of the endocardium, the endocardium which is present in the left auricle. Out of that four chambers, I am selecting left auricle. The endocardium which is present on the posterior wall. It's a three-dimensional structure now. On the posterior wall of the left auricle, the endocardium becomes wrinkled. Wrinkling is there, and a patch is formed. This is known as Mac Callum patch. The Mac Callum patch. So in the endocardium, two things are there. Both are in front of you. Everyone here, please say yes, you got it. The two things in the endocardium. Valvular endocardium has vegetations. Mural, you should know both. What are vegetations? What are the details of the vegetation? I have written. What is Mac Callum patch? It is a wrinkled area present in the posterior wall of the auricle. Everyone say yes, you got it. Kindly interact. Yes, you got it. What is Mac Callum patch? The Mac Callum patch is present on the posterior wall of the left auricle. It's a wrinkled area. So this is known as Mac Callum patch. Okay, so we are done with endocardium. Now coming on myocardium. What happens in myocardium? In the myocardium, Ashkoff bodies are formed. The Ashkoff bodies are the pathognomonic feature of rheumatic heart disease. Can you see the myocardium? Don't see endocardium now. In the endocardium, two things are over. Vegetations we have seen. Mac Callum patch we have seen. Now come on the myocardium. In the myocardium also, nodules are formed. Can you see the nodularity? The nodularity in the myocardium. It is known as Ashkoff nodules. These are not vegetations. These are Ashkoff nodules. What is the Ashkoff nodule? What is the Ashkoff nodule? If you see and zoom it out, Ashkoff nodule. This is Ashkoff nodule. It's a granuloma. Ashkoff nodule is a granuloma. What is a granuloma? In the granuloma, in the center, you can see in the center, there is fibrinoid necrosis. Yesterday, I taught you five types of necrosis. Now the fifth one, fibrinoid necrosis. It occurs at the center. It is surrounded by five types of cells. So let me draw the fibrinoid necrosis in the center, and let me surround it with five types of cells. The first type of cells are giant cells. The giant cells are known as Ashkoff cells. The giant cells are known as Ashkoff cells. The second type of cells are anti-Ashkoff cells. These are uninuclear. So the nucleus is either, if you see from front, it's caterpillar-like. The nucleus is like caterpillar. And if you cut it from here and see the cross-section, the same cell, the nucleus is like owl eye. The same cell, the nucleus is like owl eye. So caterpillar and owl eye is the same. These are anti-Ashkoff cells. So we have Ashkoff cells, these are the red ones. These ones are Ashkoff cells. And the blue ones are anti-Ashkoff cells. Okay, both are modified macrophages. Apart from that, we have lymphocytes. We all know. We have plasma cells. We all know. We have fibroblasts. We all know. There is no neutrophil. So it's a cellular body. Everyone, give me a thumbs up. You got it? This is bodies are formed. The Ashkoff nodules are formed. You all can see. In the center, there is fibrinoid necrosis. Okay, it is surrounded by. Can you see the cells? It is a multinucleated cell. So it's an Ashkoff cell. Can you see these two cells? These are anti-Ashkoff. Here the nucleus is caterpillar type. Here the nucleus, the same nucleus is owl eye. It is the same cell. We are seeing the front view or the cross-sectional view. So both are same. Okay, you can see here a multinucleated giant cell, it's an Ashkoff cell. And these are anti-Ashkoff cells, the caterpillar and the owl eye. It's an Ashkoff body. It's an Ashkoff body. Last is pericarditis. We are done with endo. We are done with mayo. And now coming on pericarditis. In the pericardium, what is pericardium? Do you know what is pericardium? The heart is surrounded by a space known as pericardial space. We all have the space, right? Now, this space contains a small amount of fluid known as pericardial fluid. A very small amount of watery fluid. There is watery, thin fluid. We all have it. A small amount of fluid is present in the pericardium. But a small amount. Now, what happens in rheumatic heart disease? In the pericardium, this fluid, the pericardial fluid, becomes thready in consistency. It becomes thready. It becomes thready in consistency. It is known as fibrinous pericarditis. The word to be picked here is fibrinous pericarditis. This one is fibrinous pericarditis. It is thready appearance, right? So can you see this person is dead? I am doing the autopsy. I'm opening the heart. Imagine there is a child who is dead of rheumatic heart disease. This is the heart of that child. So I am doing the autopsy. I'm taking the heart out. So what I will do? I will use a scissor and with the scissor, I will cut the pericardium and separate it from the myocardium. So can you see here? A scissor. I'm cutting the pericardium. I'm cutting the pericardium and separating it from the myocardium. This is all myocardium behind. This is all myocardium. I am cutting the pericardium, separating it from the myocardium. Now you can see bread and butter appearance. Now you can see bread and butter. What do you mean by bread? Have you ever eaten bread and butter sandwich? Yes, in the breakfast, we, we sometimes eat it, no? Bread. So in bread and butter sandwich, the two bread slices are there, and there is a butter in between. This is bread and butter sandwich. Have you ever tried separating the two slices away from each other? Have you ever tried? If you have not tried, try it next time. So if you separate the two pieces of the bread away from each other in a bread butter sandwich, you can see the threads. The threads of the butter in between. You can see the threads. You can see the threads of the butter in between. So whenever you are separating the pericardium from the myocardium, please appreciate the threads. This is looking like butter, and the two slices, one is myocardium, one is pericardium. I hope you got it. The two bread slices are mayo and peri, and in between them, the butter is the fibrinous pericarditis. It is looking a bread and butter appearance. Please, please say this word. This is the summary. We are done. This is the summary. The summary is in front of you. Endocardium, myocardium, pericardium, pancardium, pancarditis. All three layers are involved. In the endocardium, there are two types of endocardium. Endocardium, vegetations are there. Describe vegetation. Say, Ma'am, they are small, they are multiple, they are sterile. They are present on all four walls. The mnemonic is MUTAP. They are present on the line of closure, and they produce fish mouth deformity. Vegetation done. Come on the mural endocardium. There is a Mac Callum patch. Describe it. It is present on the left auricle. It is a wrinkled patch on the posterior wall. Come on myocardium. In the myocardium, there are bodies. These are granuloma. In the center, there is fibrinoid necrosis, surrounded by five types of cells. Anti-Ashkoff cells, you know that. And in the pericardium, there is fibrinous pericarditis, giving bread and butter appearance. I cannot simplify more than this. These are the limits. And height cycle. Say yes. This is rheumatic heart disease. Everyone, appreciate rheumatic heart disease. Or all pan cardiac, as shown here. You see endocarditis, you see myocarditis, you see pericarditis. You see endocarditis. These two things are there. You see myocarditis. This is there. You see pericarditis. This is there. So basically, this is pancarditis. Everyone, give me a thumbs up. Yes, very good, very good. Amisha, very good. Can we go ahead? You see. So can you see, uh, the three things? Endocarditis, myocarditis, pericarditis. All the three layers are involved, and it is known as pancarditis. Pan means all three layers are involved. Now, please learn the important pointings in each of the layer. Okay, so we are done with pancarditis. So as I told you, in rheumatic heart disease and rheumatic fever, it's the umbrella term having five diseases. We are done with the heart. What five organs are involved? I told you heart, then brain, then skin, then subcutaneous tissue, and then joints. So we are done with the heart. In the heart, there is pericarditis. But what about the remaining four? What about the remaining four? Remaining four. So these are known as extracardiac lesions. I will tell you two, three, two, three lines on each of them. Let's start with joints. What happens in the joints? It's migratory polyarthritis. So child will come to you. Child will come to you. You are a pediatrician. Child will come to your doctor and with the mother. The mother will complain, my child is having pain in the joints. So you will ask, with joints? So the child will say, it's the mother will say, it's the large joints. In the knee, ankle, wrist, elbow. These all are large joints, no? Not the small finger joints. First, the large joints are involved, right? Number one. Number two, the joints are hot, red, so swollen, and there is extreme pain. If you touch the joint, the child will shout. If there is extreme pain, and the pain is migratory. Today, child is saying I'm having pain in the shoulder. The next day, child is saying I'm having a pain in the elbow, and now I'm having in the wrist. It is migratory in nature. So large joints are involved. The joint is having the pain which is extra disproportionate as compared to the finding. It is red, hot joint. The pain is a migratory. Several joints are involved one after the another. This is polyarthritis, that's why poly. It's the earliest manifestation out of the five, and it is the most common, even more than heart. It is the most common manifestation, right? So that is the joints. Coming on brain. In the brain, it's chorea. It's chorea, known as Sydenham's chorea. It is also known as St. Vitus' dance because the first patient in which it was discovered, it was a girl, the name of the girl is St. Vitus. That's why it is known as St. Vitus. But Vitus is known as dance. It is looking the girl is dancing. Is the girl is dancing? No. The girl is having brain involvement in the rheumatic fever because of molecular mimicry, antigen-antibody reaction. So basically, basically, the caudate nucleus is damaged in the brain. When the caudate nucleus in the brain is damaged, there is involuntary spontaneous movement in the air. It is looking like the girl is dancing, but these are not dancing. It is chorea. It is chorea. What is chorea? Involuntary jerky movements in the air, right? So this is chorea. Okay, so there is damage to the caudate nucleus. So patient have neuropsychiatric symptoms here. The third is the erythema marginatum. In the skin, in the skin, you can see. In the skin, the person has multiple lesions. The lesions are circular, sometimes they are serpentine, like a snake. They are circular, they are red with a yellow center, okay? And they are present on the trunk, on the limbs, but never on the face. They are never present on the face. So this distribution is known as bathing suit distribution. Bathing suit. When the swimming swimming suit or bathing suit, the bathing suit or swimming suit is not worn on the face, right? So on face, they never occur. So this distribution is known as skin bathing suit distribution. They occur on the trunk, on activity, but never on the face. There is no itching. No itching, please mind my words. The negative finding. No itching. No itching means non-pruritic. These are non-pruritic. These are red. These are serpentigenous. They have pale center. No itching. No pruritus. Bathing suit distribution, and they will disappear by their own. There is no scarring in the end. There is no scarring in the end. The next is the subcutaneous nodules. Just below the skin, there are subcutaneous nodules. So multiple subcutaneous nodules are formed like this, like this. They are near joints. They are near joints. These are one centimeter, small, small subcutaneous nodules are formed. They are non-painful, non-tender. No pain, no tenderness, right? They disappear spontaneously. They are one centimeter, near the bony prominences, on the extensor surface, okay? That is the thing, right? We are done. I guess we are done with all five. So in the rheumatic fever, most importantly, I told you the rheumatic heart disease, pancarditis in the heart. I told you endocarditis, myocarditis, pericarditis. Then I told you the brain chorea. I told you the joints. I told you the skin erythema marginatum. And I told you the subcutaneous nodules also. So I told you all five findings. I mean to say, these extracardiac lesions, I told you two, three, two, three important lines. Don't go in the detail, but heart, I told you the detail. What happens in endo? What happens in mayo? What happens in peri? So basically, pancarditis, we are done. Everyone, appreciate pancarditis. Say yes, yes. It is more than sufficient for FMG. Definitely, definitely. You just watch my due to some videos. The general and he met yesterday. I covered and systemic I'm covering today. It is more than sufficient. All questions will be from just only. Okay, so let's solve some questions on rheumatic heart disease and move on the next endocarditis. You please read the question. There is a 10-year-old boy, Pappu, that of rheumatic fever. Okay, so there is a 10-year-old boy who's dead of rheumatic fever. We are doing the autopsy. In the autopsy, we find all of the following except. What is not present in the autopsy? So what is not a feature? What is not a feature of rheumatic fever? Tell me that. Tell me that. What is not, not present? Yes, tell me. So is it Ashkoff nodule? Yes or no? Rupture of chordae tendineae? Yes or no? Mac Callum patch? Yes or no? The Ashkoff nodules are present. They are present in myocardium. Mac Callum patch present in mural endocardium. Fibrinous pericarditis present in pericardium. But we have not read there is anything rupture. Rupture of chordae tendineae taking place. So I will go with B. It is not a feature. The correct answer is B. It is not a feature. The correct answer is B. Ashkoff nodule is the pathognomonic feature. The most important among them is the pathognomonic, which is present in the myocardium. Yes, rupture of chordae tendineae is not a feature of rheumatic fever. Maybe some other disease, but not a feature of rheumatic fever. The correct answer here is B.

Coming on the next question. Ashkoff cells are what? I told you two types of cells. Ashkoff cells are giant cells, and anti-Ashkoff cells are uninuclear cells having two types of nucleus, either the caterpillar or owl eye. It is the same cell. From front, it's caterpillar. From side view, it's like owl eye. So what are these two cells? These are modified macrophages or neutrophils or modified B lymphocytes or modified RBCs? Can you please answer? Yes, these both are modified macrophages. Please learn. Both of them are modified macrophages. You all are right. Can we go ahead? Now, okay.

Most common valve involved in rheumatic fever. Can you tell me what is the most common valve? And what is it? Mitral, aortic, pulmonary, tricuspid? Which is the most common valve? I told you the mnemonic. Can you please apply the mnemonic and tell me the correct answer? Most common valve involved in rheumatic fever. The mnemonic is MUTAP. Yes, you all are right. The correct answer here is the mitral valve. Very good. Mitral valve. If I change the question, instead of most common, the same question, I'm asking least common. What is your answer now? So pulmonary will be the least common, right? So based on the question, you should answer it correctly. You know the mnemonic MUTAP. You can answer it.

Coming on the next question. The next question is in front of you. The most characteristic histological finding of rheumatic carditis. Characteristic finding. I'm not asking what is happening. They all will happen. They all will happen in a rheumatic fever, in rheumatic heart disease. I'm asking the pathognomonic feature. What is the correct answer now? The pathognomonic feature. What is the correct answer now? Yes, the correct answer here is the Ashkoff nodules. Ashkoff nodules is the pathognomonic feature. You all are right.

The next question is in front of you. Mac Callum patches are seen in which auricle? There are four chambers in heart now. Right auricle, left auricle, right ventricle, left ventricle. So among them, the Mac Callum patch is present in which chamber? Which chamber? I have drawn the diagram and shown it to you where it is present. So what is Mac Callum patch? It's a wrinkled area which is present in one of the chamber. So yes, you all are right. It is present in the left auricle. So correct answer here is B. It is present in the left auricle on the posterior wall.

Okay, the next question is in front of you. All are true about erythema marginatum except. The question includes except. Don't miss it. About erythema marginatum, which is occurring in the skin. Remember the diagram I have shown you. Bathing suit distribution. Yes or no? Early manifestation? Yes or no? Pruritic means itching takes place? Yes or no? And seen rarely. So what is not seen? Tell me the except. Tell me the except. Who will tell me the answer? Yes, you all are right. You all are right. The correct answer is pruritic. It is never pruritic. I told you these are non-pruritic. These are not pruritic, right? So I guess we are done. We are done with the rheumatic fever till now. Till now, we are done with rheumatic fever. Now let's come on the next two together. So let's say, first we will say Libman-Sack ah, no. First, we will take yes, Libman-Sack endocarditis. Second endocarditis occurs in SLE. You know what is SLE? Systemic Lupus Erythematosus. It's an autoimmune disease. So here also vegetations are found. But the reason for the vegetations is SLE. The reason for the vegetations is SLE. Here also vegetations are formed. Here vegetations are medium-sized. Small size in rheumatic fever. Here they are medium-sized. Small size. Here they are flat. That's why known as verrucous. Flat. So more or less the vegetations are flat. They are like flat, right? They are granular. They are also sterile. They don't have bacteria. Okay, what is the location? What's the location? Can you see this is left auricle, this is left ventricle, and these are the two cusps. These are the two cusps. So they are present on the upper surface as well as lower surface. Not at the junction. They are present on the upper and lower both surface. You see, I have drawn the vegetations both ways. Upper surface also, lower surface also. They are flat and present on both surface. Not only on both surface, they continue on the adjoining auricle and adjoining ventricle along with the pockets. Pockets is the corners. So they are present on upper surface, lower surface, on the corners, and the continuing with the auricle and ventricle. So this is the location. Please appreciate. Right? On which wall they are present? The mnemonic is MUTAP. Present most commonly on mitral. Location on both surface along with adjoining auricle and ventricle. And they do not produce fish mouth deformity. So please compare rheumatic heart disease with Libman-Sack. Till now, we have covered two. Rheumatic heart disease, they are small, present at the junction, line of closure. In Libman-Sack, they are medium-sized. Medium size, please learn, right? Here they are present on line of closure. Here, see intentionally I have shown you the diagram. Lower surface. They are present on lower also, upper as well as lower, both surface. Upper plus lower along with the adjoining, uh, along with the adjoining auricular and ventricular surface, right? So they are present on both the surface, right? So we are done with SLE also. Libman-Sack. Here we will see a small detail. So rheumatic fever is done. SLE is done. Coming on the next one. NBTE. Non-bacterial thrombotic endocarditis. Here also vegetations are formed on the surface of the heart. But the reason for this vegetation is hypercoagulability. Actually, these are not vegetations. These are thrombi. Multiple small, small thrombi are formed. You know what is thrombus? Small, small clots which are formed without injury. With clot, it's thrombus. So when the blood is hypercoagulable, multiple thrombi are formed on the heart walls. They are looking like vegetations. So that is the reason for vegetations. It's hypercoagulable blood. These are also sterile. Bacteria is not present in them. But these are small or medium. And, uh, these are small or medium. And where they are present? Where they are present? Let me see the location. They are present again on the line of closure, like rheumatic heart disease. They are present at the junctions. They are present at the junctions, right? So compare. And they are present on the same wall. Is same for all of them? The mnemonic is MUTAP. Okay, so here also the mnemonic is MUTAP. You can see that. So you can see three till now. Please see this one. This one.

