Week 9- Hematologic and Hepatic/Biliary Disease Flashcards
PART 1: HEMATOLOGIC DISEASE
PART 1: HEMATOLOGIC DISEASE
Blood consists of what (4) things?
- Plasma
- Erythrocytes
- Leukocytes
- Platelets
Act as inflammatory/immune responses.
Leukocytes
Together with coagulation factors in plasma, control the clotting of the blood.
Platelets
Carries antibodies and nutrients to tissues and removes waste from tissues.
Plasma
Carry O2 to tissues and removes CO2 from them.
Erythrocytes
S/Sx of Hematologic Disorder with minimal exertion. (5)
- Dyspnea
- Chest pain
- Palpitations
- Severe weakness
- Fatigue
Neurological S/Sx of Hematologic Disorder. (5)
- HA
- Drowsiness
- Dizziness
- Syncope
- Polyneuropathy
Other S/Sx of Hematologic Disorder. (3)
- Skin/fingernail changes
- Blood in stool
- Easy bruising
List some hematologic disorders. (8)
- Anemia
- Polycythemia
- Sickle Cell Anemia
- Leukocytosis
- Leukopenia
- Thrombocytosis
- Thrombocytopenia
- Hemophilia
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?
- 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.
Polycythemia:
- What is it?
- What is an important PT consideration for someone with polycythemia?
- 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.
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.
- 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
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?
- 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
Leukocytosis:
- What is leukocytosis?
- What is it a sign of?
- What is a normal WBC count? What is considered leukocytosis?
- High level of WBC in the blood.
- Sign of inflammatory response.
- 5000-10000, >10000 leukocytes/mm
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?
- 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
Thrombocytosis:
- What is thrombocytosis?
- Is it usually permanent or temporary?
- What is an important PT consideration with thrombocytosis?
- Increase in platelet count.
- usually temporary
- Associated with tendency to clot, secondary to high platelet count and increased blood viscocity.
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)
- 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)
Thrombocytopenia S/Sx. (5)
- Bleeding after minor trauma
- Spontaneous bleeding (petechiae, purpura spots, epistaxis)
- Excessive menstruation
- Gingival bleeding
- Melena
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?
- 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)
Hemophilia S/Sx. (11)
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.
Hematologic Disease Screening:
- Previous Hx of _________/_______ therapy.
- Chronic or long-term use of _______ or other _______.
- __________ bleeding.
- Recent major ________/__________.
- chemo/radiation therapy
- aspirin or other NSAIDs
- spontaneous bleeding
- major surgery/transplantation
S/Sx of __________ = immediate medical attention.
-New episodes of _______/_____ pain in pts with hemophilia = MD referral.
- thrombocytopenia
- muscle/joint pain
What hematologic disorders are associated with increased clotting risk?
1
What hematologic disorders are associated with patients receiving chemo/radiation?
1
Complications of overuse of NSAIDs can result in what hematologic disorders?
1
PART 2: HEPATIC/BILIARY DISEASE
PART 2: HEPATIC/BILIARY DISEASE
What organ systems are included in hepatic and biliary disease? (3)
- liver
- gallbladder
- common bile duct
MSK symptoms associated with hepatic and biliary disease most often refer to what (3) areas?
- Mid-back
- Scapula
- R shoulder
Hepatic/Biliary S/Sx. (5)
- Skin/nail bed changes
- MSK pain
- Neurological symptoms
- GI symptoms
- Ascites
What are the most common signs of an impaired hepatic system? (2)
- JAUNDICE
- SCLERA CHANGES
What are some other skin/nail bed changes that can occur with hepatic/biliary disease? (5)
- Pruritis (itching)
- Bruising
- Spider anginomas
- Palmar erythema
- Nails of Terry
Spider Anginomas:
- What are they?
- Common in patients with ______ impairments. Why?
- 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.
Palmar Erythema:
- How does it present?
- What causes it?
- What may patients complain of?
- Warm redness of the skin over the palms.
- Caused by extensive collection of arteriovenous anastomoses.
- May c/o throbbing or tingling in the palms.
Nails of Terry:
-How does it present?
Opaque nail plate with a narrow line of pink at the distal end instead of the more normal pink nail plate in the caucasian.
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.
- thoracic pain between shoulder blades, R shoulder/upper trap/interscap/subscap
- Rhabdomyolysis
Rhabdomyolysis may occur with acute trauma, severe burns, overexertion, or liver impairment secondary to ______ _____/_________ or __________.
alcohol abuse/poison or statins
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.
- confusion, sleep disturbances, muscle tremors, hyper-reactive reflexes, numbness/tingling, and asterixis
- bilateral carpal tunnel syndrome
What is asterixis?
- OUTWARD SIGN of liver disease
- Also called flapping tremors or LIVER FLAP
- Inability to maintain wrist extension with forward flexion of UE.
Things needed to screen for liver impairment in bilateral carpal tunnel syndrome. (5)
- 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.
GI Symptoms:
- _____-colored stools. What are some potential causes?
- Urine the color of tea/cola.
-Light-colored stools. Potentially due to gallbladder disease, hepatotoxic medications, or pancreatic cancer blocking bile duct.
Ascites:
- What is it?
- Sign of _______ disease.
- Accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
- hepatic disease
- What are some hepatic pathologies?
- What are some biliary pathologies?
Hepatic
- Hepatitis
- Cirrhosis
- Liver Cancer
Biliary
-Cholelithiasis
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?
- 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
What are the most common risk factors for hepatitis? (5)
- Injection drug use
- Liver transplant recipient
- Healthcare worker exposed to blood products or bodily fluid
- Severe alcoholism
- Travel to high risk areas
Hepatitis S/Sx. (11)
- Fatigue
- Jaundice
- Abdominal pain
- Anorexia
- Arthralgia
- Fever
- Splenomegaly/hepatomegaly
- Weakness
- Ascites
- Hepatic encephalopathy
- Referred pain to T-spine and R shoulder/upper trap
Cirrhosis:
- What is cirrhosis?
- What is it characterized by?
- What is the most common cause?
- Where does it most commonly refer pain to?
- 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
Cirrhosis S/Sx. (12)
- 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
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?
- metastasis
- stomach, colorectal, and pancreas
- esophagus, lung, breast
- cirrhosis
- -T-spine, R upper trap or R shoulder
Liver Cancer S/Sx. (8)
- 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
What test can be performed to assess for liver abnormality?
Liver Fist Percussion
Cholelithiasis:
- What is cholelithiasis?
- Problems arise if stone leaves gallbladder and causes obstruction somewhere else.
- Incidence _______ with age.
- Presence of formation of gallstones.
- increases
What are the 5 F’s associated with gallstones?
- Fat
- Fair
- Forty (or older)
- Female
- Flatulent
Where does pain associated with cholelithiasis commonly refer to? (3)
- Tenderness on tip of 10th rib or R
- Pain radiating into the R shoulder and between the scapulae.
- Pain at R shoulder/upper trap
Cholelithiasis S/Sx. (11)
- 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
What test can be performed to test for cholelithiasis?
Murphy’s Sign
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.
- shoulder/scapular
- GI symptoms
- bilateral carpal tunnel syndrome
- statin use
