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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions β€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

Back to skin conditions

Back pain and bowel or bladder dysfunction

Introduction

Abbreviations: ABG = Arterial blood gases, ANA = Antinuclear antibodies, BUN = Blood urea nitrogen, CRP = C-reactive protein, CT = Computed tomography, DRA = Dual energy radiographic absorptiometry, DRE = Digital rectal exam, ERCP = Endoscopic retrograde cholangiopancreatography, ESR = Erythrocyte sedimentation rate, HSV = Herpes simplex virus, IVP = Intravenous pyelography, KUB = Kidney, bladder, ureter, LDH = Lactate dehydrogenase, LFT = Liver function test, MRA = Magnetic resonance angiography, MRC = Magnetic resonance cholangiopancreatography, MRI = Magnetic resonance imaging, MRU = Magnetic resonance urography, NSAIDs = Non-steroidal anti-inflammatory drugs, PCR = Polymerase chain reaction, PET – FDG = Positive emission tomography – fluorodeoxyglucose, PET = Positive emission tomography, PID = Pelvic inflammatory disease, PSA = Prostatic specific antigen, PTC = Percutaneous transhepatic cholangiography, RUQ = Right upper quadrant, SPECT = Single-photon emission computed tomography, TFT = Thyroid function test, VZV = Varicella zoster virus

Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Neurological Arachnoiditis[1] Acute Hours Dull aching pain Head, neck and back +/- + +/- +/- +/- +/- +/- +/- +/- – – +/- +/- CSF
  • Elevated protein with normal or low glucose

Culture and sensitivity

Nucleic acid tests

Radiography
  • Thickened nerve roots

CT

  • Narrowing of subarachnoid space
  • Irregular collections of contrast material
  • Thickened nerve roots

MRI

  • Study of choice shows indistinct cord outline
Cauda equina syndrome[2][3] Acute Hours Severe, sharp local pain Rarely to sacroiliac joint – – – – – – – + +/- – – +/- – CBC

Electrolytes, blood urea nitrogen, and creatinine

Erythrocyte sedimentation rate

  • To rule out inflammatory origin

Syphilis serology

  • To rule out meningovascular syphilis
 Radiography
  • May show vertebral erosions

MRI

  • Of choice and may show nerve root abnormalities

Duplex

  • For vascular abnormalities

Lumbar puncture

  • For inflammation
 Electrical studies:

EMG

  • Done to rule out acute denervation

SSEPs

Epidural abscess[4][5] Acute Variable Dull, throbbing pain Locally – +/- +/- +/- +/- +/- +/- +/- +/- – – +/- +/- CBC

ESR

  • Elevated

Culture and sensitivity

  • To identify causative organism

Immunohistochemical staining

MRI
  • Of choice and demonstrates fluid collection

CT

  • Demonstrates fluid collection

Radiography

  • LP carries risk of spread of infection
Radiculopathy[6][7] Acute Variable Severe, shooting pain Anterior thigh and knee +/- – – – – – – +/- +/- – – +/- –
  • Typically no specific lab findings

Radiography

  • To rule out serious underlying etiology

CT

MRI

Myelography

  • Used preoperatively to visualize spinal anatomy accurately

Discography

  • To localize a symptomatic disc
Sciatica[8][9][9] Acute Minutes to hours Severe, shooting pain Posterior thigh, buttocks and knee +/- – – – – – – +/- +/- – – +/- – To exclude other pathologies
  • CBC with differential
  • ESR
  • Alkaline and acid phosphatase level
  • Serum calcium level
  • Serum protein electrophoresis

Radiography

  • With technetium-99m labeled phosphorus to indicate bone mineralization status

CT

MRI

Myelography

  • Used preoperatively to visualize spinal anatomy accurately

Discography

  • To localize a symptomatic disc
  • May have a psychological component
Spinal cord compression[2][3]

– Thoracic spine

– Lumbar spine

Acute Minutes to hours Severe and localized Locally, may radiate below lesion – – – – – – – +/- +/- – –

+/-

– Neoplasm must be suspected and is ruled out by MRI
  • May demonstrate tumors and collapse of intervertebral spaces
  • May distinguish between bone lesions and malignancy

Radiography

Nuclear imaging

  • To identify neoplasms
  • Aggressive radiotherapy is often needed
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Bone
Degenerative disc disease[10][11] Subacute or chronic Years Dull aching Local +/- – – – – – – +/- +/- – – +/- +/- Serology

CBC

ESR

  • May be elevated

CRP

  • May be elevated

Uric acid

  • May be elevated
 MRI
  • Demonstrates delineation and position of vertebrae

CT

  • Demonstrates delineation and position of vertebrae
  • May also visualize nerve root compression and nerve swelling

Diskography

  • Transforaminal selective nerve root blocks are used diagnostically and therapeutically in cases presenting with radicular pain
Disc herniation[12][13] Acute Minutes to hours Sharp,shooting Legs and hips – – – – – – – +/- +/- – – +/- –
  • Typically no specific lab findings
 MRI
  • Demonstrates the size and location of the herniated disc and surrounding soft tissue

CT myelography

Radiography

  • Demonstrates osteophytes, disc-space narrowing, and kyphosis

Discography

  • Controversial, may show endplate irregularites or annular tears
  • Often presents with parathesias and no pain
Discitis[14][15] Chronic Years Dull aching or throbbing Local – + +/- – +/- – +/- +/- +/- – – +/- – CBC

ESR

  • May be elevated

CRP

  • May be elevated

Procalcitonin

  • May be elevated

Culture and sensitivity

  • To identify causative agent
 MRI
  • Narrowing of disk space and low signalling indicates edema

CT

  • Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus

Radiography

  • Disk space narrowing with destruction of endplates and calcification of annulus

Nuclear imaging

  • Focal uptake of gallium-67 and technetium-99m in area of destruction
  • Most likely due to hematogenous spread of organism
Sacroiliac joint dysfunction[16][17] Chronic Years Dull aching Hips and legs +/- – – – – – – +/- +/- – – +/- – CBC

ESR

  • May be elevated

CRP

  • May be elevated

Serology

Metabolic panel

  • May indicate hypothyroidism or cortisol abnormalities
 Imaging is controversial, however, CT may demonstrate;
  • Reactive spurs
  • Sclerosis
  • Subluxation

MRI

Nuclear imaging

  • Used to rule out stress fractures and metastatic bone disease
Sacroilitis[17][18] Acute or chronic Variable Dull aching or throbbing Hips and legs +/- + +/- – – – +/- +/- +/- – – +/- – CBC

ESR

  • May be elevated

CRP

  • May be elevated

Procalcitonin

  • May be elevated

Culture and sensitivity

  • To identify causative agent
 MRI
  • Narrowing of joint space and low signalling indicates edema

CT

  • Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface

Radiography

  • Joint space narrowing with destruction of joint space

Nuclear imaging

  • Focal uptake of gallium-67 and technetium-99m in area of destruction
  • Most likely due to hematogenous spread of organism
Scoliosis[19][20][21] Chronic Years Dull aching Shoulders, arms, hips and legs +/- – – – – – – +/- +/- – – +/- –
  • Typically no specific lab findings
 Radiography
  • Bending of the thoracic curve is noted

MRI

  • Used to assess additional complaints such as headaches, not routine for adolescents
Spinal stenosis[22][23] Chronic Years Dull aching Hips and legs +/- – – – – – – +/- +/- – – +/- +/-
  • Typically no specific lab findings
 MRI
  • Demonstrates narrowing of central canal, lateral recess, and neuronal foramina

CT

  • Demonstrates narrowing of central canal, lateral recess, and neuronal foramina
  • Premature imaging is strongly not recommended and may harm patient
  • Normal aging process
Spondylosis[24][25] Chronic[26] Years Dull aching Shoulders, arms, hips and legs +/- – – +/- – – – +/- +/- – – +/- +/-
  • Typically no specific lab findings
 Radiography
  • Demonstrates osteophytes and disc-space narrowing