And this one, yes. So here, I told you the vegetations are small here. I told you it's medium here. Also, it's medium here. They are present at the line of closure. Here, they are present on the upper and lower surface. Here again, on the line of closure. Here, the cause is rheumatic fever. Here, the cause is SLE. Here, the cause is hypercoagulability. See, yes, I'm trying very hard to explain you. Let's solve some MCQs. And coming on the last one, infective endocarditis. Okay, so after that, CVS is also done. So, let me come on some MCQs. See, this is the question. Can you tell me the answer, please? Thank you. Can you please tell me the answer? What's the correct answer? The flat vegetations present in the pockets. Two clues are given to you. The vegetation, vegetations are flat only in one of them, and their presence in pockets means corners, only in one of them. Is it rheumatic heart disease? No, here the vegetations are present on the line of closure. Is it NBTE? No, here the vegetations are present again at the line of closure. Is it infective? I'm not taught you till now, but I will tell you here. Vegetation is present only on the upper surface. But in Libman-Sack, they are present on both surfaces. They are flat also, along with the both surface, present in the pocket also, and they are present on adjoining Oracle, varicle also, ventricle also. Correct answer is endocarditis. Is everyone agree with me? The correct answer here is B. You all are right. The next question is in front of you. Which type of endocarditis have vegetations on both surfaces? I told you one of the endocarditis is having vegetation on both surfaces. Learn their location. Their location is very typical. In rheumatic fever, they are present on the line of closure. In infective endocarditis, it is present only on the upper surface. I will tell you in the next one, only on the upper surface. But in Libman-Sack, it is present on upper plus lower, both surfaces. So, correct answer here is B. It's Libman-Sack endocarditis. Yes, rate is enough for NEET PG, FMG, all exams. I am doing you a complete coverage. I mean to say, I am covering the most important high-yielding topics. So, your 90% paper will hit from these topics only. Otherwise, I cannot take the guarantee. No one can take the guarantee of all questions now, but I can challenge 90% of the questions will be from these topics. These are highly repeated topics, you know. You cannot miss them. So, yes, the correct answer here is B, and you all are right. The next question is in front of you. Vegetations in Libman-Sack are, can you describe? Okay, we can leave it. We have already done. So, coming on the last type of endocarditis, that is infective or bacterial endocarditis. Infective here also, vegetations are formed on the surface of the heart. Here also, vegetations are formed. Can you see vegetations are forming in all four? So, here also, vegetations are formed. But here, the vegetations are formed only on the upper surface. You can see on all four walls, only on upper, upper, upper, but not lower, not at the line of junction. It is present on the upper surface, number one. The reason for vegetation is infection. Infection by the bacteria. So, here the reason is not SLE. It is not rheumatic fever. It is not thrombi or hypercoagulability. Yet, the reason is the infection by the bacteria. I will tell you the name of the bacteria also. So, it is infective endocarditis. It is due to microorganism, the bacteria. It is of two types: acute bacterial endocarditis, subacute bacterial endocarditis. It is of two types: ABE and SABE. Acute bacterial, Subacute bacterial. What do you mean by that? Imagine two hearts in front of you. Can you see the two heart diagrams in front of you? Imagine the first and the second. In the first heart, see the middle wall. This is a healthy wall. In the second heart, this is the material wall. It is diseased. It is having either MR or it is having MS, or it is a prosthetic wall. It is not a healthy wall. It is a weak wall. It is a diseased wall. So, here, if some bacteria want to cause the vegetation or infection of this healthy heart wall, the bacteria should be very brilliant, very powerful, very virulent bacteria is required to damage the healthy wall. And the name of that bacteria is Staph aureus. Okay. Here, since the wall is already diseased, already weak, so even a bacteria with low virulence, low power, can cause the vegetation, can cause the disease. So, here the name of the bacteria is Streptococcus viridians. Here, since the bacteria is very powerful, in less than six weeks, it's done. It is known as acute bacterial endocarditis. And here, since the bacteria is very weak, low potent, low virulence, it is more than six weeks are required. It is known as subacute. But tell me the meaning of acute and subacute bacterial endocarditis. I mean to say, what's the difference? Here, the heart walls are healthy. Here, they are diseased. Okay. Here, the heart walls are healthy, so a high virulent bacteria like Staph aureus is required for causing the damage, and it will do in less than six weeks because it is very virulent. Here, since the heart walls are diseased, even a bacteria with low virulence will work, and the name of that bacteria is Streptococcus viridians, and it requires more than six weeks. Everyone say yes, you got it. Can we go ahead? So, ABE and SABE, you can see the same thing is written right here. The vegetations are large. Vegetation, compare all four. Who is the biggest one? I guess everyone can see it is the large one. Here, vegetations are small. In this, it's small. Here, it's medium. Here, it's medium. Here, it's large and most fragile. You know the meaning of fragile. You know the meaning of fragile. They can dissociate and go away. They will form the emboli. They are not very fragile. The others one, but this one is large. This one is fragile. It is present only on the upper surface, right? So, here the vegetation present on line of closure. Here on upper surface. Here it is present again, line of closure. Here on both surfaces, upper surface plus lower surface. Okay. Here, vegetations are flat in Libman-Sack. In others, it's not flat. The reason is different. Here, reason is rheumatic fever. Your reason is bacteria, the two bacteria I taught you, Staph aureus in ABE and Streptococcus in SABE. Here, the reason is thrombi or hypercoagulability. And here, the reason is SLE, right? So, learn the location of the vegetation, learn the size of the vegetation, learn the reason. So, this is the most important thing. Okay. Yeah. So, Sama, you can say the najuk, fragile is najuk. You can say that. Okay. So, these are the vegetations. They are very fragile, very fragile. Don't miss this word. They are very large, and that's why they are fragile. So, they are large and fragile. You can see on which wall they are formed? In all of them, it's mural, only, but they are formed only on upper surface, not on lower surface, right? Right. So, you can compare. They can form abscess, you know, since they are bacterial, bacteria pumps. So, inside the vegetation, they go in the myocardium and they can form abscess. Can you see here? They can form abscess. They have complications also. Listen. This is the abscess. Most common complication in the heart. See the pus. See the yellow pus. They form abscess. Only one of them forms abscess, this one. And the extra-cardiac complications. See here. Where are the vegetations? So, these are the heart walls. Where are the vegetations? You will say, man, vegetations are present on the upper surface. They are large, they are big, they are present on the upper surface, okay? Not on lower surface. I told you these vegetations are very fragile. Imagine from the left side, these vegetations get detached. So, where do they go? From they will go in the left ventricle. After detaching from the left ventricle, they will go in the aorta, and from the aorta, they will go in various organs and obstruct various organs, causing ischemia and various organs. Agree or not agree? Yes. So, they will obstruct most commonly. They will go in the nail, nail beds. They will go in the fingers and arteries, right? And they can cause two types of complications because of the emboli which is traveling in the aorta after fragile dissociating from the left ventricle, they are reaching here in the hands. The blood supply of the hands. They can cause two things. What two things? Osler's node and Janeway spots. These are Osler node and these are Janeway. These are Janeway spots. Osler nodes are present at the tip of the finger. They are painful. And Janeway are present on the palm. They are non-painful, right? Again, Osler present at the tip. They are painful. They are painful. Pain present, tenderness present. Janeway present on the palm, the pulp of the palm. Pain absent, tenderness absent. Please learn all these are your MCQs. Say yes. For rheumatic fever, we have Jones criteria. Romantic endocarditis. For infective, we have Duke's criteria, modified, modified Duke. So, here also, we have three major criteria, six minor criteria, and two pathological. But don't go in the detail. Just learn the Duke's criteria. We are done with the four types of endocarditis. Everyone give me a thumbs up. The four types of endocarditis is in front of you. Everyone here. The rheumatic fever and BTE, non-bacterial thrombotic endocarditis, SLE, and infective endocarditis. Most important is their location. The first three are sterile. They are not caused by bacteria. The rheumatic fever caused by rheumatic fever. Uh, the non-bacterial one is caused by hypercoagulability. Libman-Sack is caused by SLE. That's why they are sterile. But the last one is seen due to bacteria infection, abscess. That's why this one is non-sterile. See their location, please. See their location. So, this one is at line of closure. This one also at line of closure. This one only on upper surface. This one on upper surface plus lower surface. Please appreciate it. Now, any question on endocarditis, you can crack like this with this master table, with this orientation. Any image-based question, conceptual question, clinical question, doesn't matter. You are prepared. I guess you are prepared. Give me a thumbs up. Yes. Can we go ahead? Only few people interact with me. What about others? What about those? Why don't you interact? Why don't you talk? Why don't you say something? If you have doubt, you can ask. If you don't have doubt, you should appreciate that you got it. Okay. Anyways, we will solve some MCQs. Please have a look on the question and tell me the answer. Bacterial endocarditis most commonly caused by? I forgot to tell you. Most commonly Staph aureus is the cause. That is okay. So, correct answer here is Staph aureus. The bacterial endocarditis is the most common cause of Staph aureus. Okay. Okay. One more question. Non-sterile vegetations are seen in which? It is only one of them have non-sterile vegetation. What is the correct answer? Is it rheumatic fever, infective endocarditis, NBTE, or Libman-Sack? Non-sterile, non-sterile means bacteria is present. In which of them? The bacteria is present. Can you tell me the answer? What is the correct answer? Then infective, of course. Common sense. In infective one, it is non-sterile because bacteria is present. Okay. The next question, very, very commonly asked question, important question. In which of the following vegetations are friable? Very friable, easily detachable. One of them, the vegetation is very friable, easily detachable. They are very najuk. So, is it rheumatic fever, rheumatoid heart essentially, or infective endocarditis? So, what is the correct answer? I guess everyone knows the correct answer is the infective endocarditis because here the vegetations are very large, that's why they are very friable and fragile. Friable, fragile is one and the same thing. Okay. So, is it done? Can I come on the next question? Tell me firm, watery vegetation along the line of a position, the line of closure. It is present in which one? Line of closure. It was present in two. It was present in, it was present in okay, rheumatic heart disease also, NBT also. So, you can go with both because in both of them, line of closure. Here only. See, I have written A and C both as the correct answer. In both of them, it is at the line of closure. We are done. We are done till now. Can we go ahead? Can we go ahead? Say yes if we can go ahead. Say yes. Can we move to the next topic? Till now, we have covered two systems. We have covered blood vessels. We have covered CVS. It's a non-stop marathon. So, I'm starting the third system, CNS. In CNS, I will be teaching you meningitis. So, let's start meningitis. You always get a question on meningitis. Especially in FMG, you every year get a question on meningitis. You cannot skip that. This is a very important topic. Can we start CNS? The meningitis? Are you people there? Yes. So, let's start meningitis. Okay. So, let's start meningitis. First, you should understand what is meningitis. Then only you should have understanding what is meningitis. Okay. Now, what is meningitis? For understanding meningitis, you should understand central nervous system. In central nervous system, we have two things: the parenchyma and the coverings. The meninges are the coverings. Can you see central nervous system made up of two things? The brain and the spinal cord. You can appreciate the brain. You can appreciate this is spinal cord. This is central nervous system. Now, the cells which are present inside the brain and the spinal cord, that is forming the parenchyma. Right? So, for parenchyma, three types of cells are present. So, the neurons are the most important cell which are present. We all know neurons are present. So, neurons are the most important cells which are present here. Along with the neuron, the three supportive cells are present, which are known as neuroglia, and the macrophages are present, which are known as microglia. The three supportive cells that is neuroglia are astrocytes, oligodendrocytes, ependymal cells. These are the neuroglia. These are the supportive cells. Right? And neurons are the main cell. And microglia are the macrophages of the brain. Like the macrophages in the liver are known as Kupffer cells, in the same way, the macrophages in the brain are known as microglial cells. Can we go ahead? So, this is the parenchyma. Now, what about the coverings? There are three coverings. The three meninges. The meninges are the coverings. You know, the innermost is the pia mater. The middle one is the arachnoid. And the outermost is the dura. See, this is the innermost pia mater. I have shown you with red color. This is innermost. It is adhered with the brain and the spinal cord. The middle one is the arachnoid. You can appreciate arachnoid. It is just above the pia mater. And the outermost is the dura mater. You can see the dura mater is adhered to the skull. The skull and the vertebra. So, innermost, middle, outermost, right? So, you can see what are the spaces? Let me draw. Let me draw the brain here. I am drawing the brain. This is brain. And this is skull. This is skull bone. And this is brain inside that. This is the brain parenchyma. These are the cells. This is brain parenchyma. And this is skull bone. So, what are the three meninges? I mean to say, the pia mater is adhered here. So, let me use the highlighter. Let me use different colors. So, this is the pia mater. It is the innermost. It is closely adhered with the brain and spinal cord. There is no space. So, this one is pia mater. Okay. The middle one, the middle one is the arachnoid. This one is arachnoid. And the outermost one, the outermost one is the dura mater. So, how many spaces you can see? How many spaces you can see? I have drawn this diagram to show you the spaces. So, there is a space between pia and arachnoid. Can you see the space? It is known as subarachnoid, because it is present below arachnoid. This is known as subarachnoid space. And there are two spaces. One, this is dura. This is dura. One above dura, one below dura. So, above dura is epidural. And below dura, subdural. Very easy. Epidural and subdural. The concept should be strong. Okay. And there is subarachnoid. This one is subarachnoid. So, you can see the three spaces: epidural, subdural, subarachnoid. The subarachnoid one is filled with CSF. So, CSF is present here. Imagine, just a second. The CSF is present in the subarachnoid space. This is CSF. The CSF is present here. You got my point? Now, let me come on the disease meningitis. What is meningitis? As I told you, meningitis is the inflammation of the meninges. The meninges get inflamed. That is known as meningitis. So, for diagnosis, we do the CSF tapping and take the CSF out in a test tube and look for that. But CSF is taken out in case of meningitis. You got my point? So, this is the same diagram. You can see this is brain. This is skull bone. And the meninges are shown to you in between. So, let's come on the topic meningitis. Let's come on the topic. Let's come on the topic meningitis. Meningitis is the inflammation of the meninges. It is the inflammation of the meninges, the three meninges. Right? Now, there are three types of meningitis. One is caused by the bacteria, known as bacterial meningitis. It is acute. It is acute in nature. That's why acute bacterial or pyogenic meningitis, because bacteria produce pus. So, bacterial meningitis or acute pyogenic meningitis, one and the same thing. The second is caused by the virus. It is known as viral meningitis. Here, the lymphocytes are raised. That's why it is known as acute lymphocytic meningitis. Right? It is also acute. This one is acute. This one is acute. The third one is the chronic meningitis. The third one is the chronic meningitis. You got my point? Chronic meningitis. The third one. Chronic meningitis is caused by one bacteria, that is TB. And one fungus, that is cryptococcus. So, that is the cause here. All bacteria producing pus. Here, all some viruses. And here, TB and cryptococcus is the cause. So, basically, out of the three types of meningitis, it is two of them are acute, one is chronic. So, what are the three types of meningitis, please? Acute, acute, chronic. Acute bacterial, I'm sorry, acute viral. And in the chronic one, causes TB. And the second cause is the crypto, cryptococcus fungus. Right? So, that is the three types of the meningitis: acute bacterial, acute viral, and chronic. Chronic is due to TB. And the bacterial one also known as pyogenic. The viral one also known as lymphocytic. I told you the other name. Okay. Now, which type of meningitis is it? If it is bacterial, the treatment is antibacterial drug, antibiotic, I mean. If it is viral, the treatment will be antiviral drug. And if it is due to TB, the treatment will be DOTS. If it is due to cryptococcus, the treatment will be anti-fungal drug. So, knowing the cause is very important. All of them are meningitis. But the knowing is the cause is very important for diagnosis. You take the CSF out. How to take the CSF out? How to take the CSF out? The CSF is taken by the lumbar puncture. So, in the vertebra, in the vertebra, between L3 and L4 vertebra, we put a needle. I don't have a diagram. We put a needle there, and we just take the plunger out, the lumbar puncture needle, and we take the CSF and transfer in a test tube. So, this is the CSF collection. And looking in the CSF, we can decide the type of the meningitis. So, before looking at the abnormal CSF, you should know the normal CSF. What are the findings of the normal CSF? The normal CSF is clear and colorless, like water. Clear, colorless, like water in a test tube. The normal CSF pressure is 60 to 150 mm of water. It's up to 150 mm of water. Normal CSF have cells. If you take out any healthy human being's CSF, does it have cells? It never have neutrophils. Normal CSF have never even a single neutrophil. Is abnormal? Even a single neutrophil in CSF is abnormal. The normal CSF have lymphocytes up to zero to four per microliter. Not more than four. More than four is abnormal, right? Normal CSF have glucose as well as protein. Learn the normal value. Protein is 45. 15 to 45. And glucose is 50 to 80 milligram per deciliter. Both of them are milligram per deciliter. And normal CSF don't have any bacteria, virus, fungus, parasite, etc. Of course, we know the normal finding. Now, what are the symptoms of meningitis? All the three meningitis, whether acute bacterial, acute viral, or chronic, all of them have these symptoms. The patient have fever, especially the fever is high grade if it is pyogenic one, bacterial one. The patient have headache. And the patient have neck stiffness, especially on forward bending. It's a very typical finding. Whenever in your question, you get a clue, the patient is having neck stiffness, it's a very typical finding, right? And the changes have altered mentation. Altered mentation can be there, right? So, these are the symptoms which are seen in meningitis. Now, let's talk about three meningitis one by one. Let's take the first meningitis, bacterial one. Now, compare with normal. What will happen here? The CSF has become past-like, cloudy. See, can you see? It is looking like pus filled in the test tube. Normal CSF is clear water. So, here the CSF is cloudy, purulent, like pus. Number one. Number one. See the pressure. Normal pressure is 150. Here it's 180. If you see the pressure, the pressure is up to 180. A little bit rise. See the cells. Here neutrophils are present. Normal CSF never have neutrophils. Normal CSF have lymphocytes. Here, if you make a slide of this, you can see only neutrophils. Abundant of neutrophils. See, both, all the cells are multilobulated. All of them are neutrophils. Abundant. Even a single neutrophil in CSF is abnormal. Here, 100 to 10,000 neutrophils are present. T. The glucose is reduced. And the protein is raised as compared to normal. You will say, what is the reason for both of them? I will tell you the reason. Now, this test tube contain bacteria. Imagine this test tube contain bacteria. We are talking about bacterial one. So, CSF contained the bacteria. So, whatever glucose present in the CSF, that is occurred. It is eaten by the bacteria as a nutrition. So, that's why if you check the glucose, it is reduced because it is consumed by the bacteria. This is the reason why glucose falls. It is consumed by the bacteria. You will not forget now. And all the bacteria have cell wall, agree? So, all the bacteria have cell wall. Cell wall is made up of protein. So, if you check the protein, the total protein is more because the bacterial cell wall is also contributing in the protein. So, glucose is reduced and protein is increased. I told you the reason. And if you make a culture, you will get positive growth. Positive growth of the bacteria. Say yes, everyone got it. This is the bacterial one. Compare it with the normal. Coming on the next one, the viral one. Please, everyone on the screen. Compare the viral one. The viral meningitis with the normal now. Compare it. Normal is clear, colorless. This one is also clear, colorless. It's clear and colorless, right? Here, the pressure is up to 250. Normal is 150. Here, up to 250. Here, cells are still lymphocyte. You will see my normal also have lymphocyte. But see the count. Normal have zero to four. This one is having 10 to 100. Please learn. It matters. Here, virus don't take glucose. Virus don't have cell wall. So, protein is normal. And make it normal. Glucose is also normal. Here, in bacterial, the glucose was falling. The protein is elevated. But here, both are normal because viruses present in the test tube. They don't consume glucose. And they don't have cell wall. So, glucose is still normal. Protein is still normal. That may differentiate it from the bacterial. And if you find, if you culture it, you will you will not get the growth. Viruses don't grow on culture plates. Okay. So, we are done with the bacterial. We are done with viral. Coming on the last one, TB. I mean, the chronic one. TB and cryptococcus are the two causes. The chronic one. Can I come on the chronic one? Right. Here, if you see the gross, it is having cobweb formation at the bottom. You can see the cobweb is formed at the bottom. This is the cobweb formation, like this, right? A cobweb is formed. Normally, this clear, colorless. Here, a cob appearance is there. Cobweb is formed, right? Here, the pressure is up to 300. Pressure is up to 300. Normal pressure is up to 150. Its highest pressure. Here, the cells are again lymphocyte. You will see my viral maybe the lymphocyte or normal lymphocyte. So, compare the count. Normally, it's zero to four lymphocyte. Here, it's 10 to 100. But here, 800 to 2000. Number matters. Neutrophils present only, only in bacteria. Here also, glucose will fall. Protein will rise. The same reason. And you will find TB and cryptococcus here. For special stain for TB, do the Ziehl-Neelsen stain. For cryptococcus, you do India ink, the negative stain. India ink negative stain. So, these are the special stains. Everyone give me a thumbs up. So, basically, what does matter to find out the three types of the meningitis? The bacterial, the viral, and the chronic? You have to see the cells. Which cells are there? The cells matches. Here, it's neutrophil. And in the remaining two, it's lymphocyte. See the number. Normally also lymphocyte. See the number. See the number. Number matters. This is meningitis. The approach to a case of meningitis. Let's solve two questions on that. We are done with meningitis. Let's solve two, three questions on that. Can we solve the questions, please? Are you people there? Can we solve the questions on meningitis? Are you people there? Say yes. Okay. So, see, have a look on this diagram. There is a patient brought to the hospital with fever, with headache, and with neck stiffness. The patient have three things: the fever, the headache, whenever neck stiffness is given to you, they are talking about meningitis. Please, please take this clue. Whenever neck stiffness is given to you, they are talking about meningitis. CSF tapping is done. So, gross is given to you. Microscope is given to you. The protein is increased. And the glucose is less. Protein is more, glucose is less. And the cells are lymphocyte. When the cells are lymphocyte, it cannot be pyogenic. Rule out pyogenic. Okay. When the cells are lymphocyte, it can be aseptic. Aseptic means viral. It can be TB. It can be chronic. But it cannot be pyogenic. And pyogenic, neutrophils are raised. So, by reading this, I rule out. What is the correct answer? See, appreciate the cobweb. And what is this diagram given to you? It is Ziehl-Neelsen. So, on Ziehl-Neelsen stain, you can see the TB bacilli with the blue background. So, correct answer is TB. You all are right. It is a recent PYQ. Correct answer is A. Coming on the next question. What is the most common cause of viral? I forgot to tell you. The most common cause of viral is enterovirus. So, let's move ahead. We are done with the meningitis also. Let's take a small break. After that, we will continue. We will continue the systemic pathology. Till now, we have covered CNS. We have covered CVS. We have covered blood vessels. Right? Many more to go. So, I have to cover endocrine, respiratory, GIT, liver. I guess these are the important ones which we have to go more. The breast also. Okay. So, I will be taking them one by one. Don't worry. We will cover all today. But I will try to concise the session till 3 PM. Let me start the next system, breast. So, in breast, I want to teach you only one topic: breast carcinoma. The ultra-important topic on which many frequently asked MCQs are there. So, let's start breast carcinoma quickly. Right? So, breast carcinoma, you know, it is one of the most common cancer in females. Rather, in bold, it is most common cancer in females only. The cancer of the female is one of the most common cancer in the world. Cancer of the male breast is very rare. You can see the ratio, one is to 150. So, every 150 females, there is one male who can have breast cancer. Most common age in which it occurs is perimenopausal age. Menopause is considered at 50. 50 years approx. So, 45 to 55 years. So, five years before that, five years after that. This is the age group in which breast cancer, breast cancer, um, this is the age group in which breast cancer is most common. Okay. Clinical features. What are the clinical features? Can you see a female? The female will come to you with three clinical features. There is a solid, solitary, painless, palpable lump, which is usually palpated by the self-examination in the breast. The most important thing to see here, it's painless. You know, that's why there is a delay in diagnosis. You know, whenever there is something painless, which is not giving trouble, so females usually they don't go to the doctors, to the physician for checkup. Uh, so because it is painless, but consider if it was painful, it can be diagnosed early. But unfortunately, it is single, solitary, painless, palpable lump. These are the clinical features. Usually diagnosed by the self-examination. Now, for diagnosis, we do triple technique. What is triple technique? In triple technique, the first thing is the self-palpation, the self-palpation or palpation by the physician. Number one, that is palpation. Number two, mammography. Can you see inside the mammography? You can see the breast cancer in the mammography. Number two. Number three, FNAC. We fix the lesion with one hand. With other hand, we put a very fine needle inside the lesion, you know. What is FNAC? Fine needle aspiration cytology. So, we put a very small, thin needle inside the lesion like this, and we do two and fro motion like this. We do two and fro motion like this. So, all the tumor cells present inside the lesion, they dissociate from each other. And then we suck the plunger. We take the plunger out. So, here whatever fluid is formed, a small amount of fluid will come in the syringe. And we will make a smear out of that. We make a smear out of that fluid on the slide. And we look for the tumor cells. So, it is a non-invasive, minimally invasive procedure. It is a quick procedure. It is a very cheap procedure. It is known as FNAC, fine needle aspiration cytology. Okay. Can we go ahead? This is known as triple technique. The triple technique of diagnosis of the breast cancer. The most important thing which I want to tell you in this session is the histopathology. The various types of the breast cancer and histopathology of all of them. So, before going on that, you should understand the structure of a female breast. So, I forgot to put the diagram. I will, I will draw it for you. So, I am drawing the diagram of a female breast. So, this is the nipple area. You can see. I'm drawing a female breast. This is the pectoralis major muscle. On the pectoralis muscle, the female breast is there. Now, in the female breast, small, small ductules are present. I am calling them either you say ductules or you say glands or you say acini. One and the same thing. So, these circular structures, I am talking, these are either ductules or glands or acini. So, multiple small ductules are present throughout the glands. So, they all open in terminal duct. This is terminal duct. They all are opening in terminal duct. So, multiple ductules opening in one terminal duct, they form one lobule. So, this is one lobule. This is one lobule. You can see these are the lobules in the breast. Please understand the difference between ductule and lobule. Ductule is one. Lobule is multiple ductules forming one lobule. So, all the ductules opening in one terminal duct. Can you see this is lactiferous duct? So, this is lactiferous duct. Go in the nipple and open in the nipple. Just before opening, there is a dilatation in the lactiferous duct, which is known as lactiferous sinus. You got my point? Now, what is the function? Can you tell me what is the function of female breast? What is the function? So, male breast is rudimentary. Female breast is functional or only during the lactation, during the breastfeeding to the baby after pregnancy, I mean, during breastfeeding, during lactation, it is functional. So, main function of the breast is breast milk synthesis and milk ejection for the baby, right? So, milk synthesis takes place inside the ductules, inside all these ducts. The cells synthesize the milk. The milk will be going in the terminal duct, from terminal ductule, the milk will come in the lactiferous duct, from lactiferous duct, and get accumulated there. Now, whenever the baby, whenever the baby will suck the nipple of the mother, during breastfeeding, whenever the baby sucked the nipple of the mother, all the milk will be going in the mouth of the baby. So, this is the normal function and normal structure of the breast. Have you got it? Can we go ahead? This is the normal structure. Okay. Now, I hope you got what is this? This is a ductule. This is a ductule. This is a ductule. All these yellow structures are ductules, because I'm going to teach you two types of breast cancer now. So, this is a ductule. And multiple ductules combined together, and they open in one terminal duct. This is forming a lobule. So, I hope you got the difference between ductule and lobule. The yellow ones are the ducts. The green ones are the lobules. You got it? Give me a thumbs up if you got it. The ductule and the lobule. So, I told you two things here. The ductule and multiple ductules opening in one lobule. Okay. So, there are two types of breast cancer. If the breast cancer involves the ductule only, it is a ductal carcinoma. And if the breast cancer involving one lobule completely, it is a lobular carcinoma. So, there are two types of breast cancer: the ductular and the lobular. Ductal and lobular. I hope you understood the difference. If you understood, give me a thumbs up. If you understood what is ductule, what is lobule, then only you can understand the various types of the breast cancer, the ductal and the lobular. What is the duct? You can see these yellow structures are the ducts. Can you see this one? This one? The small circular structures? These are ductules, glands, that's enough, one and the same thing. Multiple ductules combined together, and they open in one terminal duct. This is forming a lobule. So, I hope you got it. You can see this is one of the ductule shown to you. These are normal cells of the ductule. Now, please understand the difference. See the upper three diagrams. See the lower three diagrams. The upper one, ductule is shown to you. In this diagram, ductule is shown to you. And in the lower diagram, multiple ductules, two, two ductules are shown to you. It is a lobule. Multiple ducts are lobule. So, you can understand this is all ductules. And this is all lobules. Okay. Now, this is a normal duct. See, normal duct, right? If the tumor cells are present only inside the duct, it's known as ductal carcinoma in situ. DCIS. Take the full form. Ductal carcinoma in situ. It is ductal. One duct is involved. Only one duct is involved. And it is in situ. It is present inside the duct. Okay. Once it penetrates out in the stroma, you can see it penetrating out in the stroma, it is invasive. One. It is invasive. Now, it converts to invasive. But this is also ductal. This is also ductal. Both of them are ductal. Now, coming on the lobular one. Please come on the lobular one. Here, you can see a normal lobule. Here, the tumor cells are present inside the lobule. They are not coming out. It is lobular carcinoma in situ. LCIS. Lobular carcinoma in situ. Once they penetrate out, see, once they penetrate out, it is invasive lobular carcinoma. So, please understand the four types of the breast cancer. They are in front of you. DCIS, LCIS, ductal carcinoma in situ, lobular carcinoma in situ. Both of them are in situ. Invasive ductal carcinoma, invasive lobular carcinoma. These both are invasive ones. Please appreciate. Give me a thumbs up. You got the four types. So, these are the four types of the breast cancer. The four types of the breast cancer: ductal carcinoma in situ, lobular carcinoma in situ, both are in situ. In situ means carcinoma in situ are non-invasive. And ductal invasive carcinoma, lobular invasive carcinoma. Both of them are invasive ones. So, I'm going to give you four diagrams, one by one. You got it? So, basically, breast cancer is of two types: non-invasive one and invasive one. You got the meaning? Invasive means it is coming in the stroma, the yellow stroma. Non-invasive one also known as carcinoma in situ. Each of them is two types: ductal, lobular. Ductal, lobular. The duct is involved or lobule is involved. This is ductal carcinoma in situ. Okay. This is lobular carcinoma in situ. DCIS, LCIS. This is invasive ductal carcinoma. This is invasive lobular carcinoma. IDC, ILC. So, we use these terminologies only. So, if I say these terminologies, you must have an overview what I'm talking about. If I say DCIS, LCIS, IDC, ILC, the first thing you should know their full form. Not knowing only their full form, you should understand the meaning of them. Let me show you the diagrams. The histopathological diagram for each of them. Let me start with in situ first. Let me show you the diagram of DCIS and LCIS. Then I will come on the invasive ones. So, let's start the non-invasive ones. Let's start with this portion. The non-invasive carcinoma in situ. Non-invasive carcinoma in situ. The two types: DCIS, LCIS. So, let's talk about DCIS. Can you see? See the first four diagrams. First four. Don't see the last one. See the first four diagrams. All of them are DCIS. The various types of DCIS. I mean to say, the DCIS are four types. Listen, listen. Can you see a duct here? Can you see a duct here? Can you see a duct here? Can you see a duct here? You can see the tumor cells inside them. None of them, tumor cell is coming out. So, all of them are ductal carcinoma. And in situ. In all of them, tumor cells are concised. They are within the duct. They are not coming out. They are not penetrating out. That's why they all are carcinoma in situ. And they all involve one duct. That's why they are ductal carcinoma in situ. So, one thing is common in all of them. But the arrangement of the tumor cells is different. See the first one. Here, the tumor cells is compactly present throughout the duct. It is known as solid. It is known as solid. In the second one, there is necrosis at the center. And tumor cells are present at the periphery. It is known as comedo. Comedo. Tumor necrosis is present at the center. The third is the papillary. The tumor cells are orange like finger-like projections. Can you see the finger-like projections? The tumor cells are arranged like fingers. It is known as papillary type. And last one is the cribriform. In which, in which, the holes are there. I mean, cribriform means sieve. Sieve. And a Chinese matter. It is same like arrangement, you know. So, to see like arrangement. So, see the four arrangements. They all are DCIS. One thing is common in all of them. They are present. All the tumor cells are present within the duct. None of them is coming outside the duct. That's why they all are carcinoma in situ. And they all involve one duct. That's why they are ductal carcinoma in situ. So, one thing is common in them, but the arrangement of the cells is different. So, say what are the four types? Solid, comedo, papillary, cribriform. You understood the difference? In the solid, it is completely plugged with the tumor cells. In comedo, there is a central necrosis, tumor cells are present at the periphery. In papillary, they are finger-like projections, papillary projections. And in cribriform, it is the fenestrations, like sieve. Okay. I appreciate you got it. Now, coming on lobular carcinoma in situ. It is only of one type. The last one, this one. It is only of one type. It is solid only. Here, the lobule is involved. This is not duct. Here, multiple ducts are involved. Multiple ducts means one lobule. And here, only one pattern is there, like solid. You will see them. Then what is the difference between this solid and this solid? Here, one duct is involved. Here, one lobule is involved. Here also, it's in situ. It is not coming out. The tumor cells are within the duct. Here, tumor cells are within the lobule. It is not coming out. Both are in situ. Okay. Here, tumor cells are compactly placed with each other. Here, tumor cells are loosely arranged with each other. So, there is a difference in pattern. Here also, solid. Here also, solid. But here, tumor cells are compact. And here, tumor cells are loose. The word loose is indicating LCIS. The tumor cells are loosely cohesive with each other. You got it? Can we go ahead? So, we have seen the two diagrams till now. DCIS, LCIS. What is DCIS? DCIS is of four types: solid, solid comedo, papillary, cribriform. And LCIS is only one type: solid. Right? So, here the duct is involved. Here the lobule is involved. I hope you can draw the diagrams here. You have to draw the four diagrams. Here, you have to draw one diagram. We are done with carcinoma in situ. Let's come on invasive carcinoma. Let's come on invasive carcinoma. So, invasive is also of two types: invasive ductal carcinoma, invasive lobular carcinoma. Here, the duct is involved. Here, the lobular is involved. Both of them are invasive. So, let's start with the invasive ductal carcinoma. Then we will come on invasive lobular one. This is invasive ductal carcinoma. See, okay. I will draw diagram for you. I will draw diagram beautiful diagram for both of you. For both of them. So, see IDC, ILC. Okay. Let me draw the ducts here. Okay. These are the ducts. Let me draw the lobules. These are the lobules. Multiple ducts are forming the lobules. These all are lobules. Here. Okay. Let me draw the tumor cells here. Four types are possible. So, here it can be solid. It can be central necrosis like comedo. Okay. It can be papillary. It can be cribriform. Whatever. Here, only one pattern is there. Here, it's solid only. In lobular, it's only solid. Okay. The lobules are filled with a solid, solid pattern of the tumor cells, loosely cohesive with each other. My point is that in both of them, the most important thing, the tumor cell will penetrate and come in the background. Let me penetrate the tumor cell and let me take them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. 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So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. So, let's take the tumor cell out and please fill them in the background. 