Hepatic and Biliary Flashcards
What do you look for in the history of someone who has a hepatic or biliary disorder?
- Drug or alcohol dependence
- Hepatitis
- Pregnancy, postmenopause
- Diabetes
- Blood transfusions or hemodialysis
Signs and Symptoms for Hepatic/biliary disorders:
- Skin and nail bed changes- due to inability to excrete bilirubin and increase estrogen levels
- Musculoskeletal pain-associated with abnormal bone changes-related to changes in estrogen and bilirubin suppression (symp fibers run through celiac and visceral plexus)
- Neurologic- result of increase levels of ammonia and urea→decrease glutamate in brain→altered neurotransmission
What are some examples of skind and nail bed changes?
- Jaundice-1st noticeable in sclera,then skin
- Spider angiomas-due to increased estrogen levels
- Palmar Erythema- warm redness over palms
- Bowel and bladder-Light stools,dark urine are results of improper bilirubin excretion
- Depuytren’s contracture- may indicate chronic alcoholism
- Peripheral edema and ascities- may indicate decreased albumin and impaired liver function
What are some referall sites for musculoskeletal pain (pg 375)?
- mid thoracic
- Right shoulder and trap
- Right subscap area
- Right upper abdominal quadrant
What is osteodystrophy and what conditions are associated with it?
- abnormal bone development. May present as vertebral wedging, crush fxs, kyphosis, ribcage decalcification or pseudo fxs
- ostemalacia, osteoporsis, osteoarthropathy
How much vitamin D does the body store?
1-4 months
What causes, and results from, Rhabdomyolysis?
- Acute trauma,overexertion, or statins (lipitor,crestor, zocor)
- Results: Dark urine that results from bilirubin and/or mygobin
What are some neurologic symptoms?
CNS and PNS symptoms, Confusion, Sleep disturbances, Asterisis, hyperreflexia
What is asterixis and what is it misdiagnosed as?
“Flapping tremors”- inability to maintain wrist extension with flexion of shoulders. It is misdiagnosed as carpal tunnel syndrome
What is hepatitis and what are the types?
Chronic or acute inflammation of the liver
Types: viral,chronic, nonviral
What risk factors do you look for with Hepatitis C?
Contact with contaminated feces, water or food; homsexual,drug user,tatoo, blood transfusion
Percentage of non-alcoholic fatty liver disease patients that progress to cirrhosis
20%
What is Cirrhosis?
Destruction of liver cells that are replaced by fibrous bands of connective tissue
What is hepatic encephalopathy and what type of signs do you look for?
Inability of liver to process ammonia. look for UMN signs such as asterixisis and hyperreflexia
What is a liver abscess?
A rare condition where bacteria destroy hepatic tissue and produces a cavity that fills with infectious organisms, liquefied liver cells, and leukocytes. Has a high mortality rate
