Screening for Hepatic and Biliary Disease Flashcards
what organ systems are included in the hepatic and biliary system?
- liver
- gallbladder
- common bile duct
MSK symptoms associated with hepatic and biliary disease more often refer to:
- Mid-back
- Scapular
- R Shoulder
S/S of hepatic and biliary disorder
- Skin and nail bed changes
- MSK pain
- neurological symptoms
- GI symptoms
- Ascites
Skin and nail bed changes associated with impairment to the hepatic system
- Jaundice, pallor and orange/green skin
- sclera changes
- skin changes
- pruritus
- bruising
- spider angiomas
- palmar erythema
- nails of terry
what are spider angiomas?
- permanently enlarged and dilated capillaries visible on the surface of the skin caused by vascular dilation
- common in pts w/liver impairment as a result of increased estrogen levels that are normally detoxified by the liver
what are palmar erythema?
warm redness of the skin over the palms
- due to extensive collection of arteriovenous anastomoses
a pt with a palmar erythema may c/o what?
throbbing or tingling in the palms
what are nails of Terry?
opaque nail plate with a narrow line of pink at the distal end instead of the more normal pink nail plate in the Caucasian
List MSK pain that is associated with hepatic and biliary systems
- Thoracic pain between shoulder blades
- R shoulder
- R upper trapezius
- R interscapular
- R subscapular
Rhabdomyolysis may occur with what?
- acute trauma
- severe burns
- overextension
- liver impairment secondary to alcohol abuse
- alcohol poisoning
- statins
what causes neurological symptoms in hepatic and biliary diseases?
secondary to increased serum ammonia and urea levels because of liver dysfunction
list neurological symptoms that can occur in hepatic and biliary diseases
- confusion
- sleep disturbances
- muscle tremors
- hyper-reactive reflexes
- numbness/tingling
- asterixis
T/F: there is no correlation between liver disease and bilateral carpal tunnel syndrome
FALSE
what is Asterixis?
inability to maintain wrist extension with forward flexion of UE
- outward sign of liver disease
- also called flapping tremors or liver flap
when screening for liver impairment in pts with bilateral carpal tunnel what should you ask about?
- ask about similar symptoms in the feet (bilateral tarsal tunnel)
- ask about personal history of liver/hepatic disease
- look for history of alcoholism
- ask about current or previous use of statins
- look for other signs of liver impairment
describe GI symptoms related to hepatic and biliary disease
- light colored stool (almost white)
- potential causes
- gallbladder diseases
- hepatotoxic medications
- pancreatic cancer blocking bile duct
- potential causes
- urine the color of tea or cola
what is ascites?
accumulation of fluid in the peritoneal cavity, causing abdominal swelling
sign of hepatic disease
what is included in the review of systems for the hepatic and biliary systems?
- change in taste/smell
- anorexia
- feeling of abdominal fullness, ascites
- asterixis (muscle tremors)
- change in urine color (dark, cola-colored)
- light-colored stools
- change in skin color (yellow, green)
- Skin changes
- rash, itching, purpura, spider angiomas, palmar erythema
List hepatic and biliary pathologies
- Hepatitis
- Cirrhosis
- Liver Cancer
- Cholelithiasis
what is hepatitis? what causes it?
acute or chronic inflammation of the liver
- caused by:
- virus
- chemical
- drug reaction
- alcohol abuse
- secondary to a disease condition
what is viral hepatitis?
acute infectious inflammation of the liver caused by one of the following viruses: A, B, C, D, E and G
which forms of hepatitis are most commonly spread via fecal-oral route?
Hep A and E
which forms of hepatitis are primarily blood borne pathogens?
Hep B, C, D, and G
List major risk factors for hepatitis
- injection drug use
- liver transplant recipient
- healthcare worker exposed to blood products or body fluids
- severe alcoholism
- travel to high risk areas
list additional risk factors for hepatitis
- acupuncture
- tattoo inscription or removal
- ear or body piercing
- recent operative procedure
- blood or plasma transfusion before 1991
- hemodialysis
- exposure to certain chemicals or medications
- unprotected homosexual/bisexual activity
- consumption of raw shellfish
S/S of chronic active hepatitis
- may refer pain to T-spine, R upper trap or R shoulder
- fatigue
- jaundice
- abdominal pain
- anorexia
- arthralgia
- fever
- splenomegaly and hepatomegaly
- weakness
- ascites
- hepatic encephalopathy
what is cirrhosis?
- characterized by destruction of liver cells and replacement of tissue with fibrous bands
- with increased scaring comes impaired blood and lymph flow causing hepatic insufficiency
- chronic hepatic disease
what is the cause of cirrhosis?
causes vary but most common cause is alcohol abuse
Clinical S/S of cirrhosis
- May refer to T-spine, R upper trap, or R shoulder
- Mild R upper quadrant pain
- GI symptoms
- anorexia
- indigestion
- weight loss
- N/V/D or constipation
- dull abdominal ache
- ease of fatigue (with mild exertion)
- weakness
- fever
most liver tumors are due to _______
metastasis
what are the most common places to metastasis to the liver
stomach, colorectal and pancreas
(liver filters blood coming from GI)
other primary cancers that metastasize to the liver
- esophagus
- lung
- breast
primary liver tumors often associated with _______
cirrhosis
Clinical S/S of liver neoplasm
- May refer to pain to T-spine, R upper trap or R shoulder
- Jaundice
- progressive failure of health
- anorexia/weight loss
- overall muscular weakness
- epigastric fullness and pain or discomfort
- constant ache in the epigastrum or mid-back
- early satiety
what is cholelithiasis?
the presence of formation of gallstones
what are gallstones?
stone like masses aka calculi
- possibly result of changes in normal components of bile
- problems arise if stone leaves gallbladder and causes obstruction somewhere else
- incidence increases with age
Risk factors for gallstones
- age
- greater incidence in women than men
- elevated estrogen levels
- obesity
- diet → high cholesterol, low fiber
- DM
- liver disease
- rapid weight loss of fasting
- taking statins
- Native American/Mexican American
- family hx of gallstones
what are the 5 Fs associated with gallstones?
- Fat
- Fair
- Forty (or older)
- Female (secondary to elevated estrogen)
- Flatulent
Clinical S/S of Acute Cholelithiasis
- Tenderness on tip of 10th rib on R
- Pain radiating into the R shoulder and between the scapulae
- May refer pain to R upper trap or R shoulder
- chills, low grade fever
- Jaundice
- GI symptoms
- N/V
- anorexia
- tenderness over gallbladder
- severe pain in R upper quadrant and epigastrum
List clues to screen for hepatic disease
- R shoulder/scapular and/or mid-back pain of unknown origin
- presence of GI symptoms
- bilateral carpal/tarsal tunnel syndrome (esp of unknown origin)
- personal history of cancer, liver or gallbladder disease
- history of hepatitis (esp with joint pain)
- statin use
- changes in skin or eye color
- jaundice, spider angiomas, palmar erythema
- history of excessive alcohol consumption
guides for immediate referral?
symptoms suggestive of rhabdomyolysis
guidelines for MD referral
- obvious signs of hepatic disease
- development of arthralgias of unknown cause
- esp in pt with risk factors for hepatitis of hx of hepatitis
- presence of bilateral carpal tunnel syndrome accompanied by bilateral tarsal tunnel syndrome unknown to the MD
- presence of sensory neuropathy of unknown cause accompanied by signs and symptoms associated with hepatic system impairment
