Screening For Hepatic and Biliary Disease

Question 1

What is most common sx reported to PT for liver issues?

Answer 1

right shoulder pain, that can’t be reproduced

also scapula or mid thoracic

Question 2

What are other common symptoms reported?

Answer 2

GI sx that increase shoulder pain like after eating fatty foods

Question 3

Why would a patient with Bilateral CTS have liver issues?

Answer 3

bc liver is big player in metabolism/clearing house it will lead to fluid overload if not working correctly

Question 4

Who should be screened for liver issues?

Answer 4

previous liver or gallbladder dz (hepatitis)

recent statin use, recent surgery, recent tattoo/injection, skin changes, ETOH consumption

Question 5

What are sx of liver disease?

Answer 5

belly fullness, N/V/A, skin and nail changes

Question 6

What are examples of skin and nail changes?

Answer 6

jaundice, bruising, spider anginoma, palmar erythema, Terry’s nails

Question 7

What are sx of liver dz you can ask about?

Answer 7

dark urine and light colored stool, ascites, RUQ pain, rhabdo

Question 8

What are neuro sx of liver dz?

Answer 8

confusion, sleep issues, muscle tremors, hyper reflexes, asterixis

Question 9

What is asterixis?

Answer 9

motor disturbance with the inability to maintain wrist extension while shoulders are flexed due to ammonia buildup

usually seen in progressive liver failure

Question 10

What type of disease is Hepatitis?

Answer 10

viral so antibiotics won’t work

Question 11

What versions of Hep are most minor?

Answer 11

A- food poisoning

E- recent travel

Question 12

What are the other types of Hep?

Answer 12

B- infected blood, sexual contact, IV drug users

C- blood transfusions, organ transplants

D- has to have B first, worse version of it

G- IV drug users, dialysis (sx are less)

Question 13

What two types of Hep will have long term liver issues?

Answer 13

B and C

Question 14

What are 3 stages of Hep?

Answer 14

1. preicteric
2. Icteric
3. Recovery

Question 15

What are characteristics of preteric stage?

Answer 15

1-3 weeks, flu like Sx, start of liver enlargement

Question 16

What are characteristics of icteric stage?

Answer 16

jaundice, usually is eyes 2-3 mg/dl of bilirubin
skin- 5-6 mg/dl of bilirubin

2-8 weeks, liver will shrink to normal size but still not functioning properly

Question 17

What are characteristics of recovery phase?

Answer 17

feels better but still easily fatigues, important to teach energy conservation

Question 18

What is chronic active hepatitis?

Answer 18

usually B, C or D with a drug sensitivity to aldomet( HTN drug) and this develops into cirrhosis

Question 19

What are sx of CAH?

Answer 19

RUQ pain, anorexia, fatigue and malase

treated with Interferon and could eventually have a transplant

Question 20

What is cirrhosis of the liver?

Answer 20

permanent destruction of liver cells and replaced with fibrotic tissue

Question 21

What is progression of cirrhosis?

Answer 21

portal HTN, ascites, esophageal varicies

could present like GI

Question 22

What percent of newborns have jaundice?

Answer 22

60%

Question 23

Is liver cancer usually metastatic or primary cancer?

Answer 23

20:1 and usually comes from stomach, colon, pancreas, lung and breast

if primary usually from cirrhosis

Question 24

Can you rely on LFT’s in early stages?

Answer 24

not really as they won’t show changes until 80-90% of liver is gone

Question 25

What are sx of liver cancer?

Answer 25

jaundice, N/V/A, global weakness, belly fullness,

Question 26

What are sx of gallbladder issues?

Answer 26

RUQ pain, fevers, chills, heartburn, N/V, excessive belching and flatulence, fatty food intolerance, Pruritis, shoulder pain

Question 27

What is cholelithiasis?

Answer 27

gall stones from cholesterol

Question 28

Who is at risk for gall stones?

Answer 28

increased age, women, elevated estrogen (Preg. OC), obesity, high cholesterol diet, diabetes, statin use

Question 29

What is cholecystitis?

Answer 29

red, hot infection of gallbladder

Question 30

What are sx of acute cholecystitis?

Answer 30

chills, fever, jaundice, GI sx, rebound tenderness at RUQ, right shoulder pain

Question 31

What are sx of chronic cholecystitis?

Answer 31

biliary colic, heartburn, excessive belching, constipation, diarrhea

Question 32

Who should be sent out immediately?

Answer 32

rebound tenderness of gallbladder, myopathy with statin use and dark urine

Question 33

Who is a should see doctor soon?

Answer 33

jt related pain with hx of hep
B CTS
sensory neuropathy