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Term 3 > Differential Diagnosis Unit 8 Hepatic and Biliary System > Flashcards

Differential Diagnosis Unit 8 Hepatic and Biliary System Flashcards

1
Q

What is the First Manifestation of Liver Disease?

A

Jaundice
(Function deficit: Clearing bilirubin)

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2
Q

Hepatic and Biliary S/S

What are 3 conditions that affect both the nail are caused by a function deficit of Clearing the blood estrogen excess and Hypoestrogenism?

A
  • Palmar Erythema: This is caused by liver impairment, presents as a warm redness of the skin over the palms and soles of the feet in the caucasian population
  • Nails of Terry: Opaque white nails of terry in patients with Cirrhosis. Its characterized by an opaque nail plate with a narrow line of pink at the distal end instead of the more normal pink nail plate in the caucasian
  • Spider Angoima: Permanently enlarged and dilated capillaries visible on the surface of the skin caused by vascular dilation
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3
Q

Where would be the Referred Pain with Liver Disease (Abscess, Cirrhosis, Tumors, Hepatits)?

A
  • Thoracic Spine (T7-T10; Midline to the right)
  • Right Upper Trap and Shoulder
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4
Q

Where would be the Referred Pain with Gallbladder issues?

A
  • Right Upper trap and shoulders
  • Right Interscapular area (T4 or T5-T8)
  • Right Subscap area
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5
Q

What is hepatic osteodystrophy?

A

Abnormal development of bones due to cholestasis and hepatic disease

Cholestasis refers to the suppression of bile flow.

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6
Q

What condition is osteoporosis associated with?

A

Liver disease

Osteoporosis can result from chronic liver conditions.

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7
Q

What is Myopathy?

A

Myopathy = Rhabdomyolysis, is a potentially fatal condition characterized by the release of myoglobin and other muscle tissue contents into the bloodstream due to muscle disintegration

Rhabdomyolysis can lead to kidney damage if not treated.

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8
Q

What are the causes of myopathy?

A
  • Liver impairment from alcohol abuse
  • Alcohol poisoning
  • Use of statins
  • Acute trauma
  • Severe burns
  • Overexertion

Each cause can lead to muscle tissue damage and subsequent myopathy.

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9
Q

List symptoms of myopathy.

A
  • Muscle aches
  • Cramps
  • Soreness
  • Weakness

These symptoms can vary in severity depending on the underlying cause.

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10
Q

What condition is characterized by the liver’s inability to detoxify ammonia?

A

Hepatic Encephalopathy

Hepatic Encephalopathy occurs when ammonia is transported to the brain, affecting CNS metabolism.

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11
Q

What neurotransmitter does ammonia react with in the brain?

A

Glutamate

Ammonia reacts with glutamate, producing glutamine and reducing glutamate concentration.

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12
Q

Name a neurological symptom of hepatic encephalopathy.

A

Confusion

Confusion is one of the primary neurological symptoms associated with hepatic encephalopathy.

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13
Q

What is a common sleep-related symptom of hepatic encephalopathy?

A

Sleep disturbances

Sleep disturbances can occur due to altered CNS function.

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14
Q

What motor disturbance resembles body or extremity flapping?

A

Asterixis

Asterixis is a characteristic symptom of hepatic encephalopathy.

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15
Q

Fill in the blank: Hepatic encephalopathy may involve _______ reflexes.

A

Hyperactive

Hyperactive reflexes are indicative of CNS dysfunction in hepatic encephalopathy.

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16
Q

What is a possible physical manifestation of hepatic encephalopathy affecting the upper limbs?

A

Bilateral carpal tunnel syndrome

This syndrome can occur due to altered neurological function.

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17
Q

What is a possible physical manifestation of hepatic encephalopathy affecting the lower limbs?

A

Bilateral tarsal tunnel

Similar to carpal tunnel syndrome, tarsal tunnel can also be affected.

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18
Q

How does ammonia affect glutamate concentration in the brain?

A

It reduces glutamate concentration

This reduction alters CNS metabolism and function.

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19
Q

What should be asked about when a client presents with bilateral carpal tunnel syndrome?

