Postmortem finding of acute atherothrombosis in artery supplying the

infarcted myocardium, regardless of cTn values.

Detection of rise and/or fall of cardiac troponin (cTn) values with ≥1 value

>99th percentile of upper reference limit PLUS atleast 1 of the following:

Symptoms of ischemia

New ischemic ECG changes

Development of pathological q waves on electrocardiogram (ECG)

Imaging evidence of new loss of viable myocardium or new regional

wall motion abnormality.

Cardiac death with symptoms suggestive of myocardial ischemia and

presumed new ischemic ECG changes, but death occurring before blood

samples obtained or before increases in cardiac biomarkers in blood can

be identified.

References:

European Society of Cardiology, American College of Cardiology, American Heart

Association, and World Heart Federation (ESC/ACC/AHA/WHF) 2018 universal definition

of myocardial infarction.

PULMONARY HYPERTENSION

Pulmonary hypertension refers to a group of conditions with increased mean

pulmonary arterial pressure (mPAP) >20 mm Hg with a PVR ≥3 Wood units

(isolated postcapillary PH may have PVR <3 Wood units) as measured by

right heart catheterization in supine position at rest.

Reference

Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated

clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1).

HEART FAILURE

Heart failure is a complex clinical syndrome caused by structural or

functional impairment of ventricular filling or ejection of blood, resulting in

insufficient perfusion to meet metabolic demands.

Reference

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of

Heart Failure: A Report of the American College of Cardiology Foundation/American Heart

Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-319,

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DILATED CARDIOMYOPATHY

Dilated cardiomyopathy (DCM) refers to a large group of heterogeneous

myocardial disorders that are characterized by ventricular dilation and

depressed myocardial contractility in the absence of abnormal loading

conditions such as hypertension or valvular disease.

Reference

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of

Heart Failure: A Report of the American College of Cardiology Foundation/American Heart

Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-319.

COUGH

A cough is an explosive expiration that protects the lungs against aspiration

and promotes the movement of secretions and other airway constituents

upward toward the mouth.

Reference

Fishman’s Pulmonary Diseases and Disorders.

MASSIVE HEMOPTYSIS

No clear consensus for definition of massive hemoptysis and criteria have

ranged from 100 mL to 1,000 mL of expectorated blood within 24 hours.

Blood loss of 400 mL in 24 hours or 100–150 mL expectorated at one

time are considered massive hemoptysis.

References:

Larici AR, Franchi P, Occhipinti M, et al. Diagnosis and management of hemoptysis.

Diagn Interv Radiol. 2014;20(4):299-309.

LUNG SOUNDS (TABLE 15B.3)

Table 15B.3: Classification of common lung sounds.

Acoustic characteristics American

Thoracic Society

nomenclature

Common

synonyms

Discontinuous, interrupted explosive sounds; loud, low in

pitch

Coarse crackle Coarse

rale

Discontinuous, interrupted explosive sounds; less loud than

above and of shorter duration; higher in pitch than coarse

crackles or rales

Fine crackle Fine rale,

crepitation

Continous sounds longer than 250 ms, high-pitched;

dominant frequency of 400 Hz or more, hissing sound

Wheeze Sibilant

rhonchus

Continous sounds longer than 250 ms, low-pitched;

dominant frequency about 200 Hz or less, snoring sound

Rhonchus Sonorous

rhonchus

Source: Adapted with permission from Loudon R, Murphy RLH. Lung sounds. Am Rev

Respir Dis. 1984;130(4):663-73.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) is a common, preventable,

and treatable disease that is characterized by persistent respiratory

symptoms and airflow limitation that is due to airway and/or alveolar

abnormalities usually caused by significant exposure to noxious particles or

gases.

Reference

GOLD,2018.

CHRONIC BRONCHITIS

Cough and excess sputum production for ≥3 months per year in each of 2

consecutive years.

Reference

GOLD,2018.

EMPHYSEMA

Pathological term describing destruction of gas exchanging surfaces of lung

(alveoli).

Reference

GOLD,2018.

CHRONIC COR PULMONALE

Right ventricular hypertrophy, dilatation or both as a result of pulmonary

hypertension [defined as pulmonary artery mean pressure (PAP) >20 mm

Hg] resulting from pulmonary disorders involving lung parenchyma, impaired

bellows function or altered ventilatory drive.

