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S7- Differential Diagnosis > Week 9- Hematologic and Hepatic/Biliary Disease > Flashcards

Week 9- Hematologic and Hepatic/Biliary Disease Flashcards

1
Q

PART 1: HEMATOLOGIC DISEASE

A

PART 1: HEMATOLOGIC DISEASE

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2
Q

Blood consists of what (4) things?

A
  • Plasma
  • Erythrocytes
  • Leukocytes
  • Platelets
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3
Q

Act as inflammatory/immune responses.

A

Leukocytes

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4
Q

Together with coagulation factors in plasma, control the clotting of the blood.

A

Platelets

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5
Q

Carries antibodies and nutrients to tissues and removes waste from tissues.

A

Plasma

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6
Q

Carry O2 to tissues and removes CO2 from them.

A

Erythrocytes

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7
Q

S/Sx of Hematologic Disorder with minimal exertion. (5)

A
  • Dyspnea
  • Chest pain
  • Palpitations
  • Severe weakness
  • Fatigue
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8
Q

Neurological S/Sx of Hematologic Disorder. (5)

A
  • HA
  • Drowsiness
  • Dizziness
  • Syncope
  • Polyneuropathy
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9
Q

Other S/Sx of Hematologic Disorder. (3)

A
  • Skin/fingernail changes
  • Blood in stool
  • Easy bruising
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10
Q

List some hematologic disorders. (8)

A
  • Anemia
  • Polycythemia
  • Sickle Cell Anemia
  • Leukocytosis
  • Leukopenia
  • Thrombocytosis
  • Thrombocytopenia
  • Hemophilia
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11
Q

Anemia:

  • What is it?
  • Results in abnormality in quality/quantity of __________.
  • What are the most common causes? (3)
  • What is an important PT consideration with someone who has Anemia?
A
  • Reduction of RBC/hemoglobin resulting in decreased O2 carrying capacity of blood.
  • erythrocytes
  • EXCESSIVE BLOOD LOSS, increased destruction of erythrocytes, decreased production of erythrocytes
  • Diminished exercise tolerance expected in patients with anemia and exercise should be approved by MD.
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12
Q

Polycythemia:

  • What is it?
  • What is an important PT consideration for someone with polycythemia?
A
  • Increase in number of RBCs and concentration of hemoglobin resulting in increased whole blood viscosity and increased blood volume.
  • Results in thickening of blood and increased risk for clotting leading to stroke.
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13
Q

Sickle Cell Anemia:

  • What is it?
  • Inherited autosomal _______ disorder that is more common in _________________.
  • Characterized by presence of abnormal form of _________.
  • Altered shape of cell to ______/_______ shape.
  • Series of crises or acute manifestations of symptoms characterized by the condition.
A
  • Hereditary form of anemia in which a mutated form of hemoglobin distorts the red blood cells into a crescent shape at low oxygen levels.
  • recessive disorder more common in AA
  • hemoglobin
  • sickled/curved
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14
Q

Sickle Cell Anemia S/Sx:

  • ______ caused by blockage of sickled RBCs.
  • May be in _______, ______, or _______ of the body.
  • Joint pain most often occurs in ________ or ______.
  • How long can painful episodes last?
  • May cause ______-______ syndrome. What is this?
  • Most common factors that may cause a crisis?
A
  • pain
  • organ, bone, or joint
  • shoulder or hip
  • hours or up to 5-6 days
  • Hand-Foot Syndrome (painful swelling in dorsum of hands and feet)
  • extreme temperatures, strenuous physical activity
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15
Q

Leukocytosis:

  • What is leukocytosis?
  • What is it a sign of?
  • What is a normal WBC count? What is considered leukocytosis?
A
  • High level of WBC in the blood.
  • Sign of inflammatory response.
  • 5000-10000, >10000 leukocytes/mm
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16
Q

Leukopenia:

