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Organ System Anatomy, Physiology and Pathology - BPT06 > Hepatic, Pancreatic and Biliary Pathology > Flashcards

Hepatic, Pancreatic and Biliary Pathology Flashcards

1
Q

Signs and Symptoms of Hepatic Disease - Dark Urine and Light Stool

A

• Inability of liver or biliary system to excrete bilirubin
• Association with jaundice
Main symptom

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2
Q

Signs and Symptoms of Hepatic Disease - Skin Change

A

Yellow eyes: bilirubin 2-3 mg/dL.
Yellow skin: bilirubin above 3 mg/dL.
Spider angiomas: increased estrogen levels due to liver impairment.
Palmar and plantar erythema.

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3
Q

Changes in Urine, Stool, Skin Color - Diseases

A
  • Hepatitis
  • Cirrhosis
  • Hepatotoxic medication
  • Gallbladder
  • Pancreatic cancer
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4
Q

Signs and Symptoms of Hepatic Disease - Neurological Symptoms

A

Neurotoxins impairs peripheral nerve function
• Confusion
• Sleep disturbance
• Muscle tremors
• Hyperreactive reflexes
• Asterixis (flapping tremor): Inability to maintain wrist extension with forward flexion of the upper extremities.

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5
Q

Signs and Symptoms of Hepatic Disease - Hepatic Osteodystrophy

A 
Metabolic bone disease (osteoporosis) (joint pain)
• Cholestasis (bile flow suppression)
• Hepatocellular disease
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Alcoholic liver disease
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6
Q

Signs and Symptoms of Hepatic Disease - MSK Location of Pain

A
  • Thoracic pain between scapulae
  • Right shoulder
  • Right upper trapezius
  • Right interscapular
  • Right subscapular areas
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7
Q

Hepatic Disease - Special Implications for Therapist

A

Promote rest and healing, intense exercise avoided.
Increased risk of coagulopathy: Risks with manual therapy, intense exercises.
Liver flap or asterixis (tremor) can be observed in uremia, respiratory failure, and severe heart failure.

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8
Q

Liver Disease Complications

A
  • Jaundice (iceterus)
  • Cirrhosis
  • Portal Hypertension
  • Hepatic Encephalopathy
  • Ascites (fluid in stomach)
  • Hepatorenal Syndrome
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9
Q

Liver Disease Complications - Jaundice (Iceterus)

A 
• Liver can’t process bilirubin efficiently
• Over production of bilirubin
• Decreased uptake of bilirubin
• Impaired bile flow
• >2mg/dL
Yellow
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10
Q

Liver Disease Complications - Cirrhosis + Symptoms

A

Main complication. Normal tissues are replaced by fibrosis and nodular regeneration. Portion not working, repeated damage, liver gets bigger.
• Fatigue (unexplained)
• Weight loss (unexplained)
• Pruritus
• Jaundice
• Coagulopathies (blood doesn’t coagulate)
• Loss of ability to metabolize drugs

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11
Q

Liver Disease Complications - Portal Hypertension - Implication for Therapist

A

Increase in portal pressure > 6mmHg

Implication for therapist: patient education on how to avoid excessive intraabdominal pressure.

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12
Q

Liver Disease Complications - Hepatic Encephalopathy

A

Relates to the amount of poison the brain will have from the liver.
Grade 1: slight personality changes, short attention span, mild confusion and slight tremor.
Increasing symptoms up to grade 4 which is comatose.

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13
Q

Liver Disease Complications - Ascites

A
  • Fluid in peritoneal cavity mainly due to portal hypertension
  • Most often caused by decompensated liver
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14
Q

Liver Disease Complications - Hepatorenal Syndrome

A

• Severe complication of advanced cirrhosis associated with
poor survival (because drugs stop working).
• Consequence of abnormal hemodynamics
• Kidney failure → Systemic organ failure → complete organ failure.

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15
Q

Hepatitis

A
  • Acute or chronic
  • Caused by a virus, chemical, alcohol, drug reaction
  • 6 different virus: A, B, C, D, E, Fulminant (rapid progression)
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16
Q

Mild to Moderate Acute Hepatitis

A

Inflammation of Liver.

Symptoms appear much faster.

17
Q

Chronic Hepatitis - Description and Physio Treatment

A

chronic necroinflammatory injury
• Can lead to cirrhosis and end-stage liver disease
Maintain muscle mass, ease pain, try to slow down decline of patient.

18
Q

Chronic Hepatitis - Symptoms Advanced and Not

A 
Advanced: 
• Nausea
• Poor appetite
• Weight loss
• Jaundice
• Dark urine
• Abdominal pain
• Easy bruising
• GI bleedings
• HE with mental confusion
Not advanced: asymptomatic, may have mild fatigue, malaise, loss of appetite, joint pain.
19
Q

Acute Liver Failure - Definition

A

Fulminant Hepatic Failure.
rapidly progressing form of liver injury/inflammation without prior liver disease. Develop over days to week.
50% of cases caused by Acetaminophen hepatotoxicity.