MRI

  • Demonstrates the location of destruction and surrounding soft tissue

CT myelography

  • Demonstrates osteophytes and calcified opacities
  • Progresses with aging
Vertebral compression fracture[27][28][29] Acute Minutes to hours Sudden, severe, sharp Shoulders, arms, hips and legs +/- – – +/- +/- +/- – +/- +/- – – +/- – CBC

PSA

Urine analysis

  • To detect Bence – Jones protein

Serum protein electrophoresis

ESR

  • May be elevated
 Radiography
  • Decreased vertebral body height

CT

  • Detects more subtle fractures and calcifications

MRI

  • Useful in those with motor weakness and sensory deficits
  • May demonstrate hemorrhage, tumor, or infection

DRA scanning

  • Detects low bone density

PET scanning

  • To distinguish benign from malignant causes of compression
  • Presents as a midline back pain
Vertebral osteomyelitis[30][31][32] Acute Minutes to hours Sudden, severe, sharp Shoulders, arms, hips and legs +/- + +/- – +/- – – +/- +/- – – +/- – CBC

ESR

  • Elevated

CRP

  • Elevated

Procalcitonin

  • Elevated

Culture and sensitivity

  • To identify causative agent
 Radiography
  • Demonstrates endosteal or medullary lesion
  • Sequestration and cavity formation

MRI

CT

  • Articular and periarticular involvement

Ultrasound

  • Soft tissue abnormalities

Nuclear imaging

  • Loss of bone density
  • Often caused by hematogenous spread of organism
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Referred pain
Cystitis[33][34][35] Acute Hours Burning Suprapubic – +/- +/- – – – – – – – – +/- – Urine analysis

Urine culture

  • Detection of > 1000 colony-forming units/ml

CBC

  • Typically no routine imaging done
  • Cystitis may be infectious, hemorrhagic, radiational, or sterile
Pyelonephritis[36] Acute or chronic Variable Severe, sharp or dull aching Groin, hips and legs – + +/- – +/- – – – – – – +/- – CRP
  • Elevated

ESR

  • Elevated

Urinalysis

  • Pyuria
  • Bacteriuria
  • May be nitrite positive (gram negative organisms)
  • Culture positibe (Uncomplicated: E. coli, Proteus mirabialis, Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis
 Ultrasound

Non-contrast CT

  • Pelvicalceal dilation
  • Cortical involvement

MRI

  • T1: affected region(s) appear hypointense compared with the normal kidney parenchyma
  • T2: hyperintense compared to normal kidney parenchyma
  • T1 C+: reduced enhancement
  • Renal stones
  • Obstruction
  • Pregnancy
  • Prolonged urinary catheterization
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Tumors
Multiple myeloma[37][38] Chronic Years Dull aching Hips, groin and legs +/- +/- +/- – – – +/- – – – – +/- – Serum protein electrophoresis
  • May demonstrate a M peak

Serum free light chain assay and 24 – hour urine collection

  • May detect Bence-Jones proteins

CRP

  • May be elevated

Serum beta2-microglobulin

  • May be elevated

Albumin

  • May demonstrate elevated albumin in urine

LDH

  • May be elevated

Peripheral blood smear

Radiography, MRI and PET
  • Osteolytic lesions may be demonstrated
  • Biopsy will demonstrate elevated plasma cells in the bone marrow
Prostate cancer[39][40] Chronic Months to years Severe, sharp Lower abdomen, hips, groin and legs – +/- +/- – – – +/- – – – – +/- – PSA
  • Detection is helpful in diagnosis, usually > 10 ng/ml

Acid and alkaline phosphatase

  • Useful in detecting metastasis

Serurm creatinine and LFT

  • Useful in detecting metasstasis

Urine analysis

Ultrasound
  • Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity

MRI

  • May be used to guide biopsy
  • PSA and DRE are gold standard for screening
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Miscellaneous Trauma[41] Acute or chronic Variable Severe, sharp to dull aching Variable +/- – – – +/- +/- – +/- +/- – – +/- +/- After establishment of first aid protocol, the following lab tests may be useful;

