Week 9- Hematologic and Hepatic/Biliary Disease Flashcards
1
Q
PART 1: HEMATOLOGIC DISEASE
A
PART 1: HEMATOLOGIC DISEASE
2
Q
Blood consists of what (4) things?
A
- Plasma
- Erythrocytes
- Leukocytes
- Platelets
3
Q
Act as inflammatory/immune responses.
A
Leukocytes
4
Q
Together with coagulation factors in plasma, control the clotting of the blood.
A
Platelets
5
Q
Carries antibodies and nutrients to tissues and removes waste from tissues.
A
Plasma
6
Q
Carry O2 to tissues and removes CO2 from them.
A
Erythrocytes
7
Q
S/Sx of Hematologic Disorder with minimal exertion. (5)
A
- Dyspnea
- Chest pain
- Palpitations
- Severe weakness
- Fatigue
8
Q
Neurological S/Sx of Hematologic Disorder. (5)
A
- HA
- Drowsiness
- Dizziness
- Syncope
- Polyneuropathy
9
Q
Other S/Sx of Hematologic Disorder. (3)
A
- Skin/fingernail changes
- Blood in stool
- Easy bruising
10
Q
List some hematologic disorders. (8)
A
- Anemia
- Polycythemia
- Sickle Cell Anemia
- Leukocytosis
- Leukopenia
- Thrombocytosis
- Thrombocytopenia
- Hemophilia
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.
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.
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
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
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
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
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.
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)
19
Q
Thrombocytopenia S/Sx. (5)
A
- Bleeding after minor trauma
- Spontaneous bleeding (petechiae, purpura spots, epistaxis)
- Excessive menstruation
- Gingival bleeding
- Melena
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)
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.
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
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
What hematologic disorders are associated with patients receiving chemo/radiation?
1
26
Complications of overuse of NSAIDs can result in what hematologic disorders?
1
27
PART 2: HEPATIC/BILIARY DISEASE
PART 2: HEPATIC/BILIARY DISEASE
28
What organ systems are included in hepatic and biliary disease? (3)
- liver
- gallbladder
- common bile duct
29
MSK symptoms associated with hepatic and biliary disease most often refer to what (3) areas?
- Mid-back
- Scapula
- R shoulder
30
Hepatic/Biliary S/Sx. (5)
- Skin/nail bed changes
- MSK pain
- Neurological symptoms
- GI symptoms
- Ascites
31
What are the most common signs of an impaired hepatic system? (2)
- JAUNDICE
| - SCLERA CHANGES
32
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
33
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.
34
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.
35
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.
36
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
37
Rhabdomyolysis may occur with acute trauma, severe burns, overexertion, or liver impairment secondary to ______ _____/_________ or __________.
alcohol abuse/poison or statins
38
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
39
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.
40
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.
41
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.
42
Ascites:
- What is it?
- Sign of _______ disease.
- Accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
- hepatic disease
43
- What are some hepatic pathologies?
| - What are some biliary pathologies?
Hepatic
- Hepatitis
- Cirrhosis
- Liver Cancer
Biliary
-Cholelithiasis
44
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
45
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
46
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
47
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
48
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
49
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
50
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
51
What test can be performed to assess for liver abnormality?
Liver Fist Percussion
52
Cholelithiasis:
- What is cholelithiasis?
- Problems arise if stone leaves gallbladder and causes obstruction somewhere else.
- Incidence _______ with age.
- Presence of formation of gallstones.
| - increases
53
What are the 5 F's associated with gallstones?
- Fat
- Fair
- Forty (or older)
- Female
- Flatulent
54
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
55
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
56
What test can be performed to test for cholelithiasis?
Murphy's Sign
57
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
