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Differential Diagnosis > Hepatic/Biliary Disease Screening > Flashcards

Hepatic/Biliary Disease Screening Flashcards

1
Q

Hepatic and Biliary organs include liver, __, and common bile duct.

A

gallbladder

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2
Q

The liver maintains ____ homeostasis and has functions related to digestive, endocrine, excretory, & hematologic systems.

A

metabolic homeostasis

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3
Q

When food is introduced, the gallbladder contracts to expel ___ to duodenum (via the ___ )

A

1) bile
2) common bile duct

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4
Q

Skin changes include jaundice, pruritus, bruising, spider angiomas, palmar erythema and what other 2 changes?
Hint: they involve color

A

Pallor
Orange/green skin

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5
Q

T/F: Nailbed changes seen w/ hepatic or biliary disorder is leukonychia (white nails), clubbed nails, and koilonychia (central portion of nail depressed)

A

True

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6
Q

Primary pain patterns for these disorders include mid-epigastrium or ____ quadrant of the abdomen.

A

RUQ

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7
Q

Liver Referred pain patterns include __ spine, specifically __ segments midline to the right. Pain can also refer to R ___ and __.

A

1) thoracic
2) T7-T10
3) R upper traps
4) R shoulder

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8
Q

Gallbladder Referred pain patterns include R ___ and ___, R interscapular area, specifically __ segments, and the R subscapular area.

A

1) R upper traps
2) R shoulder
3) T4 or T5-T8

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9
Q

Hepatic osteodystrophy is the ___ development of __.

A

1) abnormal
2) bone

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10
Q

Hepatic/Biliary Disorder (incr/decr) OA risk for wrists/ankles. Combined w/ alcohol abuse and statin use, the risk for ____ is also greater.

A

1) increase OA risk
2) rhabdomyolysis

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11
Q

Neurologic S&S for Hepatic/Biliary Disorder include confusion, sleep disturbances, muscle tremors, ____ reflexes, and what other 2 S&S?

A

1) hyperreflexive
2) Asterixis & Peripheral N dysfunction (bilateral)

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12
Q

Reduced glutamate concentration in brain can cause S&S of encephalopathy like poor ___ and ___.

A

1) concentration
2) fatigue

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13
Q

GI S&S for Hepatic/Biliary Disorder include light-colored stool due to ___ not being excreted properly (Gallbladder disease, Hepatotoxic meds, pancreatic cancer). Urine is also a __color.

A

1) bilirubin
2) dark, tea or cola

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14
Q

GI S&S for Liver disease are sense of ___ of abdomen, anorexia, and __/__.

A

1) fullness
2&3) nausea/vomiting (N/V)

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15
Q

Liver disease integ. S&S include (what color?) nails of Terry and other changes in skin color and nail beds.

A

1) white

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16
Q

Murphy’s Sign Indication

A

cholecystitis (gallbladder)

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17
Q

Physical examination procedures for ascites

A

Shifting dullness
Fluid Wave

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18
Q

Physical examination procedures for Hepatomegaly

A

Liver Fist and Finger Percussion
also liver palpation

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19
Q

__ is inflammation of the liver.
Can be caused by (4). Can be secondary to disease conditions like infection.

A

1) Hepatitis
2) a virus, a chemical, drug rxn, or alcohol abuse

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20
Q

The types of viral hepatitis are Hep A-E and ____. >90% of cases in US are these types ___.

A

1) HGV
2) HAV, HBV, & HCV

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21
Q

T/F: Acute hepatitis usually requires hospitalization. Mild-mod cases won’t require a liver transplant with later progression.

A

False
acute hep. usually doesn’t require hosp.
Mild-mod cases will require liver transplant w/ later progression.

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22
Q

What diseases can accompany hepatitis? What is a red flag that can indicate this?

A

1) Rheumatic diseases (arthralgias, vasculitis, RA or fibromyalgia (HCV), etc)
2) joint/muscle pain that is disproportionate to physical findings, palmar tendinitis in RA pts, and (+) RFs for hepatitis.

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23
Q

Which type of Hepatitis is this?
-Route of transmission: fecal-oral route
-Incubation period: short
-Risk of chronic infection after acute: none
-Severity: most recover w/ no lasting liver damage
-Tx: No meds available, supportive tx
-Single vac: 2 doses 6-18 mo. apart
-HAV+HBV combo vac: 3 per 6 mo.

