Hepatic and Biliary Screening Flashcards
Hepatic and Biliary organs consist of:
liver, gallbladder, and common bile duct
the 3 major causes of acute hepatocellular injury
- hepatitis
- drug-induced hepatitis
- ingestion of hepatotoxins
medical diagnosis of liver and gallbladder done by:
- x-ray
- ultrasound
- CT scan
Skin and Nail bed changes
jaundice, pallor, and orange or green skin.
- jaundice often is the first seen
- spider angiomas
- palmar erythema
Musculoskeletal Symptoms
- generally includes thoracic pain between the scapulae, right shoulder, right upper trapezius, right interscapular, or right subscapular areas
- pseudofractures
- hepatic osteodystrophy
- rhabdomyolysis
Gastrointestinal Symptoms
- light colored stools and urine. sense of fullness of the abdomen.
- anorexia, nausea, and vomiting
Neurologic Symptoms
- confusion, sleep disturbance, muscle tremor, hyperreactive reflexes, asterixis (inability to maintain wrist extension w/ forward flexion of the UE)
- when liver doesn’t detoxify ammonia, it reacts w/ glutamate which damages CNS
- may also cause numbness/tingling
- bilateral carpal/tarsal tunnel
Gallbladder Disease
- GI - RU abdomen pain, indigestion, nausea, feel full
- skin - jaundice or pruritus
- MS - sudden, excruciating pain midepigastrium and anterior rib pain
- low grade fever, chills
______ is an acute or chronic inflammation of the liver caused by virus, chemical, drug reaction, or alcohol abuse
Hepatitis
- is viral; can be A, B, C, D, E, and G
- viral is easily spread
Hepatitis __ and ___ are transmitted primarily by the fecal-oral route
A and E
Hepatitis __, __, __, and __ are primarily blood borne pathogens can be transmitted from percutaneous or mucosal exposures to blood or other bodily fluids
B, C, D, and G
- B is often spread by infected blood or sexual contact
- C transmitted similar to B and D
3 stages of hepatitis
- preicteric stage
- icteric stage
- recovery period
Hepatitis Risk Factors
- drug injections
- acupuncture
- tattoo, piercing
- recent operation
- hemodialysis
- exposure to chemicals
- severe alcoholism
- travel to high risk areas
____ is acquired as kid and it looks like the flu. Also experience extreme fatigue, anorexia, fever, arthralgias, RU abdomen pain, clay stools, dark urine, jaundice, HA
Hepatitis A
_____ may be asymptomatic but symptoms include jaundice, rash, dark urine, anorexia, nausea, fever, painful bloating
Hepatitis B
______ is associated w/ prolonged inflammation of the liver after unresolved viral hepatitis generally 6 months or more
chronic hepatitis
-steroid therapy commonly chosen
______ ranges from asymptomatic to bedridden. Symptoms include fatigue, jaundice, abdominal pain, anorexia, arthralgia, fever, splenomegaly, weakness, ascites, hepatic encephalopathy
chronic active hepatitis
S/S of RUQ pain, anorexia, mild fatigue, and malaise suggests _______
chronic persistent hepatitis
______ has symptoms of anorexia, nausea, vomiting, fatigue, malaise, jaundice, dark urine, clay-colored stools, HA, fever, rash, arthralgias, epigastric and RUQ pain
Toxic and Drug-Induced Hepatitis
______ has symptoms of RUQ pain, GI symptoms, anorexia, indigestion, weight loss, nausea, vomiting, diarrhea/constipation, dull abdominal ache, weakness, fever
Cirrhosis
_____ refers to a chronic hepatic chronic disease characterized by destruction of liver cells and replacement of connective tissue causing scarring which alters blood and lymph flow
Cirrhosis
______ refers to symptoms of ascites, dilated collateral veins, esophageal varices, hemorrhoids, splenomegaly, thrombocytopenia
portal HTN
-refers to elevated pressure in the portal vein
_____ is an abnormal accumulation of fluid containing large amounts of protein and electrolytes in the peritoneal cavity as result of portal backup
Ascites
_______ is connected with restlessness, pallor, tachycardia, cooling of the skin, hypotension
Hemorrhage associated w/ Esophageal Varices
______ is a neurologic disorder resulting from the inability of the liver to detoxify ammonia in the intestine
Hepatic Encephalopathy (hepatic coma)
-need to protect from falling and seizure
______ is rare and has a variable presentation. Common symptoms include right shoulder/abdominal pain, weight loss, fever, chills, malaise, diaphoresis, nausea, vomiting, anemia, tender hepatomegaly , jaundice
Liver Abscess
______ is a serious and often fatal form of liver cancer and is the second most common form of hepatic malignancy
Cholangiocarcinoma (CCC)
-generally do not see liver interference until 80-90% of liver is replaced by metastic carcinoma
______ are stone like masses called calculi that form in the gallbladder, possibly as a result of bile
Gallstones
-cholelithiasis is the 5th leadin cause of hospitalization among adults and accounts for 90% of all gallbladder and duct diseases
_______ has been found to be the leading cause of sudden liver failure in adults in the US
Acetaminophen
-even a small overdose in some people can trigger sudden liver failure
______ occurs when gallstone gets lodged in the neck of gallbladder and pain results as its pushed through
biliary colic
Symptoms of jaundice (icterus), progressive health failure, anorexia, weight loss, muscular weakness, epigastric fullness, constant ache in epigastrium, early satiety
Liver Neoplasm
______ is the blockage or impaction of gallstone in the cystic duct leading to infection/inflammation of the gallbladder
cholecystitis
-they may feel steady, sever pain that increases rapidly lasting several minutes to several hours
Gallstones lodged further down in the system in the common bile duct can cause ______
Cholangitis
-will see spasm of the rectus abdominis muscle above umbilicus. there will be guarding and tendernesss
______ presents with chills, low-grade fever, GI symptoms, nausea, anorexia, vomiting, tenderness over gallbladder, tenderness of 10th rib, severe RUQ pain radiating into shoulder
acute cholecystitis
_____ may present with a vague sense of indigestion, abdominal discomfort, biliary colic in RUQ, pain in mid-back between scaps, nausea, abdominal fullness, heartburn, excessive belching, constipation/diarrhea
__Chronic Cholecystitis
_____ presents as pruritus, jaundice, GI bleed, ascites, fatigue, RUQ pain, fatigue, sensory neuropathy, osteoporosis, osteomalacia, muscle cramping
Primary Biliary Cirrhosis
_______ is a chronic, progressive, autoimmune disease of the liver that involves primarily the intrahepatic bile ducts and result sin impairment of bile secretion
Primary Biliary Cirrhosis
-two most common symptoms are fatigue and pruritus
Gallbladder cancer generally has _____ outcome
poor
-this is due to delay in diagnosis
Guideline for PT Referrals
- obvious sign of hepatic disease
- arthralgias
- bilateral carpal tunnel syndrome
- presence of sensory neuropathy
Clues to Hepatic Disease Screening
- right shoulder/scapular or/or upper mid-back pain
- shoulder not limited by pain
- presence of GI issues
- bilateral carpal tunnel
- previous history
- statin history
- recent operation
- injection use, tattoo, acupuncture, heterosexual relationships
- alcohol consumption lifestyle
- contact w/ jaundiced persons