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A line, they come out, and they are in a line, one behind the other, forming a small, small train, one behind the other. Say yes, you got it. So, this is the pattern you can see, you can appreciate in front of you. So, the most important point to understand here, or to differentiate them here, here also stromal invasion is there. Here also stroma, stroma is the background, the background is invaded in both of them. But here, there is no fixed pattern. In IDC, they can be single, they can be groups, they can be clustered, they can be nests. But in ILC, they are in a row, they are in a row, they are in a row. This typical pattern is known as Indian file pattern, Indian file pattern. Let me show you both in this diagram. See here, first IDC, you can see this is the diagram, okay? Can we see a duct here? Can you see a duct here? So, both of them, this is showing solid DCIS, this is showing comedo. I can see the central necrosis. From both of them, the tumor cells are coming out and infiltrating the background. See here also, here also tumor cells are. So, here they are arranged in groups, they are arranged singly, they are arranged in glands, they are arranged in clusters. So, you can see the invasiveness, their stromal invasion is there. In lobular carcinoma, invasive lobular carcinoma, this is the diagram, you can see this is a lobule. The lobule will have only one pattern here, it's solid. You can see solid here also, here also. From here, the tumor cells are coming, but they form a row, see the row, one behind the other. Appreciate one behind the other, appreciate one behind the other, appreciate one behind the other. They form a row in the stroma. It is known as Indian file pattern. What is Indian file pattern? This pattern, one behind the other, is known as Indian file pattern. It's very important IBQ, it's very important PYQ. Indian file pattern, please appreciate. Got it? Everyone got it? Anyone who didn't get it? The Indian file pattern. So, compare the two. IDC, they are in front of you. Just a second. Can you please compare the two? IDCs, they are in front of you. This is IDC, this is ILC, invasive ductal carcinoma, invasive lobular carcinoma. Appreciate. And both of them, see the background. The background is important in both of them. There is a background stromal invasiveness in both of them. But here, there is no fixed pattern, and here there is a fixed pattern, that is known as Indian file arrangement, Indian file arrangement. And it can be here, it can be groups, it can be clusters, it can be individual. Say yes. So, this is the difference between them. We are done, we are done with DCIS, LCIS, IDC, ILC. Can you draw the four diagrams for me? In DCIS, can you draw the four diagrams? Let's draw the four diagrams. DCIS, DCIS, LCIS, IDC, ILC. Can you please help me? BCIS is of four types. I'm not drawing, I'm just writing. You can draw if you wish. Solid, comedo, papillary, cribriform. You know how to draw it. There, they are concise inside the duct. They will not come out. Tumor cells are concise inside. Only solid pattern is there. They are concise inside the lobule. They will not come out, right? But in IDC and ILC, after filling, after filling the lumen, they infiltrate and they come in the background. So, here they can come singly, they can come in groups, they can come in glands, circular glands, they can come in clusters or nests. There is no fixed pattern. But here, when they come out, they are in a row, they are in a row, they are in a row, which is known as Indian file pattern. I cannot explain more easier than this. Please respond, please respond. If you are sleeping, please awaken and please respond. So, you got it. That is the four types of the breast cancer. I simplified for you. One more thing I would like to highlight here in the breast cancer is the Paget disease of the nipple. You know what is Paget disease of the nipple? Disease of the nipple. It looks like this. So, on the nipple of the breast in the female, around the nipple, there is an eczematoid scaly lesion in which the female has pruritis, the female has itching, and it is bleeding. It is bleeding, right? So, it looks like a skin infection. It looks like some skin infection. Can you appreciate it? So, it is always around the nipple, very areolar. This area is known as periareolar region. There is a lesion which is eczematoid, scaly, having pruritis, itchy, and it's bleeding. So, it's highly itchy, and the lady can peel. There is some skin infection. Usually, they refer, they go to the dermatologist. But it can be a hidden malignancy. It can be a hidden malignancy. I have told you the diagram of the breast. Can we revise the diagram of the breast? This is the diagram of the breast, okay? In the diagram of the breast, I told you multiple ductules are there, right? They all bind together and they form the terminal duct. Okay? Multiple terminal ducts open in the lactiferous duct. This is a lactiferous duct, and multiple terminal ducts open there. Have I told you this? Imagine if there is a cancer in one of the ductule or one of the lobule, a small cancer. So, basically, the cancers, the tumor is very small, hardly 0.5 centimeter or one centimeter. It is not palpable. The female is unable to palpate the tumor in her breast. It's a lumpy breast, and the female is unable to palpate it, okay? So, tumor cells are traveling in the terminal duct. They are traveling in the lactiferous duct. They are coming out, out, out, out, out, and after coming out, they enter in the skin. What are the layers of the skin? In the skin, we have two layers, epidermis and dermis. So, in the epidermis, there are five layers. Stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum. So, basically, these tumor cells enter in the epidermis, in the epidermis around the nipple, okay? And that's why the lady is presenting as an eczematoid lesion of the nipple. So, it looks like the lady is having some skin infection, the scaly lesion, but it is indicating some underlying hidden malignancy. So, if you are a dermatologist, and such a lady is coming to your clinic, Doctor, I am having an itchy lesion around the nipple of the breast, you should refer it to the oncologist. You should ask the lady to go for a mammography. It can be showing some hidden malignancy. You got my point? So, that is known as Paget disease of nipple, Paget's disease of nipple. It is showing the hidden malignancy. Appreciate it. Got it? This is Paget disease. So, it is the eczematoid lesion of the nipple associated with invisible, non-invasive underlying carcinoma, which is very small. It's a malignant lesion. Can you see the same diagram here? Can you see? This is the tumor. This is a tumor, a small tumor. Appreciate. The tumor cells are going in the lactiferous duct. From the lactiferous duct, it is entering around the nipple in the epidermis. They enter in the epidermis. So, these cells are known as Paget cells. The cells in the epidermis are known as Paget cells, okay? This is Paget disease. Grossly, you can identify this is the lesion around the nipple. It is crusted, fissured, ulcerated, oozing with blood. So, this is a typical, typical scenario. It can be IBQ's, typical spotter. It's an image-based question, okay? Histologically, you can see the Paget cells. Can you see? It is all epidermal skin. In the skin, you can see the big tumor cells. These are the Paget cells. So, that's all about the breast cancer. Before ending the breast cancer, I must tell you the molecular classification of the breast cancer. Shall I tell you the molecular classification of the breast cancer? Are you people there? Can I continue the molecular classification? What is molecular classification of the breast cancer? Now, all female breast, all female, healthy, healthy, all female breast. This is the breast of a healthy female, okay? These are the cells. These are the breast cells. Multiple breast cells are present. I mean, these are the ductus, the ductules are made up of the cells. These are the cells lining the ductules, okay? On all the cells, three types of receptors are present: estrogen receptor, known as ER, progesterone receptor, PR. They are present together, ERPR, and the third one, it can be together, it can be alone. So, that is known as HER2, HER2 or cerb2. So, three types of receptors are present on the cells. So, let me show you the cell. Can you see a normal breast cell? Appreciate on the surface of the cell, appreciate the receptor. This is ER and PR receptor. They are normally present, but in low amount, low amount. When this breast cancer converted, when this normal breast cancer converted into cancer cell, at that time, see the number of the receptors, ERPR increases drastically. See, 100 times, one becomes hundred. It is increasing drastically. So, basically, ER and PR, estrogen and progesterone, present in the blood, that is acting as a growth factor. When estrogen and progesterone come and bind here, the cell divide, divide, divide, and there is uncontrolled growth. Yesterday, I told you, know, how this neoplasia occurred in general pathology, right? So, whenever growth factor is coming, binding with the growth receptor, there is uncontrolled mitosis, leading to a formation of a lump, a mass. It is known as breast cancer. So, estrogen and progesterone bind with the estrogen and progesterone receptor, and they cause the cell division. So, this is a breast cell, this is a breast cell. So, estrogen and progesterone receptors are present. They increase during cancer. So, estrogen present in the blood, come and bind here. Progesterone present in the blood, come and bind here. And when estrogen, progesterone bind with their corresponding receptor, this cell undergoes uncontrolled mitosis, leading to cancer. This is regarding estrogen, progesterone. The same with HER2. HER2 also known as cerb2. See the normal breast. In the normal breast, on the surface, you can see few HER2 receptors. But during cancer, again, abundant. So, they increase 100 times. They increase 100 times. Abundant HER2 receptors, you can see many HER2 receptors on the surface, right? So, this is a normal breast, this is a cancerous breast. So, when HER2 from the blood is coming and binding with them, it is causing their abnormal growth. You got it? Now, based on that, there are four types of breast cancer. Everyone here on the screen. So, you look for ERPR, occurs together, don't differentiate them. ERPR is estrogen and progesterone receptor, and one is HER2 receptor. So, either both of them are positive, either both of them are negative, either one of them is positive, one is negative, other is positive, one is negative. So, there are four types of breast cancer. The first type is Luminal A type of breast cancer, in which ERPR responsive, HER2 is negative. The second is Luminal B, in which both are positive. The third is Basal. It is both negative. It is also known as triple. It is also known as triple negative breast. How does it matter? Being a doctor, how does it matter what type of breast cancer the lady is having? It matters for you. Number one, patient wants two things from you. Number one, patient wants the treatment, the specific treatment, and patient wants to know the prognosis of the disease, right? Both of them depends on the molecular classification, right? Now, if the patient is ERPR positive, if the patient is ERPR positive, for treatment, you give ERPR blocker, the ERPR antibody or blocker, you can say. There's a drug, Tamoxifen. You will give the Tamoxifen in, uh, in treatment. That is a blocker of ERPR receptor. If it is HER2 positive, you will give Herceptin, Herceptin or Trastuzumab. That it is a, it is a monoclonal antibody, the targeted therapy, Trastuzumab, right? It's very costly. So, depending on the molecular classification, you will decide the hormonal therapy of your patient. If the patient is ERPR positive, give this. If the patient is HER2 positive, give this. If the patient is both positive, give both. If the patient is negative or both, give none of them. Give none of them. Triple negative breast cancer are the worst breast cancer because we are not giving any treatment to them. I mean, we are not giving any hormonal treatment to them. We give only chemotherapy because we don't know what is the growth receptor for them. You got my point? Yes. Luminal A is having the best prognosis. The prognosis here is nearly 95%. Luminal A. And the trend, Basal or triple negative, having the worst prognosis. Say it out, everyone. So, what are the four types of the breast cancer based on ERPR status and based on HER2 status? Can you tell me what are the four possibilities? Everyone on the screen, tell me the possibilities, please. What are the possibilities? Say ERPR positive, HER2 negative. This is the best one, the best one. Okay? The second is the both are positive, right? Second best one. And third is only HER2 positive. This one is negative. The worst is both negative. So, both negative is triple negative. Okay? So, this one is known as Luminal A, Luminal A type. This one is known as Luminal B type. This one is known as HER2 rich, only HER2 is positive. And this one is known as Basal, Basal, also known as triple negative breast cancer, right? Being a doctor, you must tell the patient prognosis and the treatment. You must give the exact treatment. So, here for ERPR positive, you give only Tamoxifen. You don't give Herceptin. Here, you give Tamoxifen also, you give Herceptin also. Here, you give only Herceptin, but not the Tamoxifen. Here, you give nothing. You give nothing, but the prognosis is worse. Recurrence is very common. Metastasis is very common. Herceptin is very costly drug. Unnecessarily never give it. Never give it. It's very costly. One vial cost nearly around one lakh, and in Indian market, and nearly for the entire treatment, 17 vials are required. So, total cost may be 75,000 to 1 lakh is the one vial. 12, 13 lakhs is the cost of the treatment for one lady. So, everyone cannot afford that cost. Tamoxifen is a cheap drug. It is an oral drug. It's oral drug. So, tablets come. So, patient has to take one tablet every day till five years or ten years, whatever. So, that is the treatment. So, treatment part, we have covered. We are done. Can we solve some questions on breast cancer? We are done with breast cancer also. Kindly respond. Will you? Yes, very good. Version, very good. So, the question is in front of you. Okay, let's skip this. Best prognosis of the breast cancer. Which one is having best prognosis? Is it Luminal B? Is it Luminal A? Is it HER2 positive, HER2 enriched, or triple negative? The triple negative are the basal one, okay? Can you tell me what is the best prognosis? Which of the following have the best prognosis in the breast cancer? Yes, that's the correct answer. Which of the following is having the best prognosis of the breast cancer? What's the correct answer here? Yes, what is the correct answer? I'm asking. Yes, very good. Oh, you are saying C. The best is the B. Now, the best is the B. The Luminal is the best. Osama, C is not the answer. You are saying B is the correct answer. So, Luminal A is the best. If I ask the worst prognosis, answer will become triple negative. So, learn the best, learn the worst, okay? The next question is in front of you. Indian file pattern is seen in which type of breast cancer? Indian file pattern. Indian file pattern is one behind the other, one behind the other, like like this, like forming a row. It is seen in which type of breast cancer? Is it DCIS? Is it LCIS? Is it IDC? Is it ILC? I guess you know the full form. Ductal carcinoma in situ, lobular carcinoma in situ, infiltrating ductal carcinoma, infiltrating lobular carcinoma. Yes, absolutely right, Shalini. The correct answer here is ILC. In ILC, it typically we see Indian file pattern, right? So, if I change the question, correct answer is this. If I change the question and I ask you, comedo pattern is seen in which type of breast cancer? What is their answer? Now, I told you four types of DCIS. One of them is comedo. The correct answer in that scenario will become DCIS. So, in this way, if you know the various variants, you can answer them very correctly. The next question is in front of you. Unilateral breast finding around the nipple with bleeding. What is your diagnosis? It's a spotter. It's a spotter. Scaly lesion around the nipple with bleeding, and it's unilateral. Take the clues. Tell me the answer. Of course, you all are right. The correct answer here is the Paget disease. The Paget disease is the correct answer. Let's move on. The next system, we have covered four systems till now. CVS, blood vessels, CNS, and breast. Also, coming on the neck system, endocrine. In endocrine, I would like to tell you thyroid tumors and diabetes. Two important, ultra-important topics I will discuss here. So, let's discuss thyroid tumors. How many types of thyroid tumors you know? There are four types of thyroid tumors: papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma. So, these are the four types of thyroid tumor. We have to discuss their introduction, gross, and microscopy for each of them. Let's start. So, I will show you this table again in the end. I'm not reading it wrong. So, these are the four, okay? Have a look. So, papillary, follicular, medullary, and anaplastic. We will take them in the sequence only. We will take them in this sequence only. Orange occurs when lymphatics is involved. When the tumor cells enter in the lymphatics of the breast, it, the breast appeared granular and radiation appearance, that is like the skin of orange, orange fruit. That is known as peau d'orange, and it is not always indicating malignancy, but yeah, it can be indicating the hidden malignancy, okay? There are four types of thyroid cancer: papillary, follicular, medullary, anaplastic. We will be looking them in this sequence. The most common is the papillary, see, 80% is papillary. The second most common is follicular, that is the 10%. 80, 10. Medullary and anaplastic are only 5%, 5%. They are very rare, right? So, that is the thing. They all are common in female. They all are more common. See the ratio of female to male. It is three times common. This one is 2.5 times common. This is 1.5 times common. Only one is equal in male and female, that is medullary. It's a PYQ. Which of the following thyroid cancer is equal in male and female incidence-wise? So, it's medullary. Rest all are more common in female than male. So, please, please learn that. Learn the gene mutation of all of them that I will tell you, okay? So, let's start one by one. Start with the papillary. Among them, papillary is most common. It is the 80%. The risk factor is radiation or the thyroglossal cyst. If there is radiation in the thyroid due to any reason, if the radiation is there in the thyroid, it can lead to papillary carcinoma. Or thyroglossal cyst is also a risk factor. Grossly, you can see, you can see it's a cavity. The cavity have the papillary tumor. Grossly also, I can say finger-like projections, that is the papilla. Grossly also are seen, that is the finger-like projections, that is papilla. Histopathologically, this is the diagram of papillary carcinoma of thyroid. You can see. So, what you can appreciate in any histo slide? Let me give you general clues. In any histo slide, this is a histo slide. So, along with pink and purple, the first thing you have to notice is the pattern. Tell me the pattern in which tumor cells are arranged. Is it solid? Is it papillary? Is it cribriform? Is it what pattern? Is it glandular? Right? What is the pattern here? Tell me the pattern first. Number two, after describing the pattern, describe the cells. Take individual cell and describe it. Describe the nucleus, describe the cytoplasm, and then any unique finding is present, describe that. This is the way we covered the histopathology. So, look here, what is the pattern we are having? We can see this is the papillary pattern. You all can see the tumor cells are arranged in papillary, papillary pattern, like this. The tumor cells are arranged in papillary pattern. Papillary is finger-like projection, right? So, let me draw papilla for you. Imagine this is the papilla. At the center of the papilla, there is a blood vessel. The tumor cells, the tumor cells, the tumor cells are like this. Just a second. The tumor cells are like this. They surround the papilla like this. The tumor cells, okay? And in the center, there is a blood vessel with fibrosis. It is known as fibrovascular core. So, at the center, there is a fibrovascular core. Here also, you can see at the center, if you can appreciate, this is the blood vessel. Multiple blood vessels are present at the center along with the fibrosis. So, fibrovascular core is there, and tumor cells, you can see these all are tumors. These all are tumor cells. The tumor cells are forming the border, they are forming the periphery, and they are arranged around the papilla. Let me describe one tumor cell. Let me zoom one of the tumor cell for you. Let me zoom. Can you see here? Tumor cells. See the nucleus. See the nucleus. See the nucleus. See the nucleus. Nucleus is empty from inside. I'm using the word empty. Empty, matlab, khali. Nucleus, nucleus is empty from inside. It is not filled. Nucleus like this. The nucleus is not filled from inside. The nucleus is empty from inside. It's like this, right? So, it is looking like Orphan Annie. Annie is a girl. Annie is a girl, and she's a cartoon. Huh? You may be knowing the Mickey Mouse. It's like Annie only, right? So, Annie, she's orphan. He's orphan. Orphan Annie, and her eyes are empty like this. So, we compare the nucleus of the papillary carcinoma with Orphan Annie eye nucleus. What does we use the word? We use the word Orphan Annie eye nucleus. Please learn this word. Or else, it is ground glass, or it is optically clear. So, either say one and the same thing. Either you say it's Orphan Annie, or you say it is ground glass appearance, ground glass. One and the same thing, okay? Or you say it's optically clear. It's optically clear. Optically clear nucleus. This is equal to this is equal to this. So, these all are synonyms. So, the nucleus of the papillary carcinoma is very unique. It's clear, it's optically clear, ground glass like Orphan Annie eye. Appreciate it. You got it? This is the thing, okay? So, this is very unique finding. One more unique finding is there in the cell. Then you see all these tumor cells. So, inside the tumor cells, you can see the groups. Let me show you. This is a tumor cell. This is the nucleus. This is the tumor cell. This is the nucleus. So, inside the nucleus, appreciate the grooving. The grooves are there. Can you see the grooves? This is the nucleus that is divided. So, the nucleus, this is the tumor cell. This is the nucleus. Inside the nucleus, grooving is present. And most of the cell, grooving is present. Not only this, inclusion bodies are present in the cytoplasm as well as the nucleus. So, grooving, inclusion body in the cytoplasm as well as nucleus. You can appreciate multiple inclusion bodies also here. Can you see this? This is an intranuclear inclusion body. Appreciate it if you can. This is the intranuclear inclusion body. In the same way, intracytoplasmic. Appreciate grooving at many places, you can see the grooving. So, these are the important features. See the nucleus, see the inclusion body, see the grooving. So, that is the papillary carcinoma. One more last thing is there. Sometimes you can get calcification. Can you see here? The calcification. The calcification is known as psammoma body. P is silent here. Psammoma body. Can you describe the papillary carcinoma of thyroid? People, tell me. Papillary carcinoma thyroid, all important points. So, in the introduction, it is the most common among all tumors in the thyroid. The risk factor is the radiation and thyroglossal cyst, okay? Now, in the gross, in the gross, the papillas are there, the papillary stalks are there. In the microscopy, in the microscopy, tell me the important features. So, tumor cells are arranged in papilla, like this. Inside the papilla, there is a fibrovascular stalk, right? Say papilla, say fibrovascular stalk. In the tumor cell, uh, in the tumor cell, the nucleus is clear. It's optically clear, known as Orphan Annie eye nuclei, or optically clear, ground glass appearance, okay? There are inclusion bodies present in the cytoplasm also and nucleus also, and there is grooving present in the nucleus. So, please enumerate all these points along with calcification known as psammoma body. To get many questions on papillary carcinoma of thyroid. The next one is the follicular carcinoma of thyroid. The follicular carcinoma is the second most carcinoma of the thyroid. If gross is not important, but microscopically, the tumor cells have various follicles. Can you see this is tumor, but it's known as follicular? What is the arrangement? Tell me the arrangements. They are not arranged in papilla here. The tumor cells are arranged in small circular follicles, small, small circular follicles. Can you see the tumor cells are arranged in small circular follicles, small, circular follicles? Everywhere. So, this is the tumor cells arrangement. They are arranged in follicles. The nucleus is filled. It's not empty. If you appreciate, zoom it out, you can see the nucleus is filled. It is filled from inside. It's not empty. So, nucleus is hyperchromatic. In contrast to papillary carcinoma, that is sometimes cytoplasm is too much. You can see abundant cytoplasm, which is pink in color. These are known as Hürthle cells. So, Hürthle cells having abundant pink eosinophilic cytoplasm, granular cytoplasm. The next one is the medullary carcinoma, the third one. So, you can see here, in the thyroid, we are having, sorry, in the thyroid, we are having two types of cells, the follicular and parafollicular. Have you heard about parafollicular cells? See the diagram of a normal thyroid. Normal thyroid gland diagram. You can see these are the follicles. Follicles. They are lined by follicular cells. The follicles are lined by follicular cells. The follicles are lined by follicular cells. And in the stroma, you can see parafollicular cells. The medullary carcinoma is the carcinoma of parafollicular cells. The remaining three carcinoma, construm of follicular cells, but this one is a carcinoma of parafollicular cells. Parafollicular cells secrete calcitonin in the blood. That's why whenever there is a tumor, medullary carcinoma, medullary construm of thyroid, abundant of parafollicular cells are there, and they all secrete calcitonin in the blood. So, in the blood, there is hypercalcemia, hypercal, hypercalcitonin hormone, that will lead to hypocalcemia. You know what does calcitonin do? Calcitonin decreases calcium in the blood. That's why there is hypocalcemia. You got my point? And it is having familial occurrence. It is associated with MEN, it is associated with 2A, 2B. Both MEN, 2A, MEN 2B. In both of them, medullary carcinoma thyroid is there, right? So, it is associated with its familial also. Histologically, this is the diagram. See the tumor cells. The first thing, they all are uniform. What is the arrangement? Pallet arrangement. The tumor cells are arranged in nests, small, small nests. The tumor cells are arranged in nests. Papillary, papillary arrangement of follicular, follicular arrangements. The tumor cells are uniform. Background, the pink color, notice please, everyone, notice the pink color in the background. See here, the pink color. What is the pink color? What is the background pink color? This background pink color is amyloid. So, very unique tumor having amyloid in the background. The stroma contain amyloid, and sometimes calcification is also there. You can notice here, it's simple calcification. So, this is the diagram. This is the diagram, yes. It causes osteoporosis. Yes. So, this is the diagram. We can see the amyloid on Congo red, just can be seen, okay? The last one is the anaplastic. It is the most malignant, most aggressive tumor among the four. It is very aggressive. It is rapidly growing and having the metastases. Gross and microscope is not important because it is not fixed. So, we are done with the four types of thyroid cancer: papillary, follicular, medullary, and anaplastic. Can you tell me the important points? Who will help me with the important points with each of them? Please, once. Can we revise it quickly? Can we revise it quickly? I will not give you the questions now because it is taking time, and I have to cover all the systems. So, we will not solve the question. You can solve the questions by yourself, or I can provide you the PDF. You can provide the questions by yourself, okay? So, can you give me the, we can revise it here. The papillary carcinoma, the tumor cells are arranged in papilla, here, the tumor with the fibrovascular stalk at the center. Here, the tumor cells are arranged in follicular pattern. Here, the tumor cells are arranged in small, small nests, right? Here, it's not important. This one is the most common. This one is the most aggressive, most malignant, most lethal, okay? This one is second most common. Learn the important points, right? Medullary is the only one which is derived from parafollicular cell. These all derived from follicular, follicular, follicular cell, but this derived from parafollicular cell. That's why secrete calcitonin in the blood. Calcitonin decreases calcium. Patients have hypocalcemia. You got it? You got it? So, this is the thing. Now, tell me the important, important points about the cells here. The tumor cells have optically clear nucleus, Orphan Annie eye nucleus. In the nucleus, there is grooving. There is grooving is there, and inclusion bodies are present in the nucleus and the cytoplasm, along with psammoma bodies. Here, the tumor cells are uniform, and they have hyperchromatic nucleus. Here, the tumor cells are uniform, and they have amyloid stroma in the background, very unique, along with calcification. So, please learn the important histological findings. Try to see the diagram of all of them. Try to see the important findings. Got it? All of them are more common in female, except medullary, in which male is equal to female. It's a PYQ. Say yes. Got it? Can we go ahead? Can we go ahead? So, we are done with thyroid tumors. I'm not giving you questions to solve because it is taking time. I am waiting for your response. Is it done? Can we go ahead? Is it done? Can we go ahead? Say yes. Okay, so, can we go ahead? So, the next topic I am taking is the MEN. What is MEN? Multiple Endocrine Neoplasia. Multiple Endocrine Neoplasia. It is a syndrome in which multiple endocrine cancers are present in one patient. There are three types of MEN: MEN 1, MEN 2A, and MEN 2B. Sometimes MEN 2B is known as MEN 3. MEN 3. So, MEN 1, 2, 3. In some books, it is written like that. Or else, MEN 1, 2A, and 2B. When MEN 1 is known as Wermer syndrome. MEN 2A is known as Sipple syndrome. MEN 2B, no specific name is given. So, you can see the three MEN. The three types of syndrome in which multiple cancers are present in one patient. Let's start with MEN 1. Let's start with MEN 1. In MEN 1, it's triple P. Three P. Triple P cancer is present. Start from the beginning, from the head. In the head, there is pituitary adenoma. Inside the pituitary, in the brain, there is a cancer. In that, come in the neck. In the neck, there is parathyroid gland, not thyroid. Inside the thyroid, there is parathyroid gland. The parathyroid hyperplasia is there. And come in the abdomen. In the abdomen, there is pancreas. So, there is pancreatic tumor. Say triple P, everyone. Say triple P. Triple P is MEN 1. It is known as Wermer syndrome. Wermer syndrome. Say yes. Coming on MEN 2A. In MEN 2A, again, it's parathyroid. Number one, thyroid. Parathyroid both are involved. Parathyroid is medullary carcinoma, right? And there is adrenal gland involvement having pheochromocytoma. P. So, you can see two P's are there, and one M is there. Two P's and one M. Okay? And in MEN 2B, in 2B, there is mucosal neuromas. You can learn like that. So, what we have learned? We have learned MEN 1 have triple P. MEN 2A have one M and two P's. You can say P, pheochromocytoma, and MEN 3 have MMM along with pheochromocytoma. You can learn like that. I have explained you MEN 1, 2B. You get many MCQs on that. What is MEN 1, 2A, 2B? You want to revise or you got it? What is MEN 1? Start from the pituitary. Pituitary adenoma. Come on the parathyroid. Parathyroid hyperplasia. Come in the pancreas. Pancreatic tumor. Pituitary adenoma, parathyroid hyperplasia, pancreatic tumor. Triple P. Can we revise? MEN 2A. Start directly from the parathyroid. Parathyroid hyperplasia. And in the thyroid, it's medullary carcinoma, medullary carcinoma of the thyroid. And in the abdomen, its adrenal gland involvement having pheo, pheochromocytoma. Two things are common in MEN 2B out of them. Two things are common. So, pheo occurs here also, and medullary cancer markers here also. But two are additional. There is Marfanoid syndrome and mucosal tumors. So, this is the MEN. This is the thing. Yes, yes, everyone is right. Can we go ahead? The next topic is the diabetes. So, endocrine system will also be done after that. We will move on the next system, the GIT and the liver, right? And after the GIT, liver, respiratory, these are the three major systems are left. After this, and kidney, yes. So, four major systems and MGT in the hand, two small systems. So, let me try my best to give you more and more, okay? So, let's start with diabetes. The next topic we are covering here is the diabetes. The endocrine system. The diabetes. Can we go ahead with the diabetes? Say yes. So, let's start with diabetes. The next is the diabetes. To understand diabetes, you should understand pancreas. We know humans have pancreas. Can you see here? The humans have pancreas. Pancreas is the organ. It's a dual organ. The pancreas is the organ. It's a dual organ. Uh, it is, it is having, um, exocrine part and endocrine part. The exocrine part secrete enzymes, and the endocrine part secrete hormones. Currently, I am interested in the endocrine part of the pancreas. The endocrine part of pancreas is in the form of a cluster of cells which is known as islet of Langerhans. It is known as islet of Langerhans. Islet of Langerhans, the cluster of the cells, right? It is having four types of cells: the alpha cell, beta cell, delta cell, and PP cell. Alpha cell secrete glucagon. Beta cell secrete insulin. Delta cells secrete somatostatin. And PP cell secrete pancreatic polypeptide. The four types of hormones. They all are hormones. They all are hormones. Glucagon and insulin are important for glucose metabolism. They are secreted from the pancreas in the blood, okay? So, let's start with diabetes. What is diabetes? I guess everyone knows. Diabetes is hyperglycemia. More glucose in the blood. Hyperglycemia is known as diabetes. So, what is the normal level of glucose in the blood? The normal level of glucose in the blood is fasting level is 80 to 100 mg. 80 to 100 mg per deciliter. When it is more than that, it is hyperglycemia. When the blood glucose is high, it's known as diabetes mellitus. You got it? Now, see this diagram to understand what is diabetes. Everyone have a look. Very important diagram. Please understand what is diabetes here. In this diagram, you can understand. Can you see the blood vessel? Yes, you all can see. This is a blood vessel. You all can see. This is a cell, okay? Uh, so, insulin is a hormone which transmits the glucose from blood to cell. Look at the arrow, from blood to cell. And glucose is stored in the cell in the form of glycogen. Glucagon is a hormone which degrades the glycogen and take the glucose from cell to blood. You can see the two hormones. So, talk about the blood level. Insulin decreases the glucose level of the blood, and glucagon increases the glucose level of the blood. Am I right? So, this is normal. This happens in all of us. In my body, in your body, we all have insulin as well as glucagon. So, whenever our blood glucose level is high after eating, insulin takes care of it. It decreases the glucose level. And during fasting, if I'm not eating anything, if I'm fasting, so my blood glucose level will fall. So, at that time, glucagon will take care, and it increases the blood glucose levels. So, because of the two hormones, the blood glucose level is maintained between 80 to 100 all the time, all the time. This is the basal level, because of insulin and glucagon balance, right? So, the balance is very necessary. The balance is very necessary. You got it? Now, insulin is absent. Imagine if insulin is absent. Either it is absent or it is present and non-functional. Either the insulin is absent, or the insulin is present, but it is non-functional. You're going to give me a minute. So, what will happen in this case? In such scenario, what will happen? Can you tell me what will happen in such scenario? So, in this scenario, the blood glucose level will rise, right? The blood glucose, the hormone which is carrying the glucose from blood to, from blood to the cell, it is non-functional. So, blood glucose level will rise, and cell glucose that will fall. So, this is known as diabetes. And in diabetes, there are two problems. The blood, there is more glucose in the cell, there is less glucose. So, cells are starving. Can I say cells are starving? Cells are not getting the glucose, right? Although having abundant of glucose at the doorstep, cells cannot utilize it. So, there is a problem in utilization. Have you heard in Hindi, "andhera"? You know? So, the same proverb fits here. So, the cell is starving of glucose, having abundant of glucose in the blood, the cell cannot take it. So, that is the problem. The mystery in the diabetes. In the blood, there is abundant, abundant, abundant of glucose, but cell cannot take it. Cell cannot utilize it. So, cells are starving, they are dying of glucose. And in the blood, there is abundant of glucose. This is the problem in diabetes. And why the insulin is not functional? I mean, there are two problems. Either the insulin is absent, or it is non-functional. So, that is the two types of diabetes: Type 1 and Type 2. In Type 1, the insulin is absent because insulin is secreted by beta cells of the pancreas. The beta cells are destroyed by destroyed by autoimmune phenomenon. In Type 1, the insulin is absent. In Type 2 diabetes, insulin is present, but it is non-functional. It is present, but non-functional. You got it? Have you got it? Can you please, um, tell me that whether you want it or not? Didn't got it? So, that is the normal physiology. I told you. Now, come on the classification. How many types of diabetes are there? There are two main types of diabetes: Type 1 and Type 2. Type 1 diabetes is 10%. Type 2 diabetes is more common. It's 90%. Type 1 diabetes occurs in juvenile age. It is known as juvenile onset diabetes, JOD. Type 2 diabetes is maturity onset diabetes. Type 1, insulin is given as a treatment. That's why known as insulin dependent diabetes mellitus. And in Type 2, insulin is given as a last resort. That's why known as non-insulin dependent diabetes mellitus. That is the classification. Now, to understand the pathogenesis of the two types of diabetes along with the clinical features, you have to understand the insulin regulation. You have to understand the insulin regulation. How does the insulin is synthesized? How it is released? How it is acting? What is the action of the insulin? So, you have to understand that. Okay? Now, please see this diagram. Normally, I'm telling you the insulin, um, pathogenesis. Non-pathogenesis. Everyone see it is a normal individual. I have shown in this diagram. Imagine this normal individual is having the meal. Either the breakfast, lunch, or dinner. The person is eating. So, whatever the person is eating, it is going in the mouth, it is going in the stomach, it is going in the intestine. So, whatever we eat contain glucose, some or little amount or more amount. Fried. So, the glucose will be absorbed. The glucose is going in the blood. In the blood, the red dots, these red dots are glucose, right? Whenever we eat, our glucose level rises in the blood. Normal glucose level is 80 to 100. But whenever we eat, it is more than 80. It is more than 80, of course. Whenever we eat, after that, immediately after five to ten minutes after that, so more than 80 glucose. Whenever it is there, it is a trigger. The glucose will go to the pancreas. You can see this is pancreas. Inside the pancreas, four types of cells are present: alpha, beta, delta, and PP. We are interested in beta. You can see this is a beta cell. This is a beta cell. So, the glucose will go and knock, knock the beta cell that I have arrived. So, at that time, on receiving the signal, the beta cell will secrete insulin in the blood. So, glucose is going, knocking, and taking insulin out. Now, in the blood, both are present. Glucose is also present, and insulin is also present in the blood. Both are present. Initially, when we eat, only glucose is present. Glucose is knocking the pancreas, the beta cell of the pancreas, and taking insulin out. So, whenever glucose go to the beta cell of the pancreas, it's a trigger. The inside, the beta cell secrete insulin in the blood. Now, in the blood, both are present, glucose and insulin. So, what it will do now? They will go to the target organ. There are three target organs. You can see liver, skeletal muscle, and adipose tissue. These are the three target organs. Now, glucose want to get stored in these three, these three target organs. In the liver, the glucose can be stored as glycogen. In the skeletal muscle also, liver can be stored as glycogen. But in adipose tissue, the glucose is stored in the form of the fats, right? But glucose cannot, what is the problem then? You will say, man, what is the problem? Why not, why don't glucose is going inside these cells and getting stored? The problem is that glucose cannot enter directly in these cells. For the entry, a door is required. Close the door. The name of the door is GLUT4. What is the name of the door? The name of the door is the GLUT4. You got my point? GLUT4. But GLUT4 is absent. So, insulin is the glucose is taking the insulin pale. Insulin first, insulin will go in these cells, it will transplant GLUT4, and it will call the glucose. You got my point? Insulin, insulin, liver, skeletal muscle, or adipose, glucose. How many of you don't understand Hindi? Okay, tell me. So, I will translate in the English also. You got it? You got it? So, this is the thing. So, glucose coming in the blood. After coming in the blood, it is going to the pancreas. In the pancreas, it is knocking, knocking, and taking the insulin out. In the blood, in the blood, both are present. Now, so, first insulin goes in the target organ and opens the door for the glucose. The door for the glucose is GLUT4. GLUT4 comes on the membrane only when insulin is coming. So, once the GLUT4 is transplanted, glucose can enter in these cells and getting stored. Appreciate it. So, this happens normally in all of us. Whenever we eat, we don't think about it. If you are eating anything, this automatically happens inside you. You got my point? Everyone got it? You can see this is the insulin. It goes in three target organs: the liver, the skeletal muscle, and adipose tissue. In both, in all three of them, it is implanting the GLUT4, right? Now, let's come on diabetes. The two types of the diabetes I told you: Type 1 and Type 2. In Type 1, the body do not synthesize insulin. Insulin is zero. Insulin is absent. So, you can see inside the pancreas, the beta cells of the pancreas are destroyed by autoimmune T lymphocytes. The T lymphocytes normally kill the foreign body, but here, because of autoimmunity, the self-reactivity lymphocytes are there. They are killing body's own cell, the beta cell. The beta cell is absent. So, insulin is absent. No insulin is there. Imagine there is no insulin. So, glucose cannot enter in these three cells. Glucose will remain in the blood only. Who will not open the lock? There is no key. The key is the insulin. Insulin is absent. Key is absent. No one is opening the door. So, glucose will remain in the blood only. That is leading to diabetes, hyperglycemia, Type 1. In Type 2, so, in Type 1, the problem is in pancreas. The problematic organ is the pancreas, because inside the pancreas, the beta cells are destroyed. They are absent. Say yes. What happens in Type 2 diabetes? What happens in Type 2 diabetes? In Type 2 diabetes, there is no problem in the pancreas. The problem is in the three target organs. Here, the insulin is normal.

