DR JABIR KHAN

Acute Cholecystitis — Abdominal Examination Abdominal Examination — Acute Cholecystitis General Inspection Patient appears uncomfortable and slightly febrile. Breathing is shallow due to right upper quadrant (RUQ) pain. May prefer lying still, avoiding deep breaths or movement. Mild tachycardia and low-grade fever may be noted. No jaundice unless choledocholithiasis present. Inspection of the Abdomen Abdomen moves minimally with respiration. Localized fullness or distension in RUQ may be visible. No scars unless previous biliary surgery. Skin normal; no dilated veins or visible pulsations. Palpation Tenderness localized to RUQ and epigastrium. Murphy’s sign positive : pain and inspiratory arrest on deep palpation of gallbladder area. Guarding may be localized to RUQ. No palpable mass unless gallbladder is distended (Courvoisier’s sign in malignancy). No hepatomegaly or splenomegaly usually. Percussion Tend...

Acute Pancreatitis — Abdominal Examination Abdominal Examination — Acute Pancreatitis General Inspection Patient appears acutely ill, restless, often sitting up and leaning forward for pain relief. Facial distress, mild tachycardia and tachypnea may be evident. Skin may be flushed; in severe cases, pallor or mild jaundice noted. Grey Turner’s or Cullen’s sign (bluish discoloration of flanks or umbilicus) may appear in severe necrotizing pancreatitis. Inspection of the Abdomen Upper abdominal fullness or distension may be present. No visible peristalsis or pulsations. Movements with respiration may be reduced due to guarding. Palpation Light palpation reveals marked tenderness in epigastrium and left hypochondrium. Guarding and mild rigidity may be present. No palpable organomegaly initially, but pancreatic pseudocyst may present later as a palpable mass. Murphy’s sign negative (helps differentiate from cholecystitis). ...

Abdominal Examination – Acute Appendicitis AP Acute Appendicitis — Abdominal Examination Focused findings highlighting localized peritonism and classical appendicitis signs. RLQ tenderness McBurney’s point Rovsing’s sign General Inspection Patient appears uncomfortable and mildly distressed with guarded movements. Mild tachycardia may be present. Skin is warm, with no jaundice or pallor. Inspection of the Abdomen Abdomen may appear near-normal in contour but with localized guarding or antalgic posture. No visible surgical scars. Focal fullness or distension may be seen in the right lower quadrant (RLQ). Palpation Light palpation Marked focal tenderness in the RLQ, maximal at McBurney’s point. Deep palpation Localized rigidity and rebound tenderness present. Guarding pa...

Abdominal Examination – Peritonitis PT Peritonitis — Abdominal Examination Focused clinical findings highlighting diffuse peritoneal irritation, localization, and red flags for urgent management. Acute abdomen Guarding & rigidity Surgical emergency Inspection Patient often appears unwell and prefers to lie still. Guarding of the abdomen may be obvious with shallow respiration. Look for abdominal distension, surgical scars, external signs of peritoneal inflammation (erythema), and systemic signs such as fever, diaphoresis or pallor. Palpation Examine gently, starting away from the area of maximal pain. Widespread involuntary guarding and board-like rigidity suggest generalized peritonitis. Localized tenderness with rebound indicates focal peritoneal irritation. Note any palpable masses, localized peritoneal si...

Abdominal Examination – Intestinal Obstruction IO Intestinal Obstruction — Abdominal Examination Structured clinical findings emphasizing small vs large bowel features, signs of strangulation, and examination tips for surgical assessment. Distension & vomiting High-pitched bowel sounds Surgical emergency Inspection Patient may appear dehydrated and uncomfortable, with abdominal distension. Note any scars suggesting previous surgery (adhesions), visible peristalsis (more common in proximal obstruction), hernias, abdominal wall defects, or stoma. Observe respiratory rate and signs of systemic toxicity which may indicate strangulation. Palpation Palpation should be gentle. Assess for generalized tenderness, localized peritonism (guarding, rigidity) which suggests strangulation or perforation. Palpate for masses ...

Abdominal Examination – Splenomegaly SP Splenomegaly — Abdominal Examination Concise and clinical findings with practical tips for examination and presentation. Left upper quadrant Bimanual palpation Traube's space Inspection On inspection the patient may have a visible fullness of the left hypochondrium when the spleen is large. Note any signs of chronic disease such as pallor, jaundice, or lymphadenopathy. Abdominal contour may be normal or show mild left-sided bulge. Palpation Use the bimanual technique with the patient lying supine and the examiner standing to the right. Place your left hand behind the patient at the left lower rib cage and press gently upward while your right hand palpates below the left costal margin. Ask the patient to take a deep breath — a palpable organ edge that descends with inspi...