Reference

Budev MM, Arroliga AC, Wiedemann HP, et al. Cor pulmonale: an overview. Semin Respir

Crit Care Med. 2003;24(3):233-44.

ASTHMA

Asthma is a heterogeneous disease, usually characterized by chronic airway

inflammation. It is defined by the history of respiratory symptoms such as

wheeze, shortness of breath, chest tightness, and cough that vary over time

and in intensity, together with variable airflow limitation.

Reference

GINA 2019

BRONCHIECTASIS

Persistent or progressive suppurative lung disease characterized by

irreversibly dilated bronchi and chronic or recurrent bronchial inflammation

and infection.

Reference

Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis.

Thorax. 2010;65 Suppl 1:i1-58.

UNINTENTIONAL WEIGHT LOSS

Clinical entity whereby the patient does not purposefully set out to lose

weight for any reason and when weight loss as a consequence of advanced

chronic diseases or their treatments (e.g. diuretics for heart failure) is

excluded.

Definition criteria were numerical verification of >5% reduction in usual

body weight over the preceding 6–12 months, or, for subjects without

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numerical documentation, at least two of the following: evidence of change

in clothing size, corroboration of the reported weight loss by a relative or

friend, and ability to give a numerical estimate of the amount of weight loss.

Reference

Bosch X, Monclús E, Escoda O, et al. Unintentional weight loss: Clinical characteristics and

outcomes in a prospective cohort of 2677 patients. PLoS One. 2017;12(4):e0175125.

DYSPHAGIA

Dysphagia is sensation of impaired passage of food from the mouth to

stomach.

Reference

Lind CD. Dysphagia: evaluation and treatment. Gastroenterol Clin North Am.

2003;32(2):553-75.

DYSPEPSIA

Dyspepsia is often broadly defined as pain or discomfort centered in the

upper abdomen but may include varying symptoms like epigastric pain,

postprandial fullness, early satiation, anorexia, belching, nausea and

vomiting, upper abdominal bloating, and even heartburn and regurgitation.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

NAUSEA

Nausea is an unpleasant subjective sensation, most people have

experienced at some point in their lives and usually recognize as a feeling of

impending vomiting in the epigastrium or throat.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

RETCHING

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Retching consists of spasmodic and abortive respiratory movements with

the glottis closed. When part of the emetic sequence, retching is associated

with intense nausea and usually, but not invariably, culminates in the act of

vomiting.

Reference:

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s

Gastrointestinal and Liver Disease. Philadelphia: Saunders; 2015.

VOMITING

Vomiting is a partially voluntary act of forcefully expelling gastric or intestinal

content through the mouth.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

REGURGITATION

An effortless reflux of gastric contents into the esophagus that sometimes

reaches the mouth but is not usually associated with the forceful ejection

typical of vomiting.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

DIARRHEA

Change in normal bowel movement characterized by passage of unusually

soft or liquid stools ≥3 times in 24 hours (or >250 g unformed stool/day)

Acute diarrhea—duration <14 days

Persistent diarrhea—duration 14–29 days

Chronic diarrhea—duration ≥30 days.

Reference

DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med.

2014;370(16):1532-40.

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CONSTIPATION

Constipation defined as unsatisfactory defecation characterized by

infrequent stools (fewer than 3 in a week), hard stools, excessive straining

or a sense of incomplete evacuation.

Functional Constipation—ROME III Criteria

≥2 of the following:

Straining during ≥25% of defecations

Lumpy or hard stools during ≥25% of defecations

Feeling of incomplete evacuation during ≥25% of defecations

Feeling of anorectal obstruction or blockage during ≥25% of

defecations

Manually facilitating defecation during ≥25% of defecations

<3 unassisted bowel movements/week.

Loose stools rarely present without laxatives

Criteria for irritable bowel syndrome not sufficiently met (although

abdominal pain and/or bloating may be present, they are not predominant

symptoms)

Symptoms present for past 3 months with symptom onset ≥6 months

before diagnosis.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

FECAL INCONTINENCE

Fecal incontinence is defined as involuntary passage of fecal matter through

the anus or inability to control the discharge of bowel contents.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

HEMATEMESIS

Hematemesis is defined as vomiting of blood, which is indicative of bleeding

from the esophagus, stomach, or duodenum.

