SIGNS AND SYMPTOMS IN CLINICAL PRACTICE
SIGNS AND SYMPTOMS IN CLINICAL PRACTICE
Editors
Devendra Richhariya MBBS MD FICM
Associate Director Emergency and Trauma Care Medanta—The Medicity
Gurugram, Haryana, India
Co-Editors
Jesus Daniel López Tapia MD
Master in Research and Education President of Mexican Society of Emergency Medicine Dean of Medicine School in Universidad de Monterrey
Nuevo León, Mexico
Khusrav Bajan MD EDIC
Head, Emergency Department PD Hinduja Hospital and Medical Research Centre
Mumbai, Maharashtra, India
Bhawana Sharma MBBS DNB (Respiratory Medicine)
Classified Specialist Department of Critical Care Artemis Hospital
Gurugram, Haryana, India
Forewords
Naresh Trehan
Yatin Mehta
Praveen Aggarwal
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Signs and Symptoms in Clinical Practice
First Edition: 2020
9789389188561
Printed at:
My Parents, Family and Friends
- Aditya Agarwal MBBS MS MCh (Plastic Surgery) DNB (Plastic Surgery) MNAMS
- Director
- Department of Plastic, Esthetic and Reconstructive Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
- Ajay Singh Thapa MD DM (Emergency Medicine)
- Chief Consultant and Head
- Department of Emergency Medicine and
- Emergency Medical Services
- Grande International Hospital
- Kathmandu, Nepal
- Akanksha Rastogi MBBS DNB (Medicine) MNAMS
- Consultant
- Department of Internal Medicine
- Medanta—The Medicity
- Gurugram, Haryana, India
- Akshat Taneja MBBS MEM
- Senior Resident
- Emergency Department
- Max Super Speciality Hospital
- Patparganj, New Delhi, India
- Aldo Emigdio Bartolini Salinas MD
- Medical Surgeon and Midwife
- Medicine School
- Universidad de Monterrey
- Nuevo León, Mexico
- Aldo Tua MD
- Faculty, Emergency Department Sant'Andrea Hospital
- Vercelli, Italy
- Ali Abdolrazaghnejad MD
- Assistant Professor
- Department of Emergency Medicine
- Tehran University of Medical Sciences
- Tehran, Iran
- Alireza Baratloo MD
- Associate Professor
- Department of Emergency Medicine
- Tehran University of Medical Sciences
- Tehran, Iran
- Aman Sharma MD (Physician) Dip EM MEM
- Senior Resident
- Department of Emergency Medicine
- Apollo Hospital
- Bilaspur, Chhattisgarh, India
- Amit Mittal MBBS DNB (Medicine), DNB (Gastroenterology), MNAMS
- Senior Consultant
- Department of Gastroenterology
- Paras Hospital
- Gurugram, Haryana, India
- Amit Nabar MD DA FCPS MBBS LLB
- Head
- Department of Accident and Emergency
- SL Raheja Hospital
- Mumbai, Maharashtra, India
- Anukalp Prakash MBBS MD (Medicine) DNB (Gastroenterology)
- Senior Consultant
- Department of Gastroenterology
- Paras Hospital
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- Department of Pediatric Surgery
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- Ashok Puranik MBBS MS Fellowship Trauma RACS
- Professor and Head
- General and Trauma Surgery
- All India Institute of Medical Sciences
- Jodhpur, Rajasthan, India
- Ashok K Taneja MD DIP CARD FRCP (UK) FACP (USA) FICP FIAE FDI FAPSC (Taiwan)
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- Medanta Bone and Joint Institute
- Medanta—The Medicity
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- Au Kin Heng Constantine MBBS (HK) DPD (Wales) PG Dip SEM (Bath) Dip Clin Tox (HKPIC & HKCEM) PgDip–Medical Toxicology (Cardiff) MSc in Infectious Diseases (LSHTM, London External Program) MRCS (Ed) FHKCEM FHKAM (Emergency Medicine) FRCEM
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- Avdi Tahiri MD
- Specialist of Emergency Medicine
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- University Clinical Centre of Kosova
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- Mafraq Hospital
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- Konya, Turkey
- Azza Omar Yousif MBBS
- Arab Board in Emergency Medicine
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- Emergency Physician
- Rashid Hospital Trauma Centre
- Dubai, UAE
- Behcet Al MD
- Professor
- Emergency Department
- Sahinbey Education and Application Hospital
- University of Gaziantep
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- Gaziantep, Turkey
- Bhawana Sharma MBBS DNB (Respiratory Medicine)
- Classified Specialist
- Department of Critical Care
- Artemis Hospital
- Gurugram, Haryana, India
- Carreen Pakrasi MBBS MD
- Director
- Department of Ophthalmology
- Medanta—The Medicity
- Gurugram, Haryana, India
- Chintan Thanki MD (EU) MPH (Aus) DEM
- Registrar, Emergency Department
- Care Institute of Medical Sciences Hospital
- Ahmedabad, Gujarat, India
- Chitra Mehta DNB (Respiratory Medicine) DNB (Critical Care)
- Associate Director, Critical Care
- Medanta—The Medicity
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- Deepak Dalmia MBBS MS (ENT) DNB (ENT)
- Head, Department of ENT
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- Mumbai, Maharashtra, India
- Deepika Gupta DNB (Plastic Surgery)
- Resident
- Department of Plastic, Esthetic and Reconstructive Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
- Devendra Richhariya MBBS MD FICM
- Associate Director
- Emergency and Trauma Care
- Medanta—The Medicity
- Gurugram, Haryana, India
- Dheeraj Kapoor MD DM
- Head
- Department of Endocrinology
- Artemis Hospital
- Gurugram, Haryana, India
- Eric Revue MD
- French Society of Emergency Medicine (SFMU)
- Co-Chair of the Prehospital Section of the
- European Society of Emergency Medicine (EuSEM)
- Head of the Prehospital EMS (SMUR) and
- Emergency Department
- Chartres, France
- Evith Pereira MD
- Consultant
- PD Hinduja Hospital and Medical Research Centre
- Mumbai, Maharashtra, India
- Faiz Ahmad MD FAAP
- Division Chief
- Pediatric Emergency Department
- Tawam Hospital
- Al Ain, Abu Dhabi, UAE
- Goma Bali Bajaj MBBS MEM (GWU, USA)
- Head, Emergency Department
- Medical College
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- Govind Sharma MBBS MS (Ortho)
- Associate Consultant
- Medanta Bone and Joint Institute
- Medanta—The Medicity
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- Consultant
- Department of Plastic, Esthetic and Reconstructive Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
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- Consultant
- Department of Emergency Medicine
- Shalby Hospital
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- Hatinderjeet Singh Sethi MBBS MD (Internal Medicine)
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- Assistant Professor of Pediatrics
- Department of Pediatric Emergency Medicine
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- Saint Louis University
- Saint Louis, Missouri, USA
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- Senior Consultant
- Department of Internal Medicine and Preventive Health
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- Master in Research and Education
- President of Mexican Society of Emergency Medicine
- Dean of Medicine School in
- Universidad de Monterrey
- Nuevo León, Mexico
- Kamal Lashkari MD IDCCM EDIC
- Specialist
- Department of Critical Care Medicine
- Thumbay Hospital
- Ajman, UAE
- Khusrav Bajan MD EDIC
- Head, Emergency Department
- PD Hinduja Hospital and Medical Research Centre
- Mumbai, Maharashtra, India
- Kishalay Datta MBBS MD MRCP MACEP MHA
- Associate Director and Head
- Emergeny Department
- Max Super Speciality Hospital
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- Specialist of Parodontology and Oral Medicine
- Main Family Health Centre UBT
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- Resident
- Department of Plastic, Esthetic and Reconstructive Surgery
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- Associate Director, Pediatric Intensive Care Unit
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- Senior Consultant
- Department of Pediatric Surgery
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- Mohammed Moizuddin Qureshi MD
- PGY II Emergency Medicine
- Penn State Health Milton S Hershey Medical Center
- Hershey, Pennsylvania, USA
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- Assistant Professor
- Department of Emergency Medicine
- Tehran University of Medical Sciences
- Tehran, Iran
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- Faculty, Emergency Medicine
- Department of Medicine
- Nizip State Hospital
- University of Gaziantep
- Gaziantep, Turkey
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- Associate Professor of Pediatrics
- Department of Pediatric Emergency Medicine
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- Department of Dermatology
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- Associate Consultant
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- Hospital and Healthcare Management
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- Bangalore Baptist Hospital
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- Assistant Professor
- Department of Physiology
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- Gurugram, Haryana, India
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- Emergency Medicine, Trauma and Disaster Consultant
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- KSA, Saudi Arabia
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- Independent Medical Appraiser
- (General Medical Council, UK)
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- Emergency Physician
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- Agroha, Haryana, India
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- Senior Scientist
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- Gurugram, Haryana, India
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- Medanta—The Medicity
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- Senior Consultant
- Department of Critical Care
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- Gurugram, Haryana, India
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- Professor and Head
- Department of Emergency Medicine
- All India Institute of Medical Sciences
- New Delhi, India
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- Professor
- Department of Orthopedics
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- Jhansi, Uttar Pradesh, India
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- Chairman
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- Saint Louis, Missouri, USA
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- Emergeny Department
- Max Super Speciality Hospital
- New Delhi, India
- Ritin Mohindra MD
- Assistant Professor
- Department of Emergency Medicine
- All India Institute of Medical Sciences
- New Delhi, India
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- Faculty, Emergency Department
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- Emergency Physician
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- Emirates Society of Emergency Medicine
- Abu Dhabi, UAE
- Sandeep B Gore MBBS MRCEM (UK) FAEM (CMC, Vellore)
- Head
- Department of Emergency Medicine
- Fortis Hospital
- Mumbai, Maharashtra, India
- Sandeep Jain MS FNB (Trauma Care) PGDMLS MEM
- Senior Consultant and Head
- Emergency Department
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- Pediatric Intensivist
- Dr Mehta's Children's Hospital
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- Director and Chief Gastroenterologist
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- Associate Director
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- Head, Emergency Department
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- Care Institute of Medical Sciences Hospital
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- Department of ENT
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- Mumbai, Maharashtra, India
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- Consultant and Head
- Department of Emergency Medicine
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- Emergency Department
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- Resident
- Department of Plastic, Esthetic and Reconstructive Surgery
- Medanta—The Medicity
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- Associate Consultant
- Department of Preventive Cardiology
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- Shashank Karale DNB (3rd year)
- Emergency and Trauma Care
- Medanta—The Medicity
- Gurugram, Haryana, India
- Shubham Chelawat MBBS MD (Medicine) DNB
- Senior Resident
- Department of Cardiology
- Max Super Speciality Hospital
- Saket, New Delhi, India
- Shweta Tyagi MRCEM (UK), FAEM (CMC Vellore)
- Consultant
- Department of Emergency Medicine
- Sir HN Reliance Foundation Hospital and Research Centre
- Mumbai, Maharashtra, India
- Sourabh Malviya MD
- Fellowship in Rheumatology
- Senior Consultant and Head
- Division of Rheumatology
- Medanta Super Speciality Hospital
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- Srinivas Monanga MD (Anesthesia) FNB (Critical Care)
- Attending Consultant
- Department of Critical Care
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- Sudipto Pakrasi MBBS MD
- Chairman
- Department of Ophthalmology
- Medanta—The Medicity
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- Sukhdeep Singh MBBS MS MCh (Plastic Surgery)
- Consultant
- Department of Plastic, Esthetic and Reconstructive Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
- Suman Thakur MBBS MD
- Microbiologist
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- Indira Gandhi Medical College
- Shimla, Himachal Pradesh, India
- Thiagrajan Jaiganesh MS DNB FRCS (Surg) FRCS (A&E) DCH FRCEM PGCHCL
- Chairman and Consultant
- Emergency Department
- Tawam Hospital
- Al Ain, Abu Dhabi, UAE
- Uday Sanglodkar MBBS DNB (Gastro)
- Senior Resident
- Global Hospital
- Chennai, Tamil Nadu, India
- Veena Raghunathan MD (Pediatrics) DNB (Pediatrics) FNB (Pediatric Intensive Care)
- Senior Consultant, Pediatric Intensive Care Unit
- Medanta—The Medicity
- Gurugram, Haryana, India
- Veerottam Tomar MD FCCP EDRM
- Director
- Dr Shivraj Memorial Chest and Allergy Centre
- Meerut, Uttar Pradesh, India
- Vimlendu Brajesh MBBS MS MCh (Plastic Surgery)
- Consultant
- Department of Plastic, Esthetic and Reconstructive Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
- Vivek Chauhan MBBS MD
- Assistant Professor
- Department of Medicine
- Indira Gandhi Medical College
- Shimla, Himachal Pradesh, India
- Vivekanshu Verma MBBS
- Diploma in Forensic Medicine and Toxicology
- Associate Consultant
- Department of Emergency and Trauma Care
- Medanta—The Medicity
- Gurugram, Haryana, India
- Yatin Mehta MD MNAMS FRCA FAMS FIACTA FICCM FTEE
- Chairman
- Medanta Institute of Critical Care and Anesthesiology
- Medanta—The Medicity
- Gurugram, Haryana, India
It is a commonly accepted truth that real knowledge illustrates the extent of our ignorance. The more we learn, the more we realize how little we know, and how much more remains unknown. In the clinical field, this never-ending quest to acquire knowledge, share it widely and retain its currency is our most vital attribute.
Devendra Richhariya practices this principle and it finds expression in his medical writings. I am delighted to introduce his second book entitled ‘Signs and Symptoms in Clinical Practice’. I am certain it will be received with the same enthusiasm, as his earlier work ‘Textbook of Emergency and Trauma Care’ This too is written with great attention to detail. With comprehensive approach and easy reference. ‘Signs and Symptoms in Clinical Practice’ covers varied aspects of medicine. The content offers therapeutic approaches to critically ill patients besides a coherent understanding of primary and secondary syndromes. It should be readily accessible to everyone concerned with forming a differential diagnosis to rendering care.