A

Presence of similar symptoms in the feet.

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20
Q

Which personal history should be inquired about in clients with Bilateral Carpal Tunnel syndrome?

A

History of liver or hepatic disease.

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21
Q

Name some examples of liver diseases to ask about if the patient is presenting with Bilateral Carple Tunnel Syndrome.

A
  • Cirrhosis
  • Cancer
  • Hepatitis
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22
Q

What types of drug history should be assessed for clients with bilateral carpal tunnel syndrome?

A

History of hepatotoxic drugs.

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23
Q

What lifestyle factor should be assessed in clients with bilateral carpal tunnel syndrome?

A

History of alcoholism.

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24
Q

What current or previous medication use should be assessed with client with bilateral carple tunnel syndrome?

A

Use of statins.

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25
Q

For bilateral carple tunnel syndrome

List some examples of cholesterol-lowering drugs.

These are Statins

A
  • Crestor
  • Lipitor
  • Mevacor
  • Zocor
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26
Q

For Clients with Bilateral Carple Tunnel Syndrome

Name some signs of liver disease to test for.

A
  • Skin color changes
  • Spider angiomas
  • Palmar erythema (Liver Palms)
  • Change in nail beds (Clubbing, Nails of Terry)
  • Asterixis (Liver Flap)
27
Q

What are S/S of Gastrointestinal issues?

A
  • Sense of fullness of the abdomen
  • Anorexia, nausea, and vomiting
28
Q

What are S/S of Hepatic issues?

A
  • Dark urine and light-colored or clay-colored stools
  • Ascites
  • Edema and oliguria
  • RUQ pain
29
Q

What is Ascites?

A

Fluid accumulation in the abdominal cavity

Ascites is often associated with liver disease and can lead to discomfort and other complications.

30
Q

What does portal hypertension refer to?

A

Elevated pressure in the portal vein

This condition occurs when portal blood encounters increased resistance to flow in a fibrotic liver.

31
Q

What happens to blood flow in portal hypertension?

A

Blood backs up into esophageal, stomach, and splenic structures

This occurs as blood bypasses the liver through collateral vessels.

32
Q

What are 3 different types of Liver Disease?

A
  • Hepatitis
  • Cirrhosis
  • Hepatic Encephalopathy
33
Q

What is hepatitis?

What can cause this?

A

An acute or chronic inflammation of the liver

It can be caused by a virus, a chemical, a drug reaction, or alcohol abuse.

34
Q

How are hepatitis viruses A and E primarily transmitted?

A

By the fecal-oral route

This mode of transmission is common in areas with poor sanitation.

35
Q

What are the primary transmission routes for hepatitis viruses B, C, and D?

A

Primarily bloodborne pathogens

These viruses can be transmitted through contact with infected blood and other bodily fluids.

36
Q

With Hepatitis, which one does not have medication available. However for treatment, its best addressed through supportive treatment?

A

Hepatitis A

37
Q

With Hepatitis, which one does have medication available. However it is not curative?

A

Hepatitis B

38
Q

With Hepatitis, which one does have medication available and its curative?

A

Hepatitis C

39
Q

What is the Incubation Period for Hepatitis A, B and C?

Which has the highest mortality rate?

A

A- 15-50 days (Average: 28 days)
B- 60-150 days (Average: 90 days)
C- 14-182 days (Average 14-84 days)

Hepatitis C has the hightest mortality rate

40
Q

What is nonviral hepatitis?

A

A toxic or drug-induced form of liver inflammation

Nonviral hepatitis is not caused by viral infections but rather by other factors such as toxins or medications.

41
Q

What are some common causes of nonviral hepatitis?

A

Exposure to:
* Alcohol
* Certain chemicals or drugs
* Anti-inflammatories
* Anticonvulsants
* Antibiotics
* Cytotoxic drugs for cancer treatment
* Antitubercular drugs
* Radiographic contrast agents
* Antipsychotics
* Antidepressants

These substances can trigger liver inflammation, leading to nonviral hepatitis.

42
Q

What is cirrhosis?