Pregnancy test

  • In women of child-bearing age

Blood typing, screening and cross matching

Prothrombin time

Creatine kinase

Blood sugar

Cardiac enzymes

Toxicology screen and alcohol level

  • To determine alcoholism and drug use

Serum lactate

  • Elevated serum lactate may indicate a serious injury
 To assess trauma, the following imaging may be used;
  • Portable radiography
  • Ultrasound
  • CT
  • Peritoneal tap or lavage
  • Echocardiography
Ureteropelvic junction obstruction (UPJ)[42][43][44] Acute Hours to days Dull aching Groin, hips, legs – +/- +/- +/- +/- – – – – – – +/- – CBC

Coagulation profile

  • To rule out bleeding

Electrolyte levels

BUN and serum creatinine

  • To assess kidney function

Urine culture

Voiding cystourethrography

Renal ultrasonography

  • May determine kidney malformation and scarring
  • Dilation of collecting system
  • Annular stricturing

IVP

  • May demonstrate a hydronephrotic kidney
  • Used to map out entire urinary system

CT and MRU

  • Provides detail about the urinary system such as;
    • Renal vasculature
    • Renal pelvis anatomy
    • Location of crossing vessels
    • Renal cortical scarring
    • Ureteral fetal folds in the proximal ureter

Doppler

  • Used to detect cross vessels associated with obstruction

MRA

  • May demonstrate aberrant renal vessels
  • Congenital abrnormalities in both children and adults are usually the cause of UPJ obstruction