  • What is leukopenia?
  • Can occur due to _____/_______, overwhelming infections, dietary deficiencies, and autoimmune diseases.
  • What is a normal WBC count? What is considered leukopenia?
  • What are 2 important PT considerations related to leukopenia?
A
  • Reduction in number of WBC in the blood.
  • chemo/radiation
  • 5000-10000, <5000 leukocytes/mm
  • WASH HANDS, pt with known leukopenia presenting with constitutional S/Sx requires immediate referral
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17
Q

Thrombocytosis:

  • What is thrombocytosis?
  • Is it usually permanent or temporary?
  • What is an important PT consideration with thrombocytosis?
A
  • Increase in platelet count.
  • usually temporary
  • Associated with tendency to clot, secondary to high platelet count and increased blood viscocity.
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18
Q

Thrombocytopenia:

  • What is thrombocytopenia?
  • Results from decreased platelet ________ or increased _________.
  • What are 2 important PT considerations related to thrombocytopenia?
  • What are the main causes? (3)
A
  • Decrease in platelet count
  • decreasing platelet production or increased platelet destruction
  • PT needs to be alert to severe bruising, external hematomas, joint swelling, and multiple petechiae. Strenuous exercise or exercise involving straining/bearing down could cause hemorrhage (AVOID VALSALVA).
  • Chemotherapy, radiation, and medications (NSAIDs, coumadin/warfarin)
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19
Q

Thrombocytopenia S/Sx. (5)

A
  • Bleeding after minor trauma
  • Spontaneous bleeding (petechiae, purpura spots, epistaxis)
  • Excessive menstruation
  • Gingival bleeding
  • Melena
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20
Q

Hemophilia:
-What is hemophilia?
-What causes it?
-Bleed ______ but not ______ than those without the condition.
What is the most common site of bleeding?
-What is the 2nd most common site of bleeding?

A
  • Hereditary blood clotting disorder.
  • Caused by abnormality of functional plasma-clotting proteins.
  • longer but not faster
  • Bleeding into the joint (knee, elbow, ankle, hip, shoulder)
  • Bleeding into muscles 2nd most common site (flexor muscle groups)
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21
Q

Hemophilia S/Sx. (11)

A

Hemarthrosis

  • Stiffening into position of comfort
  • Decreased ROM
  • Pain
  • Swelling
  • Tenderness
  • Heat

Muscle Hemorrhage (FLEXORS)

  • Gradually intensifying pain.
  • Protective spasm of the muscle.
  • Limitation of movement at the surrounding joints.
  • Muscle assumes the position of comfort.
  • Loss of sensation.
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22
Q

Hematologic Disease Screening:

  • Previous Hx of _________/_______ therapy.
  • Chronic or long-term use of _______ or other _______.
  • __________ bleeding.
  • Recent major ________/__________.
A
  • chemo/radiation therapy
  • aspirin or other NSAIDs
  • spontaneous bleeding
  • major surgery/transplantation
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23
Q

S/Sx of __________ = immediate medical attention.

-New episodes of _______/_____ pain in pts with hemophilia = MD referral.

A
  • thrombocytopenia

- muscle/joint pain

24
Q

What hematologic disorders are associated with increased clotting risk?

A

1

25
Q

What hematologic disorders are associated with patients receiving chemo/radiation?

A

1

26
Q

Complications of overuse of NSAIDs can result in what hematologic disorders?

A

1

27
Q

PART 2: HEPATIC/BILIARY DISEASE

A

PART 2: HEPATIC/BILIARY DISEASE

28
Q

What organ systems are included in hepatic and biliary disease? (3)

A
  • liver
  • gallbladder
  • common bile duct
29
Q

MSK symptoms associated with hepatic and biliary disease most often refer to what (3) areas?

A
  • Mid-back
  • Scapula
  • R shoulder
30
Q

Hepatic/Biliary S/Sx. (5)

A
  • Skin/nail bed changes
  • MSK pain
  • Neurological symptoms
  • GI symptoms
  • Ascites
31
Q

What are the most common signs of an impaired hepatic system? (2)

A
  • JAUNDICE

- SCLERA CHANGES

32
Q

What are some other skin/nail bed changes that can occur with hepatic/biliary disease? (5)

A
  • Pruritis (itching)
  • Bruising
  • Spider anginomas
  • Palmar erythema
  • Nails of Terry
33
Q

Spider Anginomas:

  • What are they?
  • Common in patients with ______ impairments. Why?
A
  • Permanently enlarged/dilated capillaries visible on surface of the skin caused by vascular dilation.
  • Liver impairment, increased estrogen levels that are normally detoxified by the liver.
34
Q

Palmar Erythema:

  • How does it present?
  • What causes it?
  • What may patients complain of?
A
  • Warm redness of the skin over the palms.
  • Caused by extensive collection of arteriovenous anastomoses.
  • May c/o throbbing or tingling in the palms.
35
Q

Nails of Terry:

-How does it present?

A

Opaque nail plate with a narrow line of pink at the distal end instead of the more normal pink nail plate in the caucasian.

36
Q

MSK Pain:

  • Where does MSK pain associated with hepatic/biliary systems refer to?
  • __________ is a potentially fatal condition caused by myoglobin and other muscle tissue contents released into the bloodstream as a result of muscle tissue degeneration.
A
  • thoracic pain between shoulder blades, R shoulder/upper trap/interscap/subscap
  • Rhabdomyolysis
37
Q

Rhabdomyolysis may occur with acute trauma, severe burns, overexertion, or liver impairment secondary to ______ _____/_________ or __________.

A

alcohol abuse/poison or statins

38
Q

Neurological Symptoms:

  • Peripheral nerve function can be impaired secondary to increased serum ammonia and urea levels because of liver dysfunction.
  • What are neurological S/Sx of hepatic/biliary disease?
  • Correlation exists between liver disease and bilateral _____________ syndrome.
A
  • confusion, sleep disturbances, muscle tremors, hyper-reactive reflexes, numbness/tingling, and asterixis
  • bilateral carpal tunnel syndrome
39
Q

What is asterixis?

A
  • OUTWARD SIGN of liver disease
  • Also called flapping tremors or LIVER FLAP
  • Inability to maintain wrist extension with forward flexion of UE.
40
Q

Things needed to screen for liver impairment in bilateral carpal tunnel syndrome. (5)

A
  • Ask about similar symptoms in the feet (bilateral tarsal tunnel).
  • Ask about personal Hx of liver/hepatic disease.
  • Look for Hx of alcoholism.
  • Ask about current/previous use of statins.
  • Look for other signs of liver impairment.
41
Q

GI Symptoms:

  • _____-colored stools. What are some potential causes?
  • Urine the color of tea/cola.
A

-Light-colored stools. Potentially due to gallbladder disease, hepatotoxic medications, or pancreatic cancer blocking bile duct.

42
Q

Ascites:

  • What is it?
  • Sign of _______ disease.
A
  • Accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
  • hepatic disease
43
Q
  • What are some hepatic pathologies?

- What are some biliary pathologies?

A

Hepatic

  • Hepatitis
  • Cirrhosis
  • Liver Cancer

Biliary
-Cholelithiasis

44
Q

Hepatitis:

  • What is hepatitis?
  • What causes it?
  • Hep ___ and ____ are most commonly spread via fecal-oral route.
  • Hep ___, ___, ___, and ___ are primarily blood borne pathogens.
  • Where does it most commonly refer pain to?
A
  • Acute or chronic inflammation of the liver.
  • Caused by virus, a chemical, drug reaction, alcohol abuse, or secondary to a disease condition.
  • Hep A and E
  • Hep B, C, D, and G
  • T-spine, R upper trap or R shoulder
45
Q

What are the most common risk factors for hepatitis? (5)