In the blood, rather more than normal, you will say. Then, what is the problem? Insulin is normal. You are saying the beta cell is normal. It is secreting the insulin in the blood. Insulin is normal. Insulin is going to these three target organs, but the insulin receptor is defective. The door cannot be implanted. Insulin is non-functional. The insulin is present, but its quality is not good. It is non-functional. It cannot implant the door for the glucose. This is known as insulin resistance. Insulin is present, but it is non-functional. It is non-functional. It cannot go to the target organ and implant the door for glucose. The failure of the target organ to respond to insulin: the liver, skeletal muscle, and adipose tissue. So, in type 2 diabetes, the problem is in the three, these three organs. So, if I say type 1 diabetes, the problematic organ is the pancreas. In type 2 diabetes, the problematic organs are the target organs. In type 1 diabetes, insulin is zero. In type 2 diabetes, insulin is normal, but it is non-functional. I tried hard. You got my point? You got my point? So, those who don't understand Hindi, it's okay. I translated in English also. Now I will concise myself to English only. Don't worry, okay? So, you've got this concept. Those who don't understand Hindi, you also got to score this concept, or shall I repeat it? You got the two types of diabetes. So, the two types of diabetes. In type 1, the problem is in the pancreas. And in type 2, the problem is in the target organs, not in the pancreas. In type 1 diabetes, the beta cells are absent, so they secrete insulin. That's why insulin is zero. And in type 2 diabetes, the problem is in the target organs. Beta cells are normal, so insulin is normal, but insulin, which is present, it is non-functional. The receptor for insulin is defective, right? So, you have to check the blood level for insulin, right? Type 1 diabetes occurs from childhood, you know. Whenever the child is born, so beta cells are normal, 100 beta cells are there. Then the T cells become auto-reactive, and they start killing beta cells, beta cells, beta cells. So, at adolescent age, 15 to 20 years, all the beta cells are killed, 100% beta cells are killed. And at this age, the child manifests diabetes. It is present since childhood, but manifestation occurs in adult, in adolescence. But type 2 diabetes occurs in old age, especially after 50s, 40s, 50s. That is insulin resistance takes place. You got my point? So, that is the meaning of type 1, type 2 diabetes. You got my point? What are the clinical features? Triple P. All of us know there is a typical triad in diabetes. Patient drinks so much. Patient eats so much. Patient urinates so much. Polyphagia means eating. Polydipsia means thirsty, more and more drinking. And polyuria means urinating. See, the patient is shown to you. The patient is drinking too much. Patient is eating too much. And patient is urinating too much, right? So, you can see the triple P. No? You will not forget. Polyuria, polydipsia, polyphagia, right? Patient eats too much, still patient lean and thin. Two paradox phenomenon across together. Imagine a patient is coming to you. Doctor, I eat too much. Every time I feel hungry. I eat, I eat, still I'm losing the weight. Oh, what a good thing, huh? It has and diabetes. Hopefully, it occurs on all of us now, right? We eat too much but don't weight gain. Okay, don't gain weight, I mean. So, fortunately, it occurs in all of us. But this occurs in diabetes. When diabetes, two paradox things occurring together, the weight loss even on intense eating. So, more eating but still losing weight. So, that paradox occurs only in diabetes. You got it? Can we go ahead? Say yes. So, what is the reason? You should ask me why. You explain why all these three things are happening. Why still weight loss is there? So, why the three things happen? Let me explain you. Let me explain you. Shall I have a diagram? I don't have a diagram for that. Okay, okay. I will draw it for you. Imagine, let me draw the blood vessel. This is the blood vessel. Now, it contains abundant of glucose. Whether it is type 1 diabetes or type 2 diabetes, glucose is abundant. In type 1 diabetes, the reason for abundant glucose is absence of insulin. In type 2 diabetes, the reason for abundant of glucose in the blood is insulin resistance, right? Ultimately, there is abundant of glucose in both the diabetes, whether type 1 or type 2. So, you should ask me, ma'am, where does it go? It is present in the blood. It cannot enter in the target organs. These are the three target organs: the liver, the skeletal muscle, and adipose tissue. The glucose cannot enter in them. No, no entry. Locked is there, and the key is the insulin. Insulin is non-functional. Key is defective, okay? Insulin cannot enter inside them. What does insulin will do? I'm sorry, glucose cannot enter inside them. What does the glucose will do? Glucose will go in the kidney and excreted in the urine, okay? So, this glucose will go in the kidney and excreted in the urine. Normal urine doesn't contain glucose. A healthy individual's urine doesn't contain glucose. But urine contains glucose here in this patient. It is known as glycosuria. Glycosuria, glycosuria means glucose in the urine. Glucose in the urine. Glucose is an osmotic molecule. Please understand my words. Osmotic molecule. Drag water with it. So, glucose will not go alone in urine. Glucose will take water also in the urine. So, in the blood, in the blood, dehydration occurs, you know. Water is gone in the urine, right? Dehydration. This is the reason for polyuria. More and more patient is urinating. More and more water is coming because more and more glucose. The more glucose level, the more dragging is there, and more urination is there, and more dehydration is there. Because of dehydration, the thirst center in the brain is getting stimulated. Whenever we are dehydrated, we have thirst center in our brain that gets stimulated, and we have a feeling like we have a desire, we should drink water. We feel thirsty, right? And we drink some fluid or water, whatever. So, when the thirst center is stimulated because of the dehydration, now patient is dehydrated. That's why the thirst center in the brain is stimulated, and that's why there is poly, polydipsia. Polydipsia means more and more drinking of the water. What I mean to say, please understand. Please understand the two things I am saying. Polyuria leads to polydipsia. Polydipsia is not leading to polyuria, please understand. Hannah, the patient is urinating more, that's why patient is drinking more. It is not the thing since the patient is drinking more, that's why it is urinating more. No, urinating more, that's why getting dehydrated, and that's why drinking more. I hope you can understand what is leading what, hey? Okay. And the third thing I told you, uh, since glucose cannot enter in all these cells, there is no storage of glucose. Now, there is no storage of glucose. There is a negative balance. There is a negative energy balance in the body, and that's why the body, the patient is feeling hungry. So, these organs feel like, your body, glucose, there is no glucose in the body. These organs feel like that. So, hunger center is stimulated. So, that patient eats more, that is polyphagia. And still, there is weight loss. Whatever patient is eating, it is not going, you know, the earth. You got my point? So, the cells are still hungry. The patient go on eating, go on eating, go on eating, but it is not reaching on the cells. It is excreting in the urine. It is not reaching in the blood. The glucose is not taken by the cells. That is the problem. Say yes if you got it. Okay, okay. So, Osama is asking, if the patient is presenting at adolescent age, so how does the patient is surviving till that time? That is your question, Osama. Osama, at birth, 100% beta cells are present. Now, the T cells become self-reactive. T cells become self-reactive because of loss of tolerance. These T cells start killing the B cells, B cells, beta cells, I mean, beta cells of the pancreas. When the beta cells fall beyond a critical level, at that point, the patient presents. So, it is not a one-day job that T cells are killing all the beta cells. So, gradually their count falls. Maybe by the age of five years, there's a graph or by the age of 10 years, like so beta cells go on reducing, reducing, reducing. So, when the beta cells fall beyond 30, 40, at that time, clinical manifestation is there. So, this is the answer. Got it? So, it is not that at birth only it is zero beta cells. Beta cells are 100% at the birth. At birth, it's normal. If you check the glucose level at birth, it's normal. But gradually, at five years, it is little bit more, or maybe it is within normal range only. So, when the beta cells fall too much, then the insulin level drops too much, and that after some point, it's zero insulin. All the beta cells are destroyed after 20 or 25 years, you know. So, it's zero. You got my point? This is the answer. Can we go ahead? So, we have done the clinical features also. We have understood the clinical features also. We have seen the two types of diabetes: type 1, type 2. Type 1, the main thing is the autoimmune destruction of the beta cell by the T lymphocytes. In type 2, it's the insulin resistance. Okay, both of them have a, what do you say, both of them have genetic predispositions. It is more, it is more in type 2 as compared to type 1. The genetic, like in the concordance rate in the twins, you can see, okay? Complications, you can read it, or it will be covered in the this thing also, medicine also. So, here I am coming on the diagnosis of the diabetes. How to diagnose the diabetes? What are the ways? Imagine, how you will consider diabetes? You are suspecting diabetes in a patient. You can do urine test, blood test, and others. First, we will discuss the urine test. Collect the urine of the patient. In the urine, look for two things: the glucose, the ketone. The diabetic person has glucose and ketone in their urine. So, look for glucose, for glucose, glucose urea, ketoneuria. For glucose, there is a Benedict's test, I guess everyone knows what is Benedict's test and principle for that. So, take 5 ml of Benedict's reagent in a test tube. Add few drops of urine, the patient's urine in that, and heat that. Heat on a Bunsen flame, right? Okay, heat on a Bunsen flame and look for the color. So, you can see the color change is there. If the glucose is there, the different colors are there. If it is negative, no glucose present in the urine, the color will not change. It will still be blue. And if the color is changing to green, yellow, orange, or red, it is known as green, yellow, orange, red, it is, it is means the glucose is present in the urine, and it is indicating the severity. Green means traces, yellow means moderate, orange means moderate, and red means severe glycosuria, right? So, that is a semi-quantitative test. Benedict's test, I guess everyone has performed in their laboratory, the test to test the glucose in the urine, okay? For ketone, we have Rothera's test. I'm not going into the detail. You know the principle, the purple ring is formed. That is Rothera's test, right? In the blood test, these were the tests in the urine. Coming on the blood test. For blood test, I will give you. So, collect the blood sample of the patient and look for the sugar. I mean, look for the glucose level. Let me tell you the cutoff. I am going to, to three cutoff here. Look for the fasting blood glucose level, known as FBS, fasting blood sugar level. Look for the post-prandial blood sugar level, known as PPBS. Post-prandial means after eating. Fasting, at least eight hours fasting. Eight hours. There is no sense of night or morning, right? Usually, when we sleep in the night, after dinner, we don't eat during the night, and in the morning, the first sample is considered as fasting. Because since the last eight hours, patients have not eaten anything during the day time. If the patient is not eating anything for eight hours, the sample collected is considered as fasting. That is the point, okay? Fasting is eight hours fasting. Standard. Standard. Post-prandial. Post-prandial is standard. Eating. After eating, two hours. Two hours after that, we look for the blood sugar levels. And third is random. Random is not associated with food. Anytime you can check. That is random. So, let me give you the cutoff. Let me give you the cutoff. When you consider a patient as diabetes. So, the cutoffs are given by American Diabetes Association, ADA. ADA has given these cutoff values. We are following that in India, okay? So, what are the cutoff? The random is 200. 200. Everything is milligram per deciliter. The unit is milligram per deciliter. So, random is 200. 200. If the blood glucose level is 200 anytime along with the symptoms, consider it is positive for diabetes. Now, fasting. Below 100 is normal. 100 to 125 is a pre-diabetic. And more than 126 is diabetic, okay? And two hours after food. Actually, we don't give food. We give 75 milligram of oral glucose load, standard. Ask the patient to drink a 75 milligram of glucose. Not don't take anything. And just after two hours, take the sample. So, less than 140 is normal. 140 to 200 is pre-diabetic. And more than 200 is diabetic. So, please, can you tell me the three values? Tell me what is random, what is fasting, and what is post-prandial, please tell me. ADA, American Diabetes Association guidelines in the blood. So, random is more than 200 milligram per deciliter at any point. Fasting, less than 100. 100 to 125. More than 126. So, there are three things. 100 is normal. 100 to 125 is pre-diabetic. And more than 126 is diabetic. Post-prandial is, uh, less than 140. 140 to 200. And more than 200. So, 140 is normal. 140 to 200 is pre-diabetic. And more than 200 is diabetic. Everyone, give me a thumbs up, please. Learn these guidelines. These are ADA, American Diabetes Association guidelines. You have to learn that, right? The three types of the blood glucose level, okay? So, this is the blood levels. The same thing is written in front of you. There is one more thing which is known as glycosylated hemoglobin. Have you heard about it? What is glycosylated hemoglobin? It is known as HbA1C. HbA1C. Glycosylated hemoglobin. So, what happens now? In the blood vessel, we all have RBCs, of course. We have RBCs in the blood. The RBC contain hemoglobin. We know RBC contains hemoglobin, okay? Now, when the blood glucose is excessive, the glucose is abundant in the blood. Glucose that glucose forms bonds with the hemoglobin. That glucose, when it is abundant, it is forming the bond with the glucose, right? So, this, this hemoglobin is known as glycosylated hemoglobin. This is not normal hemoglobin. So, a percentage of total RBC is having glycosylated hemoglobin. It is known as HbA1C. It is acylated hemoglobin. That is glycosylated. Acylated hemoglobin, hemoglobin AC. It's not normal hemoglobin. We can measure that hemoglobin. We know the lifespan of RBC is 120 days. 120 days is three to four months, okay? 120 days is three to four months. So, if you measure this value, it is giving you an average of last three to four months glucose. If you want to see the average, average, you just measure the values. You can see this is hemoglobin. This is glucose. Glucose and hemoglobin, glycosylatically form bond with each other. So, this is hemoglobin. This is glucose. And this is glycosylated hemoglobin, HbA1C. You got my point? So, for long-term assessment, for 90 to 120 days average, you measure this value. In a normal individual, it is less than 6.5. In diabetes, it is more than 6.5, right? So, that is the thing. We are done. We are done. Give me a thumbs up, everyone. Give me a thumbs up. We are done till now. The next chapter we will start is GIT and followed by hepatobiliary. These two chapters we will cover. After that, renal and respiratory, right? So, we have to cover, I guess, four more major systems along with two genital, the male and female genital. So, six more to go. We have covered already, I guess, five or six. But five or six, four still to go. We will take a small break after that. We will continue, okay? So, let's say currently it's 1 o'clock. Let's start at 1:15. A 15-minute break. So, can we continue? So, till now, what all systems we have covered? So, we have covered the blood vessels, CVS, CNS, respiratory, endocrine, till now, I guess, right? We have already covered these five. The next in the row is GIT, followed by hepatobiliary. So, let's cover these two. Then after that, there is renal and respiratory, right? So, this is the sequence I'm going to follow. So, let's start with GIT. Let's continue with GIT. Can I start GIT? Okay, okay. So, let's start GIT. And GIT, one of the most important topics is the Barrett's esophagus. I guess everyone can understand. Let me tell you what is Barrett's esophagus. Can you see the diagram? You see, this is esophagus, and just in the continuity of the esophagus, you all can see this is stomach. So, what is the lining of the esophagus? Esophagus is lined by squamous epithelium. And what's the lining of the stomach? The stomach is lined by the columnar epithelium. You can see, I have, I've used two different colors. The squamous epithelium is the red color, you can see, and the columnar epithelium is the blue color, you can see. You can see the blue color epithelium. So, red and blue, you can see squamous and columnar, the two types of epithelia. There in continuity in the two organs. Why God has provided two different epithelia in the organs which are continuous to each other? But is it not all squamous? Why is it not all columnar? Why have you ever thought it? Now, the stomach contains the acid, the hydrochloric acid, HCl, is present in the stomach. So, that acid, the stress of that acid can be borne by the columnar epithelium, but not by squamous epithelium. So, that's why the stomach has the columnar epithelium. Now, what is happening in Barrett's esophagus? Now, in some people, there is GERD. What is known as GERD? GERD is gastroesophageal reflux disease. GERD, in which the acid present in the stomach is refluxed in the lower esophagus. So, the lower esophagus, the acid is hitting the lower esophagus. But in esophagus, we have squamous epithelium. So, this acid, this GERD is acting as a stress for the squamous epithelium. So, the squamous epithelium converted to columnar epithelium in the lower esophagus. So, can you see this segment of the esophagus? In this segment of the esophagus, normally esophagus has squamous. So, normally there was a squamous, but it converted to columnar. It converted to columnar. It is known as metaplasia. So, it is a type of columnar metaplasia in which the squamous get converted to columnar. The stress, the stress is the GERD. Due to the GERD, there is reflux, and due to the reflux, the acid is putting the stress on the lower esophagus. So, this segment of lower esophagus, in which the epithelium has changed, it is known as Barrett's esophagus. It is known as Barrett's esophagus. Now, you must ask me a question, ma'am, how does it matter? Now, inside my esophagus, in my lower esophagus, what is my epithelium? Does it matter to me? Even the layman doesn't know the two types of the epithelia. If you ask a non-doctor, any person, what are the epithelia? They don't know. Now, what type of linings they are present in myself? Because how does it matter? The point is that the lower esophagus, in which the Barrett's esophagus, the segment in which the epithelium has changed from squamous to columnar, it is a premalignant lesion. Now, it will, it can convert in future. Currently, it's metaplasia. The metaplasia converts into dysplasia. The dysplasia converts into anaplasia, and it leads to malignancy. It leads to adenocarcinoma of the stomach. So, whenever there is a Barrett's esophagus in any patient, due to GERD, the first thing, fix the GERD. Give them, you know, the drugs to decrease the acidity and to decrease the GERD, you know. So, all the prazoles, omeprazole, and all the prazoles you have studied in pharmacology, that can be given. So, fix the GERD so that it do not increase. And whatever already metaplastic segment is there, do regular surveillance biopsy. Every six months, you should do the biopsy. Just a second. Every six months, you should do the biopsy to see whether it is converted into dysplasia or not. I'm sorry. So, if it is converted into dysplasia, prophylactically, you should remove it before it converts to malignancy. So, that is Barrett's esophagus. It's a premalignant lesion. And in premalignant, it do not convert to squamous. It converts to a carcinoma. Due to the reflux, the squamous epithelium in the lower esophagus, it is replaced by the columnar epithelium. So, that segment is known as Barrett's esophagus. You can appreciate this is squamous. It is converted to columnar epithelium. You can appreciate due to the GERD, due to the reflux. The reflux is acting as a stress. So, you can see the lower portion of the esophagus is like stomach only, because stomach is columnar. So, it is the continuity of the stomach. You got my point? Now, you should know the squamous epithelium is white in color. It is pearly white in color. And the columnar epithelium is red in color. So, when you do the endoscopy from the nose or mouth, if you are going inside the esophagus, normally you look like this. The lower segment of the esophagus. Can you see it is white in color? And you can see this is the opening. This is the junction, right? But in Barrett's esophagus, this portion is looking like this. Can you see it is red in color? So, on endoscopy, you can see the lower segment is like the stomach, like the stomach. And as I told you, it is a premalignant condition. In, in the future, 20% of the cases of Barrett's esophagus convert into invasive adenocarcinoma of the esophagus, not squamous one. So, that's why surveillance biopsy every six months is required, okay? So, this is it. It's a premalignant condition. So, we are done with that. Grossly, you can see this is GE junction. Appreciate the stomach, red color. I appreciate the esophagus, white color. Here, you see this is the GE junction. I can see esophagus is like stomach only. I cannot find the difference. Both are red in color. So, the esophagus, the lower esophagus, the Barrett's esophagus is red and velvety in color, like the stomach. So, that's all about it. Coming on the next topic, gastritis. You know what is gastritis? The next important topic in GIT to be covered is gastritis. In pathology, "-itis" is the inflammation of that organ. You got it? So, gastritis is the inflammation of the gastric mucosa. So, in the stomach, the stomach lining is, is by columnar epithelium. There are various types of cells present in the lining. So, there is a parietal cell, you know. So, various types of cells are present in the lining. It is columnar epithelium. So, whenever there is inflammation of the gastric mucosa, it is known as gastritis. It is of two types: acute and chronic. Chronic is important. Chronic is of two types: type A and type B. So, let me explain you chronic gastritis, which is of two types: type A, type B, and type A, B mixed. Okay? What is type A? What is type B? Very important topic. A for autoimmune. A for autoimmune. Let me explain you. And what is B? B for bacteria. B for bacteria. So, let me draw two stomachs for you. This is a stomach. Let me draw one more stomach. This is a stomach. So, here I told you, various types of cells are present. Now, one of the cell is parietal cell. One of the cell is parietal cell. You know, parietal cell, chief cells, and trichrome cells. So, parietal cells are there. So, basically, this is autoimmune disease in which the body is forming autoantibodies against the parietal cell. Body do not form antibodies against its own cell. Body form antibodies against foreign cell. But it's an autoimmune disease in which the body is forming autoantibodies against the parietal cell. So, all the parietal cells are destroyed. What will happen? You will remember what will happen? Parietal cells secrete two things: parietal cells secrete HCl, and parietal cells secrete intrinsic factor. You may be knowing this in physiology. Now, if the parietal cells are destroyed by the autoantibodies, there is no HCl, no intrinsic factor. No HCl is known as achlorhydria. Achlorhydria. So, there is a problem in digestion of the food, the protein degradation, okay? Achlorhydria. And intrinsic factor is required for vitamin B12 absorption. So, no intrinsic factor, no vitamin B12 absorption. If there is no vitamin B12 absorption, the person will have pernicious anemia. So, these are the two end results of type A gastritis. A for autoimmune. Never forget. A for autoimmune. I repeat my words, okay? So, here, autoimmune, you must remember that it's the autoimmune disease in which the autoantibodies are formed against the parietal cell of the stomach. The parietal cells of the stomach lining, they are destroyed by the autoantibodies, right? So, parietal cells are destroyed. No HCl, no intrinsic factor. No HCl means achlorhydria. And no intrinsic factor means vitamin B12 is not absorbed, and patients have pernicious anemia. This is my point. If the HCl is less, you know, gastrin is the hormone. Have you heard about gastrin? So, in the blood, gastrin will be more. The gastrin in the blood will be more. Gastrin is a feedback hormone. If HCl is less, as the gastrin is secreted by the enterochromaffin cell, and it will be more, it will try to increase the HCl. So, there is hypergastrinemia. So, that is all about type A. Let me come on type B. Type B is bacteria. B stands for bacteria. You will remember what you mean by bacteria? Which bacteria? I'm talking about H. pylori, okay? A bacteria only one bacteria causes disease in stomach. H. pylori. Stomach lining. What does this do? This bacteria will come and this bacteria will cause inflammation of the gastric mucosa. Inflammation of the gastric mucosa. It involves the gastric mucosa. So, the gastric mucus get irritated. If it gets irritated, it secretes more and more HCl. So, here HCl is more. It is not less. Here HCl was less or absent. Here HCl is more. More HCl. We know when acidity is more, what happens to the stomach? When there is more acidity, it will lead to ulcer because of the acidity, there will be peptic ulcers. So, here in type B, we will have peptic ulcers. And since there is more acid, so tell me about the gastrin. Gastrin will be less. Gastrin and acid are inversely proportional to each other, no? So, here gastrin will be less. Say yes, everyone. Give me a thumbs up. You got it? The two types of gastritis are in front of you. Type A, type B. Can I remove this diagram? Can you help me in writing the important findings of type A gastritis and type B gastritis? What is A? Osama, Shalini, Nitesh, Shiri, Chan, all of you. What is type A? What is type B? A stands for what? Autoimmune. Just a second. Give me a minute, okay? A for autoimmune. And what is B? B for bacteria. Which bacteria? B for H. pylori, okay? So, A for autoimmune, and B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body. The last portion is known as pylorus. And the junction of the stomach and the duodenum is known as antrum. It is known as antrum. You can see the five portions: C, F, B, P, A. If I say one word, okay? Now, in which portion type A gastritis occurs? In which portion type B occurs? Can you tell me? Type A, type B. Type out of the five, where does type A occur? And where does type B gastritis occur? So, it is, what do you mean by that? A occurs in body. In the body, type A gastritis occurs. And B occurs in A. So, type B occurs in antrum. Now, you will never forget. A occurs in B, and B occurs in A. Say yes, if you got it. So, you will not forget. So, type A gastritis, type B gastritis. A for autoimmune. B for bacteria. Lambdas. Now, what is the problem in A? In A, there are autoantibodies are formed. The autoantibodies are formed against the parietal cell. So, parietal cells are destroyed. If the parietal cells are destroyed, it secretes two things: no HCl, no intrinsic factor. No HCl will lead to achlorhydria. Achlorhydria. Or no intrinsic factor leads to vitamin B12 absorption, and patients have pernicious anemia. Pernicious anemia. And there is less HCl, so it will increase the gastrin. So, there is hypergastrinemia in the blood. The gastrin will be more. Coming on type B. What is the problem in type B? In type B, H. pylori causes inflammation of the mucosa. Mucosa get irritated. So, there is high HCl. High HCl leads to peptic ulcer. So, here the end result will be the peptic ulcer. Compare the end result here. Compare the end result here. Yeah, is more. The gastrin will be less. So, you have to understand the two types of gastritis. Yes, very good, all of you. Very good. Please understand the two types of gastritis. Crystal clear in your mind. So, don't learn the end results. Students even don't understand why there is pernicious anemia, why there is peptic ulcer. They used to learn it. Why to learn? Come on, you can understand now. Not only one thing. A stands for autoimmune. You can make it out. And B stands for bacteria. You can make it out. One more thing I would like to tell you. The parts of the stomach. Can you tell me the five parts of a stomach? Let me draw a stomach. So, this is the stomach. The junction of the esophagus and the stomach is known as cardia. This portion is known as cardia. C for cardia. This bulge is known as fundus. The bulge, the bulge is known as fundus. The main portion is known as body, right? The main portion is known as body