References

  1. ↑ Ozateş M, Kemaloglu S, GΓΌrkan F, Ozkan U, Hoşoglu S, Simşek MM (January 2000). “CT of the brain in tuberculous meningitis. A review of 289 patients”. Acta Radiol. 41 (1): 13–7. PMIDΒ 10665863.
  2. ↑ 2.0 2.1 Bach F, Larsen BH, Rohde K, BΓΈrgesen SE, Gjerris F, BΓΈge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, SΓΈrensen PS (1990). “Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression”. Acta Neurochir (Wien). 107 (1–2): 37–43. PMIDΒ 2096606.
  3. ↑ 3.0 3.1 Helweg-Larsen S, SΓΈrensen PS (1994). “Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients”. Eur. J. Cancer. 30A (3): 396–8. PMIDΒ 8204366.
  4. ↑ Nathoo N, Nadvi SS, van Dellen JR (April 1999). “Cranial extradural empyema in the era of computed tomography: a review of 82 cases”. Neurosurgery. 44 (4): 748–53, discussion 753–4. PMIDΒ 10201299.
  5. ↑ Heran NS, Steinbok P, Cochrane DD (October 2003). “Conservative neurosurgical management of intracranial epidural abscesses in children”. Neurosurgery. 53 (4): 893–7, discussion 897–8. PMIDΒ 14519222.
  6. ↑ Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS (August 1993). “A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis”. J Spinal Disord. 6 (4): 289–95. PMIDΒ 8219542.
  7. ↑ Tarulli AW, Raynor EM (May 2007). “Lumbosacral radiculopathy”. Neurol Clin. 25 (2): 387–405. doi:10.1016/j.ncl.2007.01.008.
  8. ↑ Hay MC (June 1976). “Anatomy of the lumbar spine”. Med. J. Aust. 1 (23): 874–6. PMIDΒ 967084.
  9. ↑ 9.0 9.1 Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA (February 1999). “Lack of effectiveness of bed rest for sciatica”. N. Engl. J. Med. 340 (6): 418–23. doi:10.1056/NEJM199902113400602. PMIDΒ 9971865.
  10. ↑ Deyo RA, Tsui-Wu YJ (April 1987). “Descriptive epidemiology of low-back pain and its related medical care in the United States”. Spine. 12 (3): 264–8. PMIDΒ 2954221.
  11. ↑ Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E (March 1998). “The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome”. Arch Phys Med Rehabil. 79 (3): 288–92. PMIDΒ 9523780.
  12. ↑ Hay MC (June 1976). “Anatomy of the lumbar spine”. Med. J. Aust. 1 (23): 874–6. PMIDΒ 967084.
  13. ↑ Levin KH (May 2002). “Electrodiagnostic approach to the patient with suspected radiculopathy”. Neurol Clin. 20 (2): 397–421, vi. PMIDΒ 12152441.
  14. ↑ Hamanishi C, Tanaka S (October 1993). “Dorsal root ganglia in the lumbosacral region observed from the axial views of MRI”. Spine. 18 (13): 1753–6. PMIDΒ 8235857.
  15. ↑ Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM, Huddleston PM, Nassr A, Mandrekar JM, Berbari EF (December 2014). “Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients”. Open Forum Infect Dis. 1 (3): ofu107. doi:10.1093/ofid/ofu107. PMCΒ 4324221. PMIDΒ 25734175.
  16. ↑ Betti L, von Cramon-Taubadel N, Manica A, Lycett SJ (2013). “Global geometric morphometric analyses of the human pelvis reveal substantial neutral population history effects, even across sexes”. PLoS ONE. 8 (2): e55909. doi:10.1371/journal.pone.0055909. PMCΒ 3567032. PMIDΒ 23409086.
  17. ↑ 17.0 17.1 Foley BS, Buschbacher RM (December 2006). “Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment”. Am J Phys Med Rehabil. 85 (12): 997–1006. doi:10.1097/01.phm.0000247633.68694.c1. PMIDΒ 17117004.
  18. ↑ Carette S, Graham D, Little H, Rubenstein J, Rosen P (February 1983). “The natural disease course of ankylosing spondylitis”. Arthritis Rheum. 26 (2): 186–90. PMIDΒ 6600615.
  19. ↑ Stirling AJ, Howel D, Millner PA, Sadiq S, Sharples D, Dickson RA (September 1996). “Late-onset idiopathic scoliosis in children six to fourteen years old. A cross-sectional prevalence study”. J Bone Joint Surg Am. 78 (9): 1330–6. PMIDΒ 8816647.
  20. ↑ McAlister WH, Shackelford GD (April 1975). “Classification of spinal curvatures”. Radiol. Clin. North Am. 13 (1): 93–112. PMIDΒ 1129452.
  21. ↑ Riseborough EJ, Wynne-Davies R (July 1973). “A genetic survey of idiopathic scoliosis in Boston, Massachusetts”. J Bone Joint Surg Am. 55 (5): 974–82. PMIDΒ 4760104.
  22. ↑ Katz JN, Harris MB (February 2008). “Clinical practice. Lumbar spinal stenosis”. N. Engl. J. Med. 358 (8): 818–25. doi:10.1056/NEJMcp0708097. PMIDΒ 18287604.