A laudable effort, for which I extend my best wishes to Devendra Richhariya, his co-authors and medical students.
Naresh Trehan
Diplomate, American Board of Cardiothoracic Surgery
Chairman and Managing Director, Medanta—The Medicity
Chairman, Medanta Heart Institute
Gurugram, Haryana, India
Foreword
It is a pleasure to write the foreword for Devendra Richhariya's ‘Signs and Symptoms in Clinical Practice’. After editing his previous book ‘Textbook of Emergency and Trauma Care’, he has followed with this in quick succession! With FNB in emergency medicine starting in many major hospitals, it is important that we have adequate academic resources not only for the aspiring/trainee emergency physicians but also for practicing doctors.
This book has 91 chapters on all practical aspects of signs and symptoms of various case scenarios which are useful for any young or practicing emergency physician, general physicians or DNB/MD students and obviously undergraduate medical students. The chapters are contributed by more than 100 renowned physicians/surgeons of various specialties.
When I was in UK, the first thing which I noticed that their trainees did not read the standard textbooks like Bailey and Love, Harrison's, etc. but only read ‘lecture notes’ in all specialties! They were written in very simple sequence from the time patient presents to, how to deal with him subsequently and so on. These were actual case scenarios which one would see daily in ER. The standard textbooks which we read in undergraduates studies they read only at postgraduate (PG) level! Their fresh medical graduates were better equipped to deal with actual everyday case scenarios, although we had more theoretical knowledge!
So this book is in the right direction to close this gap. It will be a very useful too for undergraduates/emergency physicians/PG students or general practitioners.
I wish you all enjoyable reading!
Yatin Mehta
MD MNAMS FRCA FAMS FIACTA FICCM FTEE
Chairman
Medanta Institute of Critical Care and Anesthesiology
Medanta—The Medicity
Gurugram, Haryana, India
Foreword
The book ‘Signs and Symptoms in Clinical Practice’ is for every acute care unit as well as various departments including emergency medicine, surgery, pediatrics, gynecology, orthopedics, psychiatry, cardiology, neurology, pulmonology and gastroenterology. It is also well-suited for the nursing students. The book will be an asset to the medical and nursing libraries. In fact, it should be on the most easily reached shelf for anyone interested in or who comes in contact with medical illness or injury. This compilation of information has many attributes, among which are:
- Evidence-based, well-referenced information
- Editors and authors who are experts in their fields
- Concise and clear presentation
- Tables that convey critical data
- Figures and diagrams that are clinically relevant
- Paragraph headers that allow focused access to information
- Calculations and formulas that are fully explained
- Lists of treatment materials to be obtained in advance with contact information of unusual items
- Therapeutic dosages that are detailed enough to be utilized without additional references.
The quality of this book should come as no surprise after looking at the impressive listing of authors. The editor, Devendra Richhariya, also the editor of ‘Textbook of Emergency and Trauma Care’, have selected national and international experts whose credibility is unmatched. They represent the best of our profession of medical science and have written a large percentage of the most important and ground breaking publications in our field.
Knowledge of clinical signs and symptoms are the ABCs of the medical education. Thorough knowledge of the signs and symptoms is the key to diagnosis of any disease. I am sure that the ‘Signs and Symptoms in Clinical Practice’ will be helpful to all the medical students.
Praveen Aggarwal
Professor and Head
Department of Emergency Medicine
All India Institute of Medical Sciences
New Delhi, India
Preface
The practice of medicine would be simple if each symptom or sign indicated a single disease, but there are enormous number of signs and symptoms (we covered only a hundred of them) and they can occur in nearly infinite number of combinations and temporal patterns. The physician's goal in performing a clinical examination and history taking is to generate diagnostic hypothesis based on signs and symptoms since medicine evolved as an art to practice, this was true since ancient times of Hippocrates, Charaka, Suśruta, Hamilton Bailey, Osler, and remains true today, even after complete digitalization and globalization of medical information. Ancient Indian Physician and Father of Indian Surgery—The Suśruta's Sanskrit name, literally means “well-heard”, which is the most important and difficult skill to learn, requiring years of experience and practice during examining patient for hearing his history of past and present illness, hearing his heart sounds, breath and bowel sounds. By reading this book on and signs and symptoms, which are indexed in alphabetical order, just like the rough fibers for cloth weaver, from which the physician will be able to weave a clinical narrative, anatomically and pathophysiologically explicit, to form the accurate diagnostic hypotheses.
Devendra Richhariya
Acknowledgments
I am grateful to all my teachers and friends who supported me during this project.
I am thankful to each and every member of the Medanta family.
I would like to sincerely thank all the authors for providing manuscripts in spite of their busy schedules.
Special thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head), Ms Nikita Chauhan (Senior Development Editor) and all members of M/S Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for invaluable contribution.