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Differential Dx > Hepatic and Biliary Screening > Flashcards

Hepatic and Biliary Screening Flashcards

1
Q

Hepatic and Biliary organs consist of:

A

liver, gallbladder, and common bile duct

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2
Q

the 3 major causes of acute hepatocellular injury

A
  • hepatitis
  • drug-induced hepatitis
  • ingestion of hepatotoxins
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3
Q

medical diagnosis of liver and gallbladder done by:

A
  • x-ray
  • ultrasound
  • CT scan
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4
Q

Skin and Nail bed changes

A

jaundice, pallor, and orange or green skin.

  • jaundice often is the first seen
  • spider angiomas
  • palmar erythema
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5
Q

Musculoskeletal Symptoms

A
  • generally includes thoracic pain between the scapulae, right shoulder, right upper trapezius, right interscapular, or right subscapular areas
  • pseudofractures
  • hepatic osteodystrophy
  • rhabdomyolysis
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6
Q

Gastrointestinal Symptoms

A
  • light colored stools and urine. sense of fullness of the abdomen.
  • anorexia, nausea, and vomiting
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7
Q

Neurologic Symptoms

A
  • confusion, sleep disturbance, muscle tremor, hyperreactive reflexes, asterixis (inability to maintain wrist extension w/ forward flexion of the UE)
  • when liver doesn’t detoxify ammonia, it reacts w/ glutamate which damages CNS
  • may also cause numbness/tingling
  • bilateral carpal/tarsal tunnel
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8
Q

Gallbladder Disease

A
  • GI - RU abdomen pain, indigestion, nausea, feel full
  • skin - jaundice or pruritus
  • MS - sudden, excruciating pain midepigastrium and anterior rib pain
  • low grade fever, chills
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9
Q

______ is an acute or chronic inflammation of the liver caused by virus, chemical, drug reaction, or alcohol abuse

A

Hepatitis

  • is viral; can be A, B, C, D, E, and G
  • viral is easily spread
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10
Q

Hepatitis __ and ___ are transmitted primarily by the fecal-oral route

A

A and E

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11
Q

Hepatitis __, __, __, and __ are primarily blood borne pathogens can be transmitted from percutaneous or mucosal exposures to blood or other bodily fluids

A

B, C, D, and G

  • B is often spread by infected blood or sexual contact
  • C transmitted similar to B and D
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12
Q

3 stages of hepatitis

A
  1. preicteric stage
  2. icteric stage
  3. recovery period
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13
Q

Hepatitis Risk Factors

A
  • