Hepatic/Biliary Flashcards
what bilirubin level causes jaundice in the sclera?
2-3 mg/dL
what bilirubin level causes jaundiced skin?
5-6 mg/dL
you should be concerned if you see more than ___ spider angiomas on the chest
5
what is leukonychia?
white bands in nail beds
what is koilonychia?
spooning of nails (convex to concave)
where can you see referred pain for liver disease (abscess, cirrhosis, tumors, hepatitis)?
-Thoracic spine (T7-T10; midline to R)
-R UT and shoulder
where can you see referred pain for the gallbladder?
-R UT and shoulder
-R interscapular area (T4 or T5-8)
-R subscapular area
pts with liver problems are at greater risk of OA at what 2 joints?
wrist and ankle
mild to moderate cases of hepatitis require ____ with later progression
liver transplant
what are 3 reasons for urgent referral of someone with hepatitis?
-Joint or muscle pain that is disproportionate to the physical findings
-Presence of palmar tendinitis in someone with RA
-Positive risk factors for hepatitis
being a liver transplant recipient puts you at increased risk for which type of hepatitis?
B
HepA S/S (“FEL CAR JAD HAPI”)
-Fever (low-grade)
-Extreme fatigue
-Loss of desire to smoke cigarettes or drink alcohol
-Clay-colored stools
-Anorexia
-R upper abdominal pain
-Jaundice
-Arthralgia and myalgia (transient)
-Dark urine
-HA
-Alteration of taste and smell
-Pharyngitis
-Indigestion
HepB S/S (“F DAP JAR”)
-Fever
-Dark urine
-Anorexia, nausea
-Painful abdominal bloating
-Jaundice
-Arthralgia
-Rash (over entire body, itchy)
Chronic Persistent Hepatitis S&S (“RAMM”)
-RUQ pain
-Anorexia
-Mild fatigue
-Malaise
what is Wilson’s disease?
-Metabolic disease that causes chronic hepatitis
-Biliary excretion of copper is impaired
-Darkish brown on periphery of iris
-Commonly see proximal weakness (shoulders, hips, trunk)
what is hemochromatosis?
-Defect in iron aborption
-Causes liver failure
-Fibrosis of parenchymal organs
-Arthralgia/arthropathy may develop (often confused with RA and OA)
what joints are commonly involved in hemochromatosis?
-2nd and 3rd MCP joints commonly involved first
-Then knees/hips/shoulders/low back
what can happen at the knees with hemochromatosis?
pseudo-gout
what are the most common hepatotoxic agents?
-Acetaminophen (#1 most common)
-Aspirin
what 4 items should put toxic/drug-induced hepatitis on your radar? (“FARR”)
-Fever
-Arthralgias
-Rash
-RUQ or epigastric pain
If you feel nodules with liver palpation, what should be on your radar?
cirrhosis
what is a big thing we need to consider when working with a pt who has cirrhosis?
Rest periods during exercise according to level of fatigue experienced by pt during exercise (d/t diminished hepatic BF with moderate exercise)
what is portal HTN?
Dilated veins of lower esophagus
Result from portal vein HTN
Thin-walled
Can rupture, causing severe hemorrhage and sometimes death
what 3 items are in the cluster for cirrhosis?
-Ease of fatigue (with mild exertion)
-RUQ pain
-Fever
what is kernicterus?
type of brain damage from toxic levels of bilirubin in blood that occurs if jaundice is left untreated for too long
what can kernicterus cause? (“Vic And Harry Itch”)
-Vision and teeth abnormalities
-Athetoid CP
-Hearing loss
-Intellectual disabilities
what is the most common cause of liver abscess?
biliary tract disease
liver = primary metastatic site for which cancers? (“Pan and Ed Stall while Collin Looks for his Beats”)
Pancreas
Esophagus
Stomach
Colorectal
Lung
Breast
biliary colic = stone lodged where?
neck of the gallbladder (cystic duct)
what is the classic symptom of biliary colic?
R upper abdominal pain that comes and goes in waves
cholecystitis = stone blocking what?
cystic duct
cholangitis = stones lodged where?
further down in the common bile duct (after bile duct joins pancreas)
exposure to radon is a risk factor for what condition?
glallbladder cancer