Stomach and the duodenum. Because after the duodenum, the acid is neutralized, so ulcers do not occur. Ulcers can occur, but due to other reasons, not due to acid. So I will not call them peptic ulcers. In judging them, peptic ulcers will not occur, but you will say TB ulcer, typhoid ulcer, that can occur anywhere in the intestine. So that can occur, you know, but peptic ulcers will not occur. Peptic ulcers are other ulcers due to the acid; they are limited to the stomach and duodenum. My point is, can we go ahead? Can we go ahead? You can see the most common location. So in the duodenum, it's the first, it's the first location in the duodenum, in the first part of the duodenum, it is the most common location. The second most common location is in the stomach. This is the second most common location in the stomach, in the pyloric antral canal, on the left greater curvature. You can see on the lesser curvature, this is the second most common. Third most common location is the cardia. Third most common location is the cardia. Fourth most common location, you can see gastrojejunostomy, uh, stoma is there. And fifth is Meckel's diverticulum. Don't learn the five; the first two are more than sufficient. Are you people still there? Can we go ahead?

Grossly, the peptic ulcer is of two types. Now, I told you it is of two types. Now, the benign and malignant. See the margin. This is also an ulcer. This is also an ulcer. See the margin of the ulcer here. The margin is punched out. The margin is punched out. It's very sharp. It's punched out. And here the margin is rolled out. Here you can see the margin is rolled out, completely rolled out everywhere. The margin is rolled out everywhere. So here it is punched out, here it is rolled out. That is gross.