20
Q

Acute Liver Failure - Symptoms

A 
• Encephalopathy: ff Ammonia > 200 μM : intracranial pression and cerebral edema
• Liver failure
• Infection
• Hypoglycemia
• Coagulation defect.
Mortality rate <90% with no treatment.
21
Q

Liver Neoplasm Cancer - Groups

A
  • 3 groups
  • Benign
  • Primary malignant: Arising from liver itself, almost always in cirrhotic liver.
  • Secondary or Metastatic malignant
22
Q

Benign Liver Neoplasm - Cavernous Hemangioma - Description, Symptoms and Special Implication for Therapist

A

Blood-filled mass of variable size. abdominal mass is the most common finding.
Symptoms: asymptomatic until large, feeling of fullness, upper abdominal pain.
For therapist: Avoid increased intraabdominal pressure.
Appropriate breathing during exercises.

23
Q

Benign Liver Neoplasm - Adenomas - Risk Factors, Symptoms and Special Implication for Therapist

A

Oral contraceptive is a risk factor. Risk of hemorrhage.
Symptoms:
• Right upper quadrant abdominal pain.
If hemorrhage:
• Pain, Fever, Circulatory collapse.
Special implication for the therapist:
• Unlikely to see a patient pre-op: high risk of rupture and hemorrhage. Chest physio after surgery.

24
Q

Malignant Liver Neoplasm - Hepatocellular Carcinoma - Risk Factors and Symptoms

A 
Risk factors: alcohol and cirrhosis.
Symptoms: 
• Right abdominal pain
• Weight loss, Poor appetite/early satiety
• Weakness, Fatigue
• Diarrhea, Constipation
• Jaundice
25
Q

Summary of Referred Pain - Liver

A

Under right nipple.

Less: right shoulder, mid/low thoracic pain.

26
Q

Acute Pancreatitis - Etiology/Pathogenesis

A
  • Gallstones
  • Chronic alcohol consumption
  • Trauma
  • Infectious agents
  • Medication
27
Q

Acute Pancreatitis - Clinical Manifestation

A

Mild: no organ failure, nonspecific abdominal pain.
Moderately severe: organ failure for less than 48h. Local and/or systemic complication.
Severe: persistent organ failure.
Mild to moderate symptoms:
• severe right upper quadrant abdominal pain
• nausea
• anorexia
• vomiting
Related to gallstones: same as ↑ + radiating pain to the back and maximal intensity of pain within 10-20 min.

28
Q

Acute Pancreatitis - Special Implications for Therapist

A
  • Most likely to see acute pancreatitis when an undiagnosed patient present with back pain
  • Loss of spinal extension because of scar tissue
  • Might be related to GI condition
  • Preferred position : leaning forward, sitting up, lying on left side in fetal position
29
Q

Chronic Pancreatitis - Clinical Manifestation

A

Abdominal pain : epigastric region + referred pain to the back
• Nausea and vomiting
Decreased appetite
Weight loss
Worse after eating
• Relieved by bringing knees to chest or bending forward
Steatorrhea

30
Q

Chronic Pancreatitis - Special Implications for the Therapist

A

Back pain may be the presenting symptom. Pain increases without doing anything
Alcohol-related pancreatitis often have peripheral neuropathy.

31
Q

Pancreatic Cancer - Clinical Manifestation

A 
• Initially non specific and vague:
- Anorexia
- Nausea
- Fatigue
- Pruritus
• Jaundice
• Weight loss
• Significant pain
32
Q

Cholelithiasis (Gallstones) - Risk Factors

A 
Increasing age
Genetic Factors 
Decreased physical activity 
Pregnancy
Obesity
Diet
Diabetes mellitus
33
Q

Cholelithiasis (Gallstones) - Clinical Manifestation

A

• Severe abdominal pain (from 30min to 6hours)

  • Right upper quadrant (below sternum)
  • Referred pain to right shoulder and upper back
  • Nausea and vomiting
34
Q

Cholelithiasis (Gallstones) - Special Implication for Therapist

A
  • Physical activity as prevention
  • Deep breathing
  • Physical movement and activity as tolerated
  • Heating pad on the abdomen
  • Usual precaution for postoperative activities (breathing, turning, coughing,…)
35
Q

Gallbladder and Biliary Tract Neoplasm - Clinical Presentation

A 
If symptomatic, often incurable.
• Mimics gallstone disease
• Right upper quadrant pain radiating to the upper back
• Nausea and vomiting
• Progressive jaundice
• Weight loss
• Anorexia
• Fatty food intolerance 
Special implication for therapist same as gallbladder.
36
Q

Summary of Referred Pain - Gallbladder

A

Below nipple pain.

Less: upper shoulder, inferior angle of scapula and upper medial side of scapula pain.

Organ System Anatomy, Physiology and Pathology - BPT06 (34 decks)

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