  23. ↑ Ciol MA, Deyo RA, Howell E, Kreif S (March 1996). “An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations”. J Am Geriatr Soc. 44 (3): 285–90. PMIDΒ 8600197.
  24. ↑ Yabuki S, Kikuchi S (July 1996). “Positions of dorsal root ganglia in the cervical spine. An anatomic and clinical study”. Spine. 21 (13): 1513–7. PMIDΒ 8817777.
  25. ↑ Lestini WF, Wiesel SW (February 1989). “The pathogenesis of cervical spondylosis”. Clin. Orthop. Relat. Res. (239): 69–93. PMIDΒ 2536306.
  26. ↑ Storm PB, Chou D, Tamargo RJ (August 2002). “Surgical management of cervical and lumbosacral radiculopathies: indications and outcomes”. Phys Med Rehabil Clin N Am. 13 (3): 735–59. PMIDΒ 12380556.
  27. ↑ Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N (1999). “Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis”. Osteoporos Int. 10 (4): 259–64. PMIDΒ 10692972.
  28. ↑ Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE (September 2000). “Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group”. Mayo Clin. Proc. 75 (9): 888–96. PMIDΒ 10994823.
  29. ↑ Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (August 2002). “Diagnosis and management of vertebral fractures in elderly adults”. Am. J. Med. 113 (3): 220–8. PMIDΒ 12208381.
  30. ↑ Beronius M, Bergman B, Andersson R (2001). “Vertebral osteomyelitis in GΓΆteborg, Sweden: a retrospective study of patients during 1990-95”. Scand. J. Infect. Dis. 33 (7): 527–32. PMIDΒ 11515764.
  31. ↑ Digby JM, Kersley JB (February 1979). “Pyogenic non-tuberculous spinal infection: an analysis of thirty cases”. J Bone Joint Surg Br. 61 (1): 47–55. PMIDΒ 370121.
  32. ↑ McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR (1991). “Vertebral osteomyelitis and aortic lesions: case report and review”. Rev. Infect. Dis. 13 (6): 1184–94. PMIDΒ 1775852.
  33. ↑ Foxman B (March 2014). “Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden”. Infect. Dis. Clin. North Am. 28 (1): 1–13. doi:10.1016/j.idc.2013.09.003. PMIDΒ 24484571.
  34. ↑ Hooton TM (March 2012). “Clinical practice. Uncomplicated urinary tract infection”. N. Engl. J. Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMIDΒ 22417256.
  35. ↑ Gupta K, Trautner B (March 2012). “In the clinic. Urinary tract infection”. Ann. Intern. Med. 156 (5): ITC3–1–ITC3–15, quiz ITC3–16. doi:10.7326/0003-4819-156-5-201203060-01003. PMIDΒ 22393148.
  36. ↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE (March 2011). “International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases”. Clin. Infect. Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMIDΒ 21292654.
  37. ↑ Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (January 2003). “Review of 1027 patients with newly diagnosed multiple myeloma”. Mayo Clin. Proc. 78 (1): 21–33. doi:10.4065/78.1.21. PMIDΒ 12528874.
  38. ↑ Turesson I, Velez R, Kristinsson SY, Landgren O (March 2010). “Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic”. Mayo Clin. Proc. 85 (3): 225–30. doi:10.4065/mcp.2009.0426. PMCΒ 2843108. PMIDΒ 20194150.
  39. ↑ Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, SolΓ  R, Salas A, Real FX (June 2005). “Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage”. Clin Transl Oncol. 7 (5): 189–97. PMIDΒ 15960930.
  40. ↑ Crawford ED, Schutz MJ, Clejan S, Drago J, Resnick MI, Chodak GW, Gomella LG, Austenfeld M, Stone NN, Miles BJ (1992). “The effect of digital rectal examination on prostate-specific antigen levels”. JAMA. 267 (16): 2227–8. PMIDΒ 1372943.
  41. ↑ Inaba K, DuBose JJ, Barmparas G, Barbarino R, Reddy S, Talving P, Lam L, Demetriades D (January 2011). “Clinical examination is insufficient to rule out thoracolumbar spine injuries”. J Trauma. 70 (1): 174–9. doi:10.1097/TA.0b013e3181d3cc6e. PMIDΒ 20489662.
  42. ↑ Klahr S (February 1983). “Pathophysiology of obstructive nephropathy”. Kidney Int. 23 (2): 414–26. PMIDΒ 6842965.
  43. ↑ McAleer IM, Kaplan GW, LoSasso BE (October 2002). “Congenital urinary tract anomalies in pediatric renal trauma patients”. J. Urol. volume=168 (4 Pt 2): 1808–10, discussion 1810. doi:10.1097/01.ju.0000028338.48621.57. PMIDΒ 12352365.
  44. ↑ Tekin A, Tekgul S, Atsu N, Ergen A, Kendi S (March 2001). “Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities”. Urology. 57 (3): 542–5, discussion 545–6. PMIDΒ 11248635.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]