A

A chronic hepatic disease characterized by the destruction of liver cells and replacement of connective tissue by fibrous bands (Scarring)

43
Q

What are the primary consequences of cirrhosis?

A

Impaired blood and lymph flow, hepatic insufficiency, and increased clinical manifestations.

44
Q

What is the most common cause of liver disease (Cirrhosis) in the United States?

A

Alcohol abuse.

45
Q

List three signs and symptoms of cirrhosis.

A
  • Mild right upper quadrant pain
  • Weight loss
  • Nausea and vomiting
46
Q

What gastrointestinal symptoms are associated with cirrhosis?

A
  • Diarrhea or constipation
  • Indigestion
  • Anorexia
47
Q

What are some general symptoms of cirrhosis?

A
  • Dull abdominal ache
  • Ease of fatigue with mild exertion
  • Weakness
  • Fever
48
Q

What is cholelithiasis?

A

The presence or formation of gallstones

Cholelithiasis can be asymptomatic and often detected incidentally during medical imaging.

49
Q

What can occur if a gallstone gets lodged in the cystic duct?

A

Cholecystitis (inflammation of the gallbladder)

This condition arises due to the obstruction caused by the gallstone.

50
Q

What happens when the hepatic or common bile duct is obstructed?

A

Blocks the exit of bile from the liver

This obstruction can be caused by a stone or spasm.

51
Q

What is often the first symptom of bile duct obstruction?

A

Jaundice

Jaundice occurs due to the buildup of bile pigments in the bloodstream.

52
Q

What are common signs of Acute Cholecystitis?

A
  • Chills
  • Low-grade fever
  • Jaundice
  • GI symptoms
  • Nausea
  • Anorexia
  • Vomiting
  • Tenderness over the gallbladder
  • Severe pain in the right upper quadrant (RUQ) and epigastrium
  • Pain radiating into the right shoulder and between the scapulae

Tenderness on the tip of the tenth rib (right side anteriorly) is called a ‘hot rib’ and can also affect the eleventh and twelfth ribs (right anterior).

53
Q

What is biliary colic?

A

Severe, steady pain for 3 to 4 hours in the right upper quadrant (RUQ)

Biliary colic is a common symptom of Chronic cholecystitis.

54
Q

Where may the pain from chronic cholecystitis radiate?

A

To the midback between the scapulae

This occurs due to splanchnic fibers synapsing with phrenic nerve fibers.

55
Q

What symptom indicates intolerance of fatty foods in chronic cholecystitis?

A

Nausea

Decreased bile production results in decreased fat digestion.

56
Q

List three gastrointestinal symptoms of chronic cholecystitis.

A
  • Abdominal fullness
  • Heartburn
  • Excessive belching
57
Q

True or False: Constipation and diarrhea can be symptoms of chronic cholecystitis.

A

True

Both constipation and diarrhea can occur in this condition.

58
Q

What are obvious signs that warrant physician referral regarding hepatic disease?

A

History of previous cancer or risk factors for hepatitis

These signs indicate potential liver complications.

59
Q

What condition in patients with a history of hepatitis may require referral?

A

Development of arthralgias of unknown cause

This suggests possible hepatic involvement.

60
Q

What symptoms indicate the need for referral related to carpal and tarsal tunnel syndrome?

A

Bilateral carpal tunnel syndrome with bilateral tarsal tunnel syndrome

Should be accompanied by asterixis or other hepatic signs.

61
Q

What is a concerning symptom that may indicate hepatic system impairment?

A

Presence of sensory neuropathy of unknown cause

This should be accompanied by signs and symptoms associated with hepatic impairment.

62
Q

What condition should prompt immediate physician referral in clients with a history of statin use?

A

New onset of myopathy

Myopathy refers to muscle weakness or damage, which can be a side effect of statins, particularly in older adults.

63
Q

What specific demographic is particularly noted for new onset of myopathy?

A

Older adult

Older adults may have a higher risk of experiencing side effects from medications like statins.

64
Q

What should be assessed alongside new onset of myopathy?

A

Other risk factors, signs, and symptoms of liver or renal impairment

Liver and renal impairments can exacerbate the effects of statin use and contribute to myopathy.

Term 3 (50 decks)

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