A

Hep A

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24
Q

Which type of Hepatitis is this?
-Route of transmission: percutaneous, via any bodily fluids/ noncontact skin exposure
-Incubation period: avg 90 days
-Risk of chronic infection after acute: 90% for infants, 25-50% of 1-5 y/o’s newly infected, 5% of newly infected adults
-Severity: most recover w/ no lasting liver damage, 15-25% develop chronic liver disease
-Tx: acute - no meds, supportive tx; chronic - antiviral drugs, monitor signs of liver disease
-Kids: 3-4 vacs over 6-18 mo.
-Adults: 2 vacs 1 mo. apart or 3 over 6 mo.

A

Hep B

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25
Q

Which type of Hepatitis is this?
-Route of transmission: direct percutaneous exposure to blood
-Incubation period: 14-84 days
-Risk of chronic infection after acute: >50% of newly infected people
-Severity: 5-25% develop cirrhosis
-Tx: acute - tx of acute HCV w/out waiting period; chronic - most pts can be cured w/ 8-12 wks of oral therapy
-NO vaccination

A

Hep C

26
Q

S&S of Hepatitis

A

Jaundice, fever, fatigue, LOSS OF APPETITE, N/V, abd pain, JOINT PAIN, dark urine, CLAY COLORED STOOL, diarrhea (HVA only)

27
Q

General Risk Factors for hepatitis include, injection use, acupuncture, tattoo, piercing, recent procedure, blood transfusion, and more. Name 3 more RFs for Hepatitis.

A

Severe alcoholism, travel to high risk areas, unprotected sex, healthcare workers, raw shellfish consumption

28
Q

S&S specific to HBV (2)

A

potentially asymptomatic
Rash (over entire body)
Painful abdominal bloating

29
Q

S&S specific to HAV (7)

A

1 commonly in childhood mild flu-like symptoms, may be misdx/ignored
2 Extreme fatigue
3 anorexia
4 pharyngitis
5 sense of taste and smell alterations
6 loss of desire to smoke or drinik
7 low-grade fever
8 indigestion

30
Q

Chronic Hepatitis is associated w/ ____ months of liver inflammation. Active can lead to __. Persistent Hepatitis S&S different from active S&S include ____.

A

1) >6 months
2) Active Chronic Hep can lead to cirrhosis
2) malaise, mild fatigue

31
Q

Chronic Active Hepatitis S&S include splenomegaly, hepatomegaly, hepatic encephalopathy, and ascites. With disease progression, severity of S&S (incr/decr/remain constant).

A

Increase

32
Q

2 most common metabolic diseases that cause chronic hepatitis are __ and __. ___ is an autosomal recessive disorder where the biliary excretion of __ is impaired causing pts to have neurological involvement. Kayser-Flesicher rings may be seen later on, these are ___.

A

1) Wilson’s Disease
2) Hemochromatosis
3) Wilson’s Disease
4) copper
5) dark ring around iris

33
Q

___ is an autosomal recessive defect of iron absorption that causes fibrosis. Arthropathy may develop in ____ joints first, then ___, ___, ___, and ___. Pseudo-___ in the knees may develop

A

1) Hematochromatosis
2) 2nd & 3rd MCP joints
3) knees, hips, shoulders, & low back
4) pseudo-gout

34
Q

1) S&S specific to Toxic/Drug-induced Hepatitis
Hint: think about meds crossing the BBB
2) most common drug that is a hepatotoxic agent

A

1) HA, dizziness, drowsiness
Fever, Rash, arthralgia
2) Acetaminophen (Tylenol)

35
Q

Cirrhosis is characterized by chronic ___ of liver cells f/b the replacement of connective tissue by ____ __ leading to scarring and impaired ____ and __ flow. Most common cause in USA is ___.

A

1) destruction
2) fibrous band
3) Blood and lymph
3) Alcohol abuse

36
Q

Hepatic insufficiency w/ cirrhosis can come in the form of ___ __, ___, or ___ __. Rest period during exercise should be according to level of pt’s ___ d/t decr. hepatic blood flow.

A

1) Portal hypertension: dilated veins of lower esophagus, thin walls can rupture causing hemorrhage or death
2) Ascites
3) Esophageal Varices
4) Level of Fatigue

37
Q

The most common chronic liver disease in the US that’s characterized as fatty infiltration of liver exceeding 5-10% & can lead to cirrhosis is ___. Associated diseases include ___, __, & high cholesterol/triglycerides.