Coming on the microscopy, what happens if I cut and see under a microscope? This is an ulcer. See in the microscopy. Let me tell you the four zones quickly. Everyone here on the screen, can you see here? This is mucosa. Everyone appreciate the mucosa, mucosa, mucosa, mucosa. Here it is discontinuous, and here it is again continuous. So can I say this portion is an ulcer? Yes. This portion is also a breach in the mucosa. See, it is the breach, discontinuity in the mucosa. Now let's have a look on the ulcer. Can you see the uppermost portion of this? Can you see the uppermost portion? This is necrotic zone, in which necrosis is there. This is known as necrotic zone, having the necrosis. The uppermost zone. After that, the second zone is there. Let me show you the second zone. The second zone is known as exudative zone. Exudative zone, having inflammation. You can see the neutrophils, lymphocytes, plasma cells. This is exudative zone, having abundant inflammation. After that, the third zone is there. The third zone is known as granulation tissue zone, in which along with inflammation, vascularity is also there. You can notice the blood vessels. This is known as granulation tissue zone, in which along with inflammation, the vascularity is there. And last one, last one, you can see here. Which color I should select? It is the fibrosis. The last one is the fibrosis. This zone is known as thick cicatrization. Cicatrization is fibrosis. I cannot simplify more than this. You can see my color coding. The four zones are in front of you. Don't learn the meaning. It is in front of you. Huh. The first one is the necrotic. You can see the necrosis. The second one is the inflammatory. You can see the inflammation. Third one is the um granulation tissue. You can see the granulation tissue. The last one is thicker cicatrization, the fibrous. Let's say the four zones. What are the four zones? Necrotic, exudative, granulation tissue, cicatrization, one behind the other. This is a histology of an ulcer, the peptic ulcer.