Hematemesis includes vomiting of bright red blood, which suggests

recent or ongoing bleeding, and dark material (coffee-ground emesis) which

suggests bleeding that stopped some time ago.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

MALENA

Melena is defined as black tarry stool and results from degradation of blood

to hematin or other hemochromes by intestinal bacteria. Melena can signify

bleeding that originates from a UGI, small bowel, or proximal colonic source

and generally occurs when 50–100 mL or more of blood is delivered into the

GI tract (usually the upper tract), with passage of characteristic stool

occurring several hours after the bleeding event.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

HEMATOCHEZIA

Hematochezia refers to bright red blood per rectum and suggests active UGI

or small bowel bleeding or distal colonic or anorectal bleeding.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

SEVERE GI BLEEDING

Severe GI bleeding is defined as documented GI bleeding (hematemesis,

melena, hematochezia, or positive nasogastric lavage) accompanied by

shock or orthostatic hypotension, a decrease in the hematocrit value by at

least 6% (or a decrease in the hemoglobin level of at least 2 g/dL), or

transfusion of at least 2 units of packed red blood cells.

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Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

OCCULT GI BLEEDING

Occult GI bleeding refers to subacute bleeding that is not clinically visible.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

OBSCURE GI BLEEDING

Obscure GI bleeding is bleeding from a site that is not apparent after routine

endoscopic evaluation with esophagogastroduodenoscopy (upper

endoscopy) and colonoscopy, and possibly small bowel radiography.

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

ACUTE LIVER FAILURE

Acute liver failure is the clinical syndrome of liver dysfunction, coagulopathy

and encephalopathy developing within 26 weeks of onset of symptoms in

patients without pre-existing liver failure.

Reference

Sherlock’s diseases of the liver and biliary system.

Note: One categorization based on clinical patterns and outcome described

three groups based on the time interval between the onset of jaundice and

encephalopathy:

Hyperacute liver failure (7 days or less)

Acute liver failure (ALF) (8–28 days), and

Subacute liver failure (4–24 weeks).

Reference

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver

Disease. Philadelphia: Saunders; 2015.

CIRRHOSIS OF LIVER

Cirrhosis is defined as a diffuse disruption of the normal architecture of the

liver with fibrosis and nodule formation.

Reference

Sherlock’s diseases of the liver and biliary system

PORTAL HYPERTENSION

Syndrome of increased pressure (>5 mm Hg) in portal venous system due to

increased vascular resistance plus increased blood flow.

Reference

Bloom S, Kemp W, Lubel J. Portal Hypertension—Pathophysiology, Diagnosis and

Management. Intern Med J. 2015;45(1):16-26.

HEPATIC ENCEPHALOPATHY

Hepatic encephalopathy is a potentially reversible neuropsychiatric

complication of liver failure with a wide variety of clinical manifestations from

minimal changes in cognitive function to severe complications of stupor and

coma.

Reference

Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014

Practice Guideline by the American Association for the Study of Liver Diseases and the

European Association for the Study of the Liver. Hepatology. 2014;60(2):715-35.

POLYURIA

The conventional definition of polyuria is a urine volume that is more than

2.5 L/day or

Polyuria is present if the urine flow rate is higher than what is expected in

a specific setting.

Reference

Brenner and Rector’s The Kidney.

NOCTURIA

The International Continence Society defines nocturia as a urinary storage

symptom with the complaint that the individual has to wake one or more

times at night to void, with each void being preceded and followed by sleep.

OLIGURIA

Decreased urine output <300 cc/m2

/24 hours

<0.5 cc/kg/hour in children

<1 cc/kg/hour in infants

Usually <500 cc/day in adults.

Reference

CDC.

ANURIA

No or minimal urine output

Usually <100 mL/day

Reference

CDC.

HEMATURIA

Hematuria is defined as three or more erythrocytes per high-power field.

Reference

Brenner and Rector’s The Kidney.

MODERATELY INCREASED ALBUMINURIA

Urine albumin levels between 30 mg/day and 300 mg/day. This was

previously referred to as microalbuminuria.

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