What do you look for in the history of someone who has a hepatic or biliary disorder?
Drug or alcohol dependence
Blood transfusions or hemodialysis
Signs and Symptoms for Hepatic/biliary disorders:
Skin and nail bed changes- due to inability to excrete bilirubin and increase estrogen levels
Musculoskeletal pain-associated with abnormal bone changes-related to changes in estrogen and bilirubin suppression (symp fibers run through celiac and visceral plexus)
Neurologic- result of increase levels of ammonia and urea→decrease glutamate in brain→altered neurotransmission
What are some examples of skind and nail bed changes?
Jaundice-1st noticeable in sclera,then skin
Spider angiomas-due to increased estrogen levels
Palmar Erythema- warm redness over palms
Bowel and bladder-Light stools,dark urine are results of improper bilirubin excretion
Depuytren's contracture- may indicate chronic alcoholism
Peripheral edema and ascities- may indicate decreased albumin and impaired liver function
What are some referall sites for musculoskeletal pain (pg 375)?
Right shoulder and trap
Right subscap area
Right upper abdominal quadrant
What is osteodystrophy and what conditions are associated with it?
abnormal bone development. May present as vertebral wedging, crush fxs, kyphosis, ribcage decalcification or pseudo fxs
ostemalacia, osteoporsis, osteoarthropathy
How much vitamin D does the body store?
What causes, and results from, Rhabdomyolysis?
Acute trauma,overexertion, or statins (lipitor,crestor, zocor)
Results: Dark urine that results from bilirubin and/or mygobin
What are some neurologic symptoms?
CNS and PNS symptoms, Confusion, Sleep disturbances, Asterisis, hyperreflexia
What is asterixis and what is it misdiagnosed as?
"Flapping tremors"- inability to maintain wrist extension with flexion of shoulders. It is misdiagnosed as carpal tunnel syndrome
What is hepatitis and what are the types?
Chronic or acute inflammation of the liver
Types: viral,chronic, nonviral
What risk factors do you look for with Hepatitis C?
Contact with contaminated feces, water or food; homsexual,drug user,tatoo, blood transfusion
Percentage of non-alcoholic fatty liver disease patients that progress to cirrhosis
What is Cirrhosis?
Destruction of liver cells that are replaced by fibrous bands of connective tissue
What is hepatic encephalopathy and what type of signs do you look for?
Inability of liver to process ammonia. look for UMN signs such as asterixisis and hyperreflexia
What is a liver abscess?
A rare condition where bacteria destroy hepatic tissue and produces a cavity that fills with infectious organisms, liquefied liver cells, and leukocytes. Has a high mortality rate
What cancers is the liver a primary metastatic site forr?
stomach, colorectum, and pancreas
What are some signs and symptoms for Liver neoplasms?
Jaundice, anorexia and weight loss, overall muscular weakness, epigastric fullness and pain or discomfort, early satiety, constant ache in epigastrum or mid-back
What is the 5th leading cause of hospitalizations and what are risk factors associated with it?
Gallstones (cholelithiasis). Risk factors:age,gender, increased estrogen, obesity, diabetes
What is murphy's sign?
The standard sign for cholecystitis. Positive= pain felt during inhalation or coughing when the physician palpates Right upper quadrant. Pain due to inflammation of gallbladder
What is primary biliary cirrhosis (PBC) and what does affect?
PBC is a progressive inflammatory disease which affects bile ducts. It affects bone formation and breakdown
How do you treat PBC?
Liver transplant, education and monitoring of calcium and Vitamin D intake
What increases due to bile duct blockage?
What decrease with liver damage?
Serum Cholesterol (severe), Blood ammonia (severe), Total protein, Serum albumin
Values of serum bilirubin with yellowing of eyes and full on Jaundice
yellow: 2-3 mg/dl
Jaundice: 5-6 mg/dl