We have seen the types of the peptic ulcer. Let me tell you the differences between them. Imagine a patient is coming to your clinic. Doctor, I am having epigastric pain. You know, epigastric region, um, just below the diaphragm, right? There is pain in the epigastric region. Let me draw a rough sketch diagram of a patient in front of you. Imagine the patient is coming to you. Doctor, I am having epigastric pain. Whenever I eat, I am feeling fullness. I'm having pain. You are having doubt, this patient is having peptic ulcer, right? Now, it can be stomach, it can be duodenum. It can be gastric ulcer, it can be duodenal ulcer, I mean, right? The best thing to distinguish between them, do an endoscopy. Do endoscopy. Take the camera inside and see where is the ulcer. Is it present in the stomach? Is it present in the duodenum? The best is the endoscopy. But based on clinical features, can we differentiate that? Yes, we can differentiate them on based on clinical features also. This is just a guess, but final call is the endoscopy only. Finally, we can see on the endoscopy, okay? But how we can judge based on the clinical features and history of the patient? Ask the patient. Ask patient nine questions. Your answer will be in front of you. First question, imagine patient is sitting in front of me. First question, I will ask the patient, uh, on eating food, pain increases or decreases? On eating food, pain increases or decreases? If the patient is saying on eating food, pain decreases, relief of pain, it's duodenal ulcer. And on eating food, the pain increases, it's gastric ulcer. The first question you should ask always, being a doctor, whenever you are suspecting any of the peptic ulcer, you want to differentiate whether it is duodenal or gastric. Hardly it matters because treatment for both of them is same. Treatment, the medical treatment for both of them is same, right? Some differences are there that will be dealt in pharmacology, okay? So if, if on eating food, the pain decreases, it's duodenal. If pain increases, it's gastric. Okay.

Ask the second question. Do you have night pain? Night pain? Whenever you go to the bed, you are sleeping, and in the middle of the night, at 2 AM, at 3 AM, you just wake up, I'm having severe pain. Does it happen sometime? If it is night pain, is common? Yes, the patients, it frequently, it occurs, doctor. So it is duodenal ulcer. And if it is uncommon, it is gastric ulcer. It is not occurring, it is gastric ulcer. So second question is night pain. Ask the first question, pain. Second, first question is food and pain pattern. On eating food, pain decreases or increases? That pattern. The second question is the night pain.

The third thing, the third thing, let me explain you here, very easy. All ulcers bleed. There is a role. All ulcers bleed. Gastric ulcer, it will also bleed. Duodenal ulcer, it will also bleed. Listen, bleeding is the common thing. Gastric ulcer, the bleeding will come more commonly in vomiting. Bleeding in vomiting is known as hematemesis. Hematemesis, you know, emesis by vomiting. Antiemetic drug, antiemetic drug. Hematemesis. Split the term, right? And if the bleeding occurs from the duodenal ulcer, it will go in stools. It will go in stools. Bleeding in stool is known as melena. It is known as melena. So ask the patient, in which form you have bleeding? You have bleeding in vomiting or you have bleeding in the stools? Right? Here it is dark brown color. It is not fresh bleeding. It is coming from upper side, upper GI. It is a dark brown color. So, uh, coffee. And here also it will be coffee color. So either the vomiting is, is there, or the stools are coffee or brown color, right? So ask the patient, do you have melena or hematemesis? Based on that, you can differentiate the two. Say yes, yes, you got it. So say here, there is no vomiting in gastric ulcer. Vomiting is common. Vomiting at blood and vomiting, that is hematemesis, is also common. Vomiting and the blood and vomiting both are common in gastric ulcer, right? But melena is common in the duodenal ulcer. Melena is common in duodenal ulcer, right?

Now, what happens to pain of food? Food pain pattern, what was the food pain pattern? So I told you here, on eating food, the pain decreases. So patients eat more and more. Whenever patient eats, like pain, he will eat. Whenever patient has pain, patient will eat, so that pain will subside. So there is no weight loss here. But here, on eating food, the patient has pain. So patients stop eating the food. Patient has apprehension. If I eat the food, I will have pain. So patients eat very less or no food. He skipped the meals. So your significant weight loss is there. So everything is conceptual. If you understand, no need to learn. No need to learn. Got it?

Can we go ahead? Can we go ahead? Okay, here patients don't have any particular choice of food. Patient eats everything. But here, patient eats bland food, no, no spicy food. Whenever the patient eats spicy food, more pain is there. That's why patient chooses bland diet, right? Here, you know, the abdomen is divided in, um, nine quadrants. The abdomen is divided. Everyone knows, I guess. In physiology, you may have seen the nine quadrants of the abdomen, okay? Uh, this is the diaphragm. Let me divide the abdomen in nine quadrants. I guess everyone knows that. Now you tell me, where is the stomach and where, where is the duodenum? So this is the esophagus. Just here we have the stomach, and on the right side here, we have the duodenum. You tell me, the epigastric ulcer occurs in this quadrant. Um, the gastric ulcer occurs in this quadrant, and duodenal ulcer occurs in this quadrant. You can see they are falling in different quadrants. So ask the patient to lie down supine and palpate all nine quadrants as where the patient is having exact pain. If the patient is saying I am having pain in the epigastric central quadrant, epigastric central quadrant, it's gastric ulcer. And if the patient is saying I'm having pain in the right hypochondriac quadrant, this is right hypochondriac quadrant, so it is the patient is having duodenal ulcer. So palpate. Being a doctor, you should be able to palpate all nine quadrants very sincerely. Ask the patient to lie down and palpate it very sincerely and ask the patient where he feels the tenderness. Let you know. So based on the tenderness, you can tell deep tenderness is which quadrant. So if it is right hypochondriac quadrant, it is duodenal ulcer. And if it is midline epigastric quadrant, it is gastric ulcer.

Here there is no seasonal variation. And here seasonal variation is there. Here duodenal ulcer occurs more commonly. The people who take stress and here type A personality like. And gastric ulcer is more common in the people who take weight, the laboring class, right? So that is the differences between them. Say yes, you got the differences. There are many important MCQs based on that. Everyone say yes. The differences between duodenal and gastric ulcer. Can we go ahead?

Coming on the complications of the peptic ulcer. Sir, there are three complications. Most common is bleeding. I told you, all ulcers bleed. Please learn this golden rule. All are amenable. Okay? It is the most common complication. Duodenal ulcer bleeds from the posterior wall, usually from the posterior wall, and it leads to iron deficiency anemia. From the ulcer, patient goes on bleeding. So bleeding either in the melena or in the hematemesis. Bleeding either in the vomiting or in the stool. In the vomiting, it's hematemesis. In melena, it's in stool. It's known as melena. You know, gastric ulcer results in vomiting, bleeding. And duodenal ulcer results in stool bleeding. So anyway, patient will have iron deficiency anemia. Ground, ground glass, I'm sorry, coffee ground appearance, vomiting and melena. So that is the first complication.

The second complication is perforation. Can I come on the second complication? The second complication is perforation. So sometimes there can be perforation. You can see the perforation. That is the second most complication. Perforation can be there. It's a severe medical emergency. Most commonly perforation occurs in the duodenal ulcer, but from the anterior wall. So posterior wall bleeding, anterior wall perforation. Please learn both are in duodenal ulcer.

The third is the malignant transformation. Sometimes ulcer converts into malignancy. Duodenal ulcer never converts into malignant. Only one percent of gastric ulcer can convert into malignancy. So duodenal ulcer, gastric ulcer, what we have learned, these one are more common. These one are less common. This one occurs at the first part of the duodenum. These one occur at the pyloric antral canal on the lesser curvature, right? Here pain, uh, get decreased on eating food. Here pain get increased on eating the food. Here no loss of weight. Here loss of weight is there. Okay? What else we have learned? Here melena is common. Here hematemesis is common. What else we have learned? Tell me more points. Right? Uh, bleeding occurs in both of them. Perforation can occur in both of them, but both are more common in the duodenal ulcer. Bleeding occurs from posterior wall. The perforation occurs from anterior wall. But malignancy occurs only in gastric ulcer. Malignancy never, never, never occurs in duodenal ulcer. In gastric ulcer also, only one percent can convert into malignancy. Got it? Say yes, got it. Can we go ahead? Say yes.

Okay, so Sabina is asking a very good question. She is asking the reason for the pain pattern, like food pain pattern. She's asking the reason. Let me try. Sabina, I cannot guarantee, but I will try. Okay? So listen, this is the GI tract. I'm drawing. So this is the acid. Acid is more present in the stomach and lesser amount in the duodenum because acid is synthesized in the stomach only, right? So whenever a basal acid is always present, that is known as basal. Have you heard about basal? So basal acid is always present. We eat or we don't eat. A small amount of acid is always present. But whenever we eat the food, whenever we eat the food, at that time, more and more acid is secreted. More and more acid is secreted. That is known as maximal. You have heard that, right? So whenever you eat food, at that time, the acid secretion will increase. It's a physiological phenomenon. Whenever we eat, we have acid secretion in our stomach, now? So more and more acid will secrete. Imagine here is the ulcer, I'm sorry, here is the ulcer, the gastric ulcer. So more and more acid will secrete. Now that will irritate the ulcer. That will irritate the ulcer. That will irritate the ulcer and causing more pain. So gastric ulcer, on eating food, the pain increases. This is the reason, Sabina. You got it? This is the reason.

Now, you may ask the second question. I know that why in duodenal ulcer, it is decreasing, right? So in duodenal ulcer, again, there is a reason. The same reason I will continue. Imagine this is the duodenal ulcer, okay? This is the duodenal ulcer. So basal acid is always present. Now, so basal acid is always present. A little bit basal acid is always present. But on eating food, on eating food, um, this food will go ahead. But, you know, this acid will be neutralized by the alkaline secretions ahead. You know, it is, it is gradually secreted. So whenever we eat food, two things happen simultaneously. One, the acid secretion occurs in the stomach, and intestinal secretion also starts simultaneously. So the intestinal secretion is neutralizing the basal acid. And that's why on eating food, here the pain decreases. So this is the reason given in the book. You can understand like that. So gastric ulcer, the pain increases, and in duodenal ulcer, the pain decreases due to the neutralization of the acid in the duodenum. But neutralization does not take place in the stomach. Synthesis takes place. You got it? Give me a thumbs up. You got it? Can we go ahead? So Sabina, others, you got it? Okay. So this is the reason. So I explained you now.

Let me tell you two more complications. Beautiful complication of the ulcers. One is teapot. Have you seen a teapot? We all drink tea in a pot. See the shape of teapot, a cup, a cup of tea. So sometimes after ulcer, the stomach shape is like a teapot. See this shape. And compare it with this. It is teapot. Okay? Compared. Why the stomach shape is like this? Why the stomach shape is like this? What is the end of that of ulcer? In ulcer, if there is healing, what is healing? You know the steps in the healing. In healing, contraction occurs. Contractures are formed in healing. The contraction occurs. So imagine this is the ulcer. Here is the ulcer in the stomach. And longitudinal, I am using the word longitudinal, is longitudinal. And longitudinal contraction occurs. So what will happen? Imagine due to the longitudinal contraction, this portion becomes smaller. It will become contracted, contracted. So this portion is like this. It becomes contracted. And greater curvature is bigger. So the shape, the stomach is like teapot. You got my point? You got my point? It is the longitudinal contraction.

Let's do transverse contraction. Have you seen hourglass? This glass is known as hourglass. Can you see the shape? See the shape of the glass. I guess everyone knows what is hourglass. This glass is known as hourglass. Now you see if there is transverse contraction, it is hourglass shape. Compare the shape of the stomach here. It is looking like hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be like this. You can imagine. And this is known as hourglass. Let me draw the two things for you. If you are not getting confused, let me try. Okay? So there can be longitudinal contraction and there can be transverse contraction. Which contraction is taking place? If the longitudinal contraction is taking place, the shape of the stomach will become like this. Okay? The shape of the stomach becomes like this because this portion is contracted. Imagine this portion is contracted. Okay? If the transverse contraction is taking place, the shape of the stomach will be

So, you can see this is the liver. Liver is the largest solid organ in the human body. You can see the liver is having two lobes. The right lobe is larger, the left lobe is smaller. You can see this is the right lobe, this is the left lobe. The right lobe is four times larger as compared to the left lobe. And the ligament separating the two is the falciform ligament. It is an anatomy part, but you should learn the falciform ligament also.

Let me explain you the dual blood supply. Everyone here now, please. It's a difficult topic, understand the dual blood supply. Can you see this diagram? Can you see everyone? See this diagram. Now, in this diagram, all the organs of the human body, I'm talking about the liver. All the organs of the human body, they have one artery, they have one vein. Artery supplies the pure blood, and vein carries away the impure blood, right? So, liver also has one artery that comes from the aorta. All the organs have the artery that comes from the aorta. So, you see this is the aorta. Let me highlight the artery with a yellow highlighter. Let me change the color. You can see this is the aorta. Aorta is carrying pure blood. Pure blood from the aorta, hepatic artery is coming, and hepatic artery is supplying one of the blood supply. So, out of the dual, one is normal hepatic artery carrying pure blood to the liver. Like all organs, liver also gets pure blood from the aorta. The name of the artery is hepatic artery. You can understand. You will say, "Okay, we got it."

Now, the entire GIT, can you see this is the entire GIT? The esophagus, the stomach, the intestines. From the entire GIT, the blood is collected and they go in a way known as portal vein. Portal vein also drains in the liver. So, the second blood supply is the portal vein. It is not pure, it carries the impure blood. So, you can see the two yellow ones. One is hepatic artery carrying pure blood to the liver. One is portal vein carrying impure blood to the liver. Got it? You can see the dual blood supply. This is the meaning of the dual, dual blood supply. Not all organs have dual blood supply. Liver has dual blood supply. One is pure, coming from the aorta in the form of hepatic artery. One is impure, coming from the GIT in the form of the portal vein. That is dual blood supply. So, there are two entry points. See the arrow, two entry points. Okay.

Now, coming on the exit. Both the blood come, both will mix, and they exit from one point. The exit point is only one. The exit is only one, that is hepatic vein. Hepatic vein is also known as central vein. The reason I will let you know. This is also known as central vein. So, there is only one exit. You can see the hepatic vein or central vein is the exit. So, from here it is going out. In just a second, you can see this is hepatic vein or central vein. The impure blood, the mixing of the two blood takes place, and it goes out via hepatic vein. This is one of the exit.

Why God has given us liver? What is the use, function of the liver? I'm asking, what is liver? So, God has provided liver with the cells, hepatocytes. You can see these are hepatocytes. Hepatocytes synthesize bile. All the bile collected from all the hepatocytes, it leaves the liver and goes in the intestine. It opens in the intestine with the ampulla of Vater, the bile duct. So, the next exit is the bile duct. Can you see this is the bile duct? Just a second, let me highlight the bile duct for you. You can see this is the bile duct. This is the bile duct. See the two entries, see the two exits. The two entries are the two blood supply, one is hepatic artery, one is portal vein. And the two exits, one is blood, one is bile. Blood is hepatic vein, and bile is bile duct. Everyone give me a thumbs up. See this is liver. See the four supply of the liver. Two entry, two exit. Everyone got it? If everyone got it, give me a thumbs up. Give me a thumbs up.

So, let me cut the liver. If I cut this liver and make a slide of that, this liver has a hexagonal lobular model. This is hexagon, this is hexagon. So, in the entire liver, multiple hexagons are there. The entire liver has millions of hexagons. It's a hexagonal model. Now, listen. The two artery and the vein and the central, this bile duct, they all have branches inside. So, there are branches of hepatic artery, branches of portal vein, branches of hepatic vein, branches of bile duct inside this. Now, at the periphery, at the corner of this hexagonal module, three out of these four are best friends. Who three are best friends? They always travel together. Their branches travel together. Which three are best friends? Let me highlight the best friends for you. The three best friends, the two-way uh blood supply, hepatic artery, portal vein, and bile duct. These three are best friends. They always travel together. Their branches travel together, and they constitute the portal triad. But central vein travels separate from them. After going inside, they separate, right? So, central vein is present at the center, at the center of the lobules. This is hepatic vein. Since it is present at the center, that's why it is known as central vein. Now you got the reason why central vein is known as central. Hepatic vein is known as central vein because it is present at the center of the lobules. And the three best friends, the triad, the trio, the triplet, they never separate. See, one of them is artery, the hepatic artery. One of them is vein, the portal vein. And one of them is duct, the bile duct. See the triad at the six corners. See the portal triad. So, each of them is known as portal triad. Say yes. Now, if you got it, understanding hepatitis and cirrhosis is fun for you. You got this model.

So, inside this liver, not only this, now see, God has given the hepatocytes. Can you see the hepatocytes? Hepatocytes are arranged one behind the other like a train, like the bogies of a train. Can you see? Bogies one behind the other. Bogies one behind the other. So, they connect the central vein with the portal triad. They connect the central vein with the portal triad. I repeat my words, central vein is connected with the portal triad with like the bogies. This arrangement is known as trabecular arrangement. Trabecular arrangement is like a train, one behind the other. Okay.