A

1) Nonalcoholic fatty liver disease
2) obesity, DM2

38
Q

Cirrhosis S&S (unique ones)

A

-progressive mild RUQ pain
-GI s&s
-wt loss
-dull abdominal ache
-easily fatiguable
-weakness/fever
can develop palpable nodules on liver

39
Q

Clinical Manifestations of Cirrhosis:
-Resp: limited chest expansion and hypoxia manifest as dyspnea, ___, and __.
-CNS: irritability, mild memory loss, paranoia hallucination, peripheral neuritis & muscle atrophy, ___ and ___
-Hematologic: impaired ___ (watch for bleeds), anemia
-Endocrine: gynecomastia, loss of chest/axillary hair, menstrual ___, & testicular ___.
-Integ: severe itching or __, extreme ___, poor tissue __
-Hepatic: edema of __, hepatic ___
-GI: think of ways you would lose weight

A

Resp: cyanosis, clubbing
CNS: slurred speech, asterixis
Hematologic: impaired coagulation
Integ: pruritius, dryness, poor turgor
Hepatic: Bilat leg edema, hepatic encephalopathy

40
Q

S&S of hemorrhage w/ esophageal varices include restlessness, pallor, ____ (HR), cooling of skin, and ____

A

1) tachycardia
2) hypotension

41
Q

S&S of portal HTN include dilated veins (more prominent), ____ for upper GI, ___ for lower GI, splenomegaly, and thrombocytopenia

A

1) esophageal varices
2) hemorrhoids

42
Q

__ aka hepatic coma is a result of liver’s inability to detoxify ___ which is toxic to NS fxn. Common signs include __, other signs are ___. Huge indentifying sign is increased risk for ___ d/t difficulty / unsteadiness in __.

A

1) Hepatic Encephalopathy
2) ammonia
3) asterixis and extreme paresthesia/anesthesia
4) short attn span, difficulty concentrating, cogn. impaired
5) falls
6) ambulation

43
Q

~60% of newborns infants develop ___. This can cause ___, which is brain damage from toxic levels of bilirubin in the blood. If this is left untreated for too long, S&S like Athetoid cerebral palsy, ___ loss, Vision and teeth abnormalities,
___ disabilities can occur. Any __ change in newborns requires immediate referral (RED FLAG).

A

1) jaundice
2) kernicterus
3) hearing
4) intellectual
5) color

44
Q

___ is when bacteria, fungi, or ameda destroy liver tissue & cause formation of a cavity that fills w/ infectious organisms, liver cells, & WBCs. Then __ tissue isolates cavity from rest of the liver. W/ a sudden or insidous onset, the most common cause of this is ___. S&S include fever/chills/malaise, ___, R ___ & __ pain.

A

1) Liver abscess
2) necrotic
3) Biliary Tract Disease
4) diaphoresis
5) R shld and abdominal pain

45
Q

Early detection of ___ is difficult. Some S&S of this condition are __(name 4)__.

A

1) liver cancer
2) progress failure of health
-generalized weakness
-epigastric fullness/pain
-Constant Ache in epigastrum or midback
-Early satiety (filling full early) d/t cystic tumors

46
Q

T/F: Primary liver cancer is more common than metastasis.

A

False

47
Q

Most common primary liver cancer is ___. 2nd most common is __.

A

1) hepatocellular cancer (HCC)
2) intrahepatic cholangiocarcinoma

48
Q

___ disease is the most common cause of a ___ __. ___ disease is also a primary risk factor for intrahepatic cholangiocarcinoma.

A

1&3) Biliary disease
2) Liver abscess

49
Q

The presence/formation of gallstones is ___. They can be asymptomatic but leading cause of hosp. is d/t __ issues. If stones leave gallbladder, this cause biliary obstruction & can present as __, __, & __. Prognosis depends on tx, disease severity, present of infection, & response to __.

A

1) Cholelithiasis
2) GI
3) Biliary colic, Cholecystitis, or Cholangitis
4) antibioticd

50
Q

RFs for cholelithiasis include ___ w/ age, __ gender before 60 y/o, __estrogen levels, obesity, DM, liver disease, rapid wt loss, statins, ___ ethnicity, and genetics.

A

1) increases w/ age
2) women>men
3) incr.
4) Native or mexican americans

51
Q

__ is when a stone gets lodged in the neck of the gallbladder, aka ___ __, and pain is reproduced when gallbladder __ to pass stone through. A classic symptom of this is RUQ pain that comes and goes in waves.

A

1) Biliary Colic (NECK)
2) cystic duct
3) contracts
Complications: biliary stasis, delayed gallbladder emptying, mixed stone formation

52
Q

__ is a complete blockage/impaction of gallstones in cystic duct which leads to infection/inflammation of gallbladder. Gall bladder becomes __/__. Classic symptoms is steady, severe pain that rapidly increases in ___, lasting several mins-hours.