A
  • Injection drug use
  • Liver transplant recipient
  • Healthcare worker exposed to blood products or bodily fluid
  • Severe alcoholism
  • Travel to high risk areas
46
Q

Hepatitis S/Sx. (11)

A
  • Fatigue
  • Jaundice
  • Abdominal pain
  • Anorexia
  • Arthralgia
  • Fever
  • Splenomegaly/hepatomegaly
  • Weakness
  • Ascites
  • Hepatic encephalopathy
  • Referred pain to T-spine and R shoulder/upper trap
47
Q

Cirrhosis:

  • What is cirrhosis?
  • What is it characterized by?
  • What is the most common cause?
  • Where does it most commonly refer pain to?
A
  • Chronic liver damage from a variety of causes leading to scarring and liver failure.
  • Characterized by destruction of liver cells and replacement of tissue with fibrous bands.
  • alcohol abuse
  • T-spine, R upper trap or R shoulder
48
Q

Cirrhosis S/Sx. (12)

A
  • Referred pain to T-spine and R shoulder/upper trap***
  • Mild RUQ pain
  • GI symptoms
  • Anorexia
  • Indigestion
  • Weight loss
  • N/V
  • Diarrhea/constipation
  • Dull abdominal ache
  • Ease of fatigue (w/ mild exertion)
  • Weakness
  • Fever
49
Q

Liver Cancer:

  • More common that liver cancers are due to ________.
  • What (3) locations are common to metastasize to the liver?
  • What are some other primary cancers that metastasize?
  • Primary liver tumors often associated with ________.
  • Where does it most commonly refer pain to?
A
  • metastasis
  • stomach, colorectal, and pancreas
  • esophagus, lung, breast
  • cirrhosis
  • -T-spine, R upper trap or R shoulder
50
Q

Liver Cancer S/Sx. (8)

A
  • Jaundice
  • Progressive failure of health
  • Anorexia/weight loss
  • Overall muscular weakness
  • Epigastric fullness and pain/discomfort
  • Constant ache in the epigastrum or mid-back
  • early satiety
  • Referred pain to T-spine and R shoulder/upper trap
51
Q

What test can be performed to assess for liver abnormality?

A

Liver Fist Percussion

52
Q

Cholelithiasis:

  • What is cholelithiasis?
  • Problems arise if stone leaves gallbladder and causes obstruction somewhere else.
  • Incidence _______ with age.
A
  • Presence of formation of gallstones.

- increases

53
Q

What are the 5 F’s associated with gallstones?

A
  • Fat
  • Fair
  • Forty (or older)
  • Female
  • Flatulent
54
Q

Where does pain associated with cholelithiasis commonly refer to? (3)

A
  • Tenderness on tip of 10th rib or R
  • Pain radiating into the R shoulder and between the scapulae.
  • Pain at R shoulder/upper trap
55
Q

Cholelithiasis S/Sx. (11)

A
  • Chills, low grade fever
  • Jaundice
  • GI symptoms
  • N/V
  • Anorexia
  • Tenderness on tip of 10th rib or R
  • Pain radiating into the R shoulder and between the scapulae.
  • Pain at R shoulder/upper trap
  • Tenderness over gallbladder
  • Severe pain in RUQ and epigastrum
56
Q

What test can be performed to test for cholelithiasis?

A

Murphy’s Sign

57
Q

Hepatic Disease Screening:

  • R ________/________ and/or mid-back pain of unknown origin.
  • Presence of ____ symptoms.
  • Bilateral _____________.
  • Personal Hx of cancer, liver, or gallbladder disease.
  • Hx of hepatitis.
  • ______ use.
  • Changes in skin/eye color.
  • Hx of excessive alcohol consumption.
A
  • shoulder/scapular
  • GI symptoms
  • bilateral carpal tunnel syndrome
  • statin use

S7- Differential Diagnosis (15 decks)

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