Abdominal Examination – Hepatomegaly H Comprehensive abdominal examination findings in a patient with hepatomegaly — detailed for case presentation and OSCE preparation. Liver enlargement Measurement technique Benign vs Malignant General Inspection The patient is lying comfortably, with no acute distress. Mild jaundice may be visible in the sclera or skin. Hands may show palmar erythema or spider nevi, suggesting chronic liver disease. No tremors or flapping are noted. Inspection of the Abdomen Mild fullness in the right hypochondrium is noted. Abdominal movements with respiration are reduced on the right side. No scars, veins, or visible masses are observed. The umbilicus remains central and inverted. Palpation The liver edge is palpable below the right costal...

Abdominal Examination – Ascites AS Detailed clinical summary of abdominal examination findings in a patient with ascites — formatted for viva and case presentation use. Abdominal distension Fluid thrill Shifting dullness General Inspection The patient appears comfortable but has a distended abdomen. No respiratory distress is noted. The skin shows no pallor or jaundice. Peripheral edema may be present, especially over the ankles. Hands show no palmar erythema or asterixis. Inspection of the Abdomen The abdomen is uniformly distended with a smooth, tense surface. Flanks appear full and the umbilicus is everted. No visible veins, scars, or hernias are noted. Abdominal wall movements with respiration are reduced. Palpation The abdomen feels tense and non-tender. N...

Normal Abdominal Examination Summary AE Concise and well-presented findings from a routine abdominal examination — written in a natural, human tone suitable for viva, OSCE, or case notes. Clinical summary Normal findings No pathology General Inspection The patient lies comfortably in the supine position, breathing normally, with no signs of pain or distress. The hands show no pallor, jaundice, clubbing, or peripheral edema. No palmar erythema or spider nevi are noted. Inspection of the Abdomen The abdomen appears flat and symmetrical, moving well with respiration. The umbilicus is central and inverted. No scars, striae, distension, visible peristalsis, or pulsations are seen. The skin is healthy with no dilated veins. Palpation The abdomen feels soft and non-te...

Hepatitis B – High Yield Guide for Medical Students Hepatitis B – High Yield Guide for Medical Students Hepatitis B virus (HBV) is a DNA virus that causes both acute and chronic liver disease. It remains a major global health concern, particularly in Asia and Africa. Understanding its virology, transmission, diagnosis, and management is crucial for medical students and clinicians. Virology & Structure Family: Hepadnaviridae Genome: Partially double-stranded DNA Envelope with HBsAg (Hepatitis B surface antigen) Core with HBcAg (core antigen) HBeAg : secreted antigen indicating active replication HBV Lifecycle & Drug Targets (High-Yield) Lifecycle Steps: Attachment & Entry – HBV binds to NTCP receptor on hepatocytes. Uncoating – Viral DNA released into cytoplasm. Transport to Nucleus – Conversion of relaxed circular DNA (rcDNA) to covalently closed circular DNA (cccDNA). Transcription – Host RNA polymerase transcribes viral mRNAs and pre...

🩺 Case Study: Refeeding Syndrome in a Malnourished Patient Author: Dr. Jabir Khan Date: August 7, 2025 Tags: Refeeding Syndrome, Electrolyte Imbalance, Clinical Case, Internal Medicine 🧑‍⚕️ Patient Profile Age/Sex: 42-year-old male History: Chronic alcohol use disorder, poor oral intake for 10–12 days Presenting Complaint: Generalized weakness, shortness of breath, and mild confusion two days after re-initiation of feeding 📋 Background The patient was admitted to the medical ward with signs of dehydration, weight loss, and fatigue. His BMI was 16.2, and he appeared cachectic. After stabilization with IV fluids, enteral nutrition via NG tube was started at 1,200 kcal/day without electrolyte correction or thiamine supplementation. ⚠️ Clinical Deterioration 48 hours after feeding: The patient became disoriented and developed muscle cramps Tachycardia (HR: 110 bpm), tachypnea (RR: 24/min) ECG showed flattened T waves and U waves 🧪 Laborato...