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Differential Diagnosis Test 2 > Hepatic and Biliary > Flashcards

Flashcards in Hepatic and Biliary Deck (24):

What do you look for in the history of someone who has a hepatic or biliary disorder?

  1. Drug or alcohol dependence
  2. Hepatitis
  3. Pregnancy, postmenopause
  4. Diabetes
  5. Blood transfusions or hemodialysis


Signs and Symptoms for Hepatic/biliary disorders:

  1. Skin and nail bed changes- due to inability to excrete bilirubin and increase estrogen levels
  2. Musculoskeletal pain-associated with abnormal bone changes-related to changes in estrogen and bilirubin suppression (symp fibers run through celiac and visceral plexus)
  3. 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?

  1. Jaundice-1st noticeable in sclera,then skin
  2. Spider angiomas-due to increased estrogen levels
  3. Palmar Erythema- warm redness over palms
  4. Bowel and bladder-Light stools,dark urine are results of improper bilirubin excretion
  5. Depuytren's contracture- may indicate chronic alcoholism
  6. Peripheral edema and ascities- may indicate decreased albumin and impaired liver function


What are some referall sites for musculoskeletal pain (pg 375)?

  • mid thoracic
  • 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?

1-4 months


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?

Urine billirubin


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