Now, what is the use? Now, between the two adjacent cells, there is a hole, there is a defect, there is a small channel, you can say. Like, have you ever traveled in a train? Of course, I guess everyone has traveled. Maybe some of you have not traveled, but I have traveled multiple times in trains. In the train, uh, in the broad line of the train, they are connected. The bogies are connected from with each other. So, in the same way, you can compare. These are the bogies, and they are connected from inside with each other, right? Like the train only. So, the connections are there. You should ask me, "Ma'am, what is the reason for this connection?" All these cells are synthesizing bile. Imagine this cell is synthesizing bile, this is also, this is also, this is also. These all cells are synthesizing bile. So, bile from the first cell is transmitted to the next. It is transmitted to the next, it is next, next, next. Finally, all the bile is collected here. Finally, all the bile of all these is collected, and they will form the bile duct. This is the reason for the holes. Imagine if these holes are destroyed by autoantibodies. It happens in primary biliary cirrhosis. PBC is a disease in which autoantibodies are formed against these canaliculi. These are small holes known as canaliculi. So, they become blocked. So, bile will be synthesized inside the cell, but it cannot be transmitted. So, cell will burst. The cell will burst. All the hepatocytes will burst, and it will lead to cirrhosis. Such a cirrhosis is known as primary biliary cirrhosis because bile is causing this process. Everything has a concept, you know. There is no rectification if you understand the concept. Pathology is fun. Imagine pathology is a beautiful subject, a colorful subject. Images talk with us, they speak with us. The only thing we have to understand their language. Okay, pathology is a language per se, as a subject. You have to understand it as a language. It's very easy. It's like a pun. It's very interesting if someone may taught you like this, okay? So, that is the thing. So, you understood the histology of the liver. Not only this, not only this, we will not stop here. Between the two trains, there is a, there is a capillary. The capillary is known as sinusoid. Let me draw two trains separately. By train, I mean the hepatocyte. This is one row of hepatocyte. I mean to say, one trabecula of hepatocyte. This is another row of hepatocyte, another trabecula of hepatocyte. They are interconnected with each other, as I told you, canaliculi are there between the adjacent hepatocytes. Okay, this is trabecular arrangement. Between two adjacent trabeculae, there is a sinusoid. The capillary is known as sinusoid. The capillary or the sinusoid is lined by the endothelial cells. This is endothelial cell, right? In between, intermittent macrophages are present, not continuously. Intermittent Kupffer cells are present in the capillary or sinusoid lining only. There is a space. There is a space. Just a second. Uh, between the hepatocyte and the sinusoid, between the row of hepatocytes, that is trabeculae, and the sinusoid. This space is known as space of Disse. This space is known as space of Disse. What is it known as? This space is known as space of Disse. Space of Disse. It also contains a cell. It also contains a cell. Which cell? Can you name it? Ito cell. It contains few cells which are known as Ito cell. What is the function of Ito cell? Normally, Ito cell's normal function is vitamin A storage. They store vitamin A. But at the time of liver injury, if these hepatocytes are injured, can you see these hepatocytes? If anything is causing injury to these hepatocytes, then the Ito cell, which are present in space of Disse, they get stimulated and they convert into myofibroblast. The myofibroblast synthesizes collagen. It synthesizes collagen. The collagen causes fibrosis and it leads to cirrhosis. It cannot understand cirrhosis if you don't know it. Come on, okay? So, if you understand Ito cell, then only you can understand cirrhosis. So, understanding histology is very important if you want to understand pathology. You cannot understand pathology without understanding the histology of liver. If I directly jump on the hepatitis, you know, bridging fibrosis, the fancy fancy terms, you will say, "What does it mean?" If you don't know the basics. Come, come. Can we go ahead? Can we go ahead? Okay, thanks for the compliment. Thank you so much. Can we go ahead? Okay, so this is the normal histology. I have covered completely, you know, all the cells. Now, now we are ready to start with hepatitis. Let's start hepatitis. Okay, so there are five types of hepatitis. Just caused by five types of viruses. This topic is important in microbiology also. This topic is important in medicine also. So, we are covering from all the aspects, okay? There are five types of hepatitis: A, B, C, D, E. Make it C by mistake, it's G. So, A, B, C, D, E, five types of hepatitis caused by five different types of viruses. Hepatitis A caused by Hepatitis A virus. B is caused by B virus. C is by C virus. D is by D. And E is by the family of all these viruses is different. Only B of them is a DNA virus. Rest all of them is RNA viruses. I hope you know the classification of the viruses in microbiology. If you don't know, you must read it, okay? So, the classification of the viruses, you can see the Hepatitis B virus is a DNA virus. Rest all are RNA virus. First thing you have to learn that, okay? A Hepatitis A virus is the enterovirus. B is the hepadnavirus. T is a flavivirus. D is a viroid or Delta virus. And E is a calicivirus. This is C, huh? Calicivirus. So, you have to learn the name of the family. Number one, learn the incubation period for all of them. The next point I would like to tell you, I would like to draw a diagram. Imagine this is a human, and imagine this is a human. Okay, I want to give you a concept here. Imagine this person having A or E hepatitis. A or Hepatitis E. A and E both are excreted in feces. They are excreted in stools. So, A and E are excreted in stool. So, the stools will contaminate the food and water, and via contaminated food and water, it can be transmitted to other person. So, other person can also have A or E. So, the root of transmission for A and E is said to be fecal-oral. Fecal-oral root, right? Via contaminated food and water. A and E transmit by fecal-oral root. Say yes. Got it?

Now, let me draw the same individuals again. What about B, C, D? What about B, C, D? Hepatitis B, C, D viruses are not shared in stools. They do not shed in stools. The fecal-oral root is not in them. It is not possible in them. So, how does they transmit from one individual to another? So, B, C, D transmit either by sexual root between the two individuals. The sexual root is there. Or most common, even common than the sexual root, its parenteral root. Parenteral, parenteral root. You know, by parenteral root, by sharing the common syringes, the common needles, that is the parenteral root. So, it can be sexual root, it can be parenteral root, or it can be perinatal. By perinatal, I mean, this individual is inside this individual. I mean, this is the fetus, and this is the mother. So, by perinatal root or vertical root, it is through the placenta. It is through the placenta from the mother to fetus, it can spread. So, there are three roots. You got it? Can we go ahead? You got it? So, please learn the route of transmission for A and E, it's fecal-oral. The remaining all either parenteral or close contact, means sexual or perinatal or percutaneous. Percutaneous, parenteral. So, you can see the five types of hepatitis A, B, C, D, E. You can see the virus causing them: Hepatitis A virus, B virus, C virus, D virus, E virus. Okay? You can see this one is DNA, rest all are RNA. You can see that. Okay? This one is fecal-oral. This one is fecal-oral. Rest all are either parenteral or close contact, means sexual or perinatal, as I have told you. Learn the incubation period by yourself. It is rectification. I'm not telling you. Please learn the incubation period of all of them.

Now, the most important thing would which I would like to tell you here in hepatitis A, B, C, D, E, the five types of hepatitis, what I would like to tell you here, let me tell you the five types of hepatitis. Uh, what about acute and chronic hepatitis? Have you heard the three types of hepatitis: acute, chronic, fulminant? What does it mean? Acute can be caused by all five. I will tell you the histopathology. Acute is caused by all five. Most importantly, acute hepatitis is 99% time it recovers. Sometimes self-recovery or sometimes with treatment, but it recovers. Acute, it is recovering, okay? 99% time, 1% time, acute becomes more severe and death occurs. It is known as fulminant. Fulminant is very fatal. It's very fatal. The fulminant hepatitis is the most severe form of acute. So, in all five, acute is possible. In all five, 1% of the acute is fulminant. Okay? What about chronic? A, E never leads to chronicity. A and E never leads to chronic hepatitis. B, C, D can lead to chronic hepatitis. Please learn. B, C, D can lead to chronic. It is never curable. Once occur, there is no cure. There is no cure. There are two fates. Either it will result in hepatocellular carcinoma or it will result in cirrhosis. In each of them, in each of them. So, there is no treatment, okay? And it leads to carrier state also. So, chronicity, HCC, carrier state, cirrhosis is seen in B, C, D. But these all are absent in A and E. In A and E, no chronicity, no HCC, no cirrhosis, no carrier. In A as well as E. But in B, C, D, it's possible. Say yes. You got it? You got it? So, that is the thing. You can see the carrier state, you can see the chronic. Chronic is none here and here. And in between, it is possible. So, please learn the basics.

Now, among them, A, B, C, D, E, I wish if I can teach you all five, but the most important among them is B. So, I will give the discussion of B only. And after that, I will come on the histopathology of acute and chronic hepatitis, okay? So, B, can you see the diagram here? This is Hepatitis B virus. It's known as Dane particle because it was discovered by the scientist, the person Dean, that's why it is known as Dane particle. Can you see this one is DNA virus? Only B is DNA. Rest all are RNA. Please interact. Come on, give me a thumbs up. You got it? Say something in between here. Come on. Okay, so you can see this is Hepatitis B virus. It is a double-stranded DNA virus. Appreciate it. On the surface of the virus, three antigens are present. The first antigen, you can see S. S for surface. S for surface. Antigen. S for surface. Okay. The first one. The second is E. E for envelope. It is present on envelope, that's why E, right? And C for core. The third one is the core. C for core. So, you can see the three types of antigen: S, E, and C. You can see this virus enters human body. Imagine this virus is entering human blood vessel. Let me draw human blood vessel. Once it goes in blood vessel, now out of the three antigens, two leak out and come in the blood. So, which two leak out? This one will leak out in the blood, Hepatitis S antigen. And E will also leak out in the blood. Along with the DNA, DNA will also leak out in the blood. C never leaks out. C never comes in blood. It is present in core. It is deeper. It will never leak out in the blood. You will get two antigens, S, you will get E. You will get C, you will not get in blood. Please mind my words. Now, body starts forming antibodies against all three. So, against S, body forms anti-S. Against E, body forms anti-E. Right? C is not coming in the blood, so it's feeling bad. It's a mnemonic. Ah, the C is feeling bad, you know? So, body is giving two antibodies to that, just to learn. Okay? Two antibodies, anti-C. The two types of anti-C, IgM and IgG. So, total four antibodies are present. So, if you check the blood, two antigens and four antibodies, total six. These are known as serological markers of hepatitis. You got it? So, you can see what are the two antigens? Can you tell me? What is your sequence of arising? The two antigens are S and E. And the antibodies are anti-S, anti-E, anti-C. The two types of anti-C, IgM and IgG. Say yes. Got it? Got it? Can we go ahead? Huh?

So, what is the sequence of their arrival and what is their significance? What's the sequence? Of course, first antigen will come, then antibody will come. Common sense. First antigen will leak and come. The first antigen coming is S, followed by E. Antigen is over. Okay? Along with E, DNA also leaks out. They they come together in the blood, E and DNA. What about the antibodies? C is not coming now, so C is feeling bad. Why I am not coming in the blood? So, first antibody will come of C, just to learn. It's a mnemonic, okay? So, C antibody, anti-C will come. But there are two types of anti-C. So, first IgM is coming, then anti-E is coming, then again C is coming, IgG is coming this time. And now last is S. So, my point is that the first antigen is S, the last antibodies of S. Say yes. Say yes. Got it? Got it? These are the concepts. This is how you have to study. Conceptual. Okay? So, see the antigen. The first antigen is S, followed by E. The two antigens are over. C antigen, antigen coming on antibodies. Antibodies. Antibodies. Antibodies. Antibodies. So, anti-C followed by E, followed by again C, and followed by S. Okay? And this time, the C is IgM, and this time C is IgG. You got it? If you want to learn the mnemonic, S, E is the mnemonic for antigen. And for antibody, C, E, C, S. This is the mnemonic you have to learn. The sequence S, E, C, E, C, S. If you want to learn at all. So, this is IgM, and this is IgG. You will say, "Ma'am, okay, we got there are two antigens. We got there are four antibodies. Total six markers are there." You got everything. I, I know you got everything. Okay?

Now, the point is that what's the relevance of each of them? What is the relevance of each of them? Why it is necessary to understand? Being a doctor for me, why it is necessary? Let me tell you the relevance. Fast. So, let's take pair by pair. Let me talk about the first pair, this pair, S pair. S pair. Now, S pair. The antigen and antibody never present together in one person. Either the antigen will be there or antibody. They never present together. Okay? Because the antigen represents infection. The person is having infection, and the antibody present, recovery. One person either can be infected or can be recovered. Both things cannot happen simultaneously, obviously. So, either the antigen is present or the antibodies present. Say yes. The antibody also represents vaccination. Are you vaccinated for Hepatitis B? I am vaccinated. If you are not vaccinated, you should vaccinate it, okay? So, if you are vaccinated, so your body will have anti-S antibody. These are the protective antibodies, okay? So, that is S. That is the relevance of S. Coming on the next pair, E or E. Antigen, antibody, again, they never present together. One of them will be present, right? Antigen represents high infectivity. What is infectivity? And E antibody represents low infectivity. So, it is not infection, it is infectivity. Infectivity is a tendency to infect others, you know, the communicability to infect others, right? So, E is related to infectivity, high or low. Antigen and antibody. The third is last, C. What about the antibodies? We have two antibodies. So, IgM indicates acute or recent infection. And IgG indicates chronic or past infection. Say yes. Got it? Got it? So, this is the relevance of all of them. The relevance is written. You can read the relevance of all of them. You can notice the graph. This is this year's NEET PG question, right? Now, the NEET PG was there not a few days back. So, I'm sorry, in AIIMS PG. So, this year's AIIMS PG question is there. The question was based on this graph, right? So, you can make it out. The first antigen is coming is HBsAg, followed by HBeAg. Along with the DNA. So, this is the graph. Okay? After that, in the antibodies, first antibody is anti-HBc, which is IgM. After that, anti-HBe. After that, anti-HBc, which is IgG. Okay? And the last to come is HBs. You can see the sequence now. If you know the sequence, if anything is missing in the graph, they can frame the examiner can frame an image-based question. If anything is missing, you can answer that. If anything is missing, say yes. Come on. You got it? I didn't got it? Can we go ahead? Okay, so please learn the sequence.

Now, the most important thing here, which I would like to tell you, is the, you know, how to interpret the serological markers, the report. Don't see the answer. I'm having six patients. Patient one, two, three, four, five, six. Six subjects in front of you. The reports. You have to see the HBsAg positive or negative, and anti-HBs antibody positive or negative. These two are related to S. Okay? These two are related to E. E antigen, E antibody. Okay? And last is HBc and anti-HBc. I mean, IgM or IgG. Now, read the report. Imagine first patient. This is first patient. Read the first patient. HBsAg antigen positive, antibodies negative. What does it? It gives the conclusion. What does you interpret? So, patient has infection. No recovery. Infection is present. Recovery is not there. Antigen positive, antibodies negative. So, it is of high infectivity. And it is IgM. So, it is acute. So, answer is: acute infection of high infectivity. This is my answer. So, from this point, now you can cover all medicine MCQs also, not only pathology. You got my point? So, you should know the importance. You will get a big clinical question. There is a 47-year-old man. A big clinical scenario will be there. Presented with jaundice. Presented with loss of appetite. Um, on palpation, there is right hypochondrium tenderness. I mean, they want to say you hepatomegaly, right? So, hepatomegaly is there. Hepatomegaly is there. Like it will be a big question. Now, they will give you the serological markers. The hepatitis S antigen positive or negative. The antibody is positive or negative. The E is positive or negative. Antibodies positive or negative. And among the C, which one is positive? And they will ask you. They will ask you for the conclusion. In conclusion, these will be the options. If you know the interpretation, you can make it out. If you, I'm sorry, if you know the interpretation, you can make it out. Okay? You got it? Cannot see your chat. Okay, okay. Can we go ahead? Yes. In the same way, you can do the interpretation. The second case, third case, you can see. IgM, IgG will decide acute or chronic. And last, you must see immunization. If you check my blood, everything is negative apart from apart from anti-HBs. And anti-HBs is positive. Rest all is negative. Can we go ahead?

The next is the acute, chronic, and fulminant hepatitis. The histopathology. Let's talk about acute hepatitis. I told you all five can cause acute. A, B, C, D, E. All five can cause acute. This is a diagram of acute. Let me explain the diagram. Is the diagram same for all? All the diagram is same for all hepatitis, whether it is A, B, C, D, E. What is this diagram about? Have I explained you this diagram? Have I explained to you this diagram? I guess I have explained. This is a central vein in the center. And at the six corners, you can see portal triad. What does the portal triad contain? Hepatic artery, portal vein, and bile duct. Okay? This is portal triad. Now, I cannot say all six portal triads here in this diagram. So, I will draw one central vein and one portal triad in this diagram. I have drawn one, one. So, see diagonals. You can choose any diagonal. At this diagonal, this is the central vein. At this diagonal, this is the portal triad. You can see. And connecting them is the row of hepatocytes. Can you see the row of hepatocytes are connecting them? I am teaching you acute hepatitis. Okay? In acute hepatitis, four types of injury occur to these hepatocytes. The first injury which is occurring is the balloon degeneration. Can you see some of the hepatocytes? I'm marking with green color. They all are swelled up. They all are swelled up, right? These are known as balloon degeneration. Can you see these type of hepatocytes? I'm marking here with red color. Some of the hepatocytes have intense eosinophilia and the nucleus disappear. This one is known as Councilman body. Some of the hepatocytes shows Councilman body. The third type of hepatocytes, uh, the necrosis is there. Can you see the necrosis? The hepatocyte disappear. There is no center, only periphery is present. So, it is known as dropout necrosis. Some of them are showing dropout necrosis. The third thing, sometimes it is not shown here. The complete row of the hepatocyte is showing necrosis. It is known as bridging necrosis. So, four types of injury are there. What are the four types of injury? Can you please enumerate? It's balloon degeneration, Councilman body, is also known as acidophilic body, dropout necrosis, and bridging necrosis. What does it mean? I have shown all of you. Some of them swells up, it is balloon degeneration. Some of them, the cytoplasm become intense pink and nucleus disappear, its Councilman body. Some of them, hepatocyte undergo lysis, it's dropout necrosis. And the complete row is necrotic, it is known as bridging necrosis. Please learn these four findings in acute. Please learn along with that, see the portal triad. In the portal triad, where is the artery? I guess you all can make it out. This one is the artery. This one is the vein. And this one is the bile duct. Okay? We got that. But I can see a number of lymphocytes in the portal triad. It is known as inflammation in the portal triad. It is known as triaditis. The triaditis is also a finding. So, that is about the acute. You got my point? Shall I come on the chronic? In the acute hepatitis, what are the findings? The four types of the injury. Can you please enumerate the four types of injury? Say, balloon degeneration. The second was Councilman bodies or acidophilic bodies. The third one was dropout necrosis. Only one, one hepatocyte necrotic. And the complete rows necrotic, its bridging necrosis. These are the four point findings. Upon along with triaditis, that is acute. Please learn that.

Coming on the chronic hepatitis. The next is the chronic hepatitis caused by B, C, D. A and E never cause chronicity. I told you. This is the diagram. This is normal. And this is chronic hepatitis. You can compare. In the normal, you can see this is central vein. This is portal triad. And you can see the row of hepatocytes beautifully connecting them. It is a lobular model. You can understand the lobular model. Okay? Now, please learn the first, first hepatocyte of all the trabeculae. Like, you can say the engines of the train. All the engines of the train. It is known as limiting plate. It is forming a plate known as limiting plate. Now, compare it on the chronic hepatitis. So, compare where is the limiting plate? The limiting plate is gone. I cannot see the limiting plate. It is known as piecemeal necrosis. What is it known as? The first thing is the piecemeal necrosis. Just a second. Why this drawing is not going? Yeah, it's piecemeal necrosis. In which the limiting plate is necrotic. So, I cannot find the limiting plate here. The limiting plate is gone. The limiting plate is gone. So, it is known as piecemeal necrosis. Number one. And triaditis is there. Here also, there is triaditis. Compare here. Here we have only artery, vein, and duct. But here, along with artery, vein, and duct, we find multiple lymphocytes also. So, triaditis is here also. So, limiting, piecemeal necrosis is there. Is there? Apart from that, you can compare the hepatocytes. Here, all the hepatocytes are healthy. No injury. Here, in the hepatocytes, we can see acidophilic bodies. Here also, we have bridging necrosis. Dropout necrosis. Here also, we have. Here we have one unique finding, which is not present in acute, which is present on only chronic. The complete row of the hepatocyte undergo fibrosis. It is known as bridging fibrosis. There we have bridging necrosis. Here we have bridging fibrosis. So, that's all about the chronic. When acute in chronic, can you enumerate the features please? What we have learned in acute? We have learned four findings: balloon degeneration. What is the next one? Councilman bodies or acidophilic bodies. The next one is dropout necrosis. And here we are bridging necrosis. Here we don't have balloon degeneration. We don't have bridging necrosis. These two are common. Here also, we have Councilman bodies. Here also, we have dropout necrosis. But instead of bridging necrosis, we have bridging fibrosis, which is unique here. That is my point. Along with that, we have piecemeal necrosis here. Piecemeal necrosis. And we have triaditis, both the ways. In both of them. Give me a thumbs up. Come on. I'm trying hard here. Come on. Please take these catchy, catchy words which is present in acute, which is present in chronic. That's it. We are done with hepatitis also. We are done with hepatitis also.

So, do you do you find this session useful? So, I would like to end it here. It's already three o'clock. So, at three o'clock, I have to finish the session because I'm having some other commitments. Okay? So, I have to finish this session right now. But whatever is pending, kindly enumerate. I will cover all of this in one more session. So, till now, let me enumerate the renal system is pending. Respiratory system is pending. And genital system, the male and female genital system, both are pending. So, these three systems I will cover in one more session. If you wish, we can plan oncology also separately. In which I can cover the oncology of complete pathology together at one place. There is two pathology of all of them. So, we can plan more sessions. Don't worry. We will meet again. Hopefully, we will meet you soon. And thank you so much. Don't forget to give your feedback. So, do you find this class useful? The pathology yesterday, I taught you general pathology and few important topics of hematology. Today, we have taken many important systems of systemic pathology. I guess from the morning, seven to eight systems are covered. Three or four are still pending. Okay? Total 12 systems we are having. Thank you so much for being with me. And that's all. See you again. Bye-bye. Wishing you all the best for your exams. Bye.