A

1) Cholecystitis
2) distended/ischemic
3) intensity

53
Q

persistent gallbladder inflammation is __ which causes gallbladder atrophy/fibrosis, adhering to adjacent organs. S&S of this include:
___ which causes severe, steady RUQ pain for 3-4 hrs, excessive __, __ & diarhea, nausea esp. w/ fatty foods, heartburn, abd fullness, & pain that may radiate to the ___ b/w the ___.

A

1) Chronic cholecystitis
2) biliary colic
3) belching
4) constipation
5&6) midback b/w the scapulae

54
Q

Acute Cholecystitis S&S different from chronic cholecystitis include chills/low grade fever, jaundice, GI s&s, __ TTP, TTP at the tip of the __ rib aka the “ _ _” (11th & 12th also can be affected), & pain radiating into R __ & b/w the __.

A

1) gallbladder (Murray’s Sign)
2) 10th
3) hot rib
4) shoulder
5) scapulae

55
Q

__, inflammation of the bile duct system, can be caused by stone obstruction in ___ __ __. Bile flow obstruction can cause __ and infection can spread to the liver.

A

1) cholangitis
2) common bile duct
3) jaundice

56
Q

___ is a chronic, progressive, AUTOIMMUNE disease of the liver involving the intra-hepatic bile ducts. It’s a metabolic bone disease so ___ protocol is indicated w/ physical activity. Pts may benefit from __ & ___ supplementation & monitoring.

A

1) Primary Biliary Cirrhosis (the primetime bile highway to/from the liver)
2) osteoporosis (think WBing for tx)
3&4) Ca and Vit C

57
Q

Unique S&S of Primary Biliary Cirrhosis (name 6)

A

Pruritus
Dry eyes and mouth
Jaundice
GI bleeding
Ascites
Fatigue
RUQ pain (posterior)
Osteoporosis
Osteomalacia (bone softening)
Burning, pins and needles, prickling of the eyes
Muscle cramping

58
Q

___ cancer is associated with gallstone disease & delay in dx results in __ outcomes. RFs for this cancer include untreated __, obesity, ___ abnormalities, chronic __ infection, & exposure to __ and certain industrial exposures (can build up in __)

A

1) Gallbladder
2) poor
3) cholelithiasis
4) reproductive
5) gallbladder
6) radon
7) basements

59
Q

Liver Disease Pain S&S Summary

A

Nausea, anorexia (viral hepatitis)
Early satiety (cystic tumors)
Aversion to smoking for smokers (viral hepatitis)
Aversion to alcohol (hepatitis)
Arthralgias and myalgias (hepatitis A, hepatitis B, or hepatitis C)
Headaches (hepatitis A, drug-induced hepatitis)
Dizziness/drowsiness (drug-induced hepatitis)
Low-grade fever (hepatitis A)
Pharyngitis (hepatitis A)
Extreme fatigue (hepatitis A, cirrhosis)
Alterations in the sense of taste and smell (hepatitis A)
Rash (hepatitis B)
Neurologic symptoms (hepatic encephalopathy)
Skin pallor (often linked with cirrhosis or carcinoma)
Jaundice (skin and sclerae changes)
-Diaphoresis (liver abscess)
-Overall muscular weakness (cirrhosis, liver carcinoma)

60
Q

Gallbladder Disease Pain S&S Summary

A

-Pain lasting 2-3 hrs aggr. by inhalation, eating, upper body motion, & supine
-Skin: green hue (prolonged biliary obstruction)
-Persistent pruritus (cholestatic jaundice)
-Pain and nausea occur 1–3 hours after eating (gallstones)
-Pain immediately after eating (gallbladder inflammation)
-Intolerance of fatty foods or heavy meals
-Indigestion, nausea
-Excessive belching
-Flatulence (excessive intestinal gas)
Weight loss (gallbladder cancer)
Bleeding from skin and mucous membranes (late sign of gallbladder cancer)
Vomiting
Feeling of fullness
Low-grade fever, chills

61
Q

Common Bile Duct Pain S&S Summary

A

-Pain: constant 3-4 hrs (choledocholithiasis), mild at first then incr. steadily
-Dark urine, light stools
-Jaundice
-Nausea after eating
-Intolerance of fatty foods or heavy meals
Feeling of abdominal fullness
-Skin: green hue (prolonged biliary obstruction); pruritus (skin itching)
-Low-grade fever, chills
-Excessive belching (choledocholithiasis)
-Constipation and diarrhea (choledocholithiasis)
-Sensory neuropathy (primary biliary cirrhosis)
-Osteomalacia (primary biliary cirrhosis)
-Osteoporosis (primary biliary cirrhosis)

Differential Diagnosis (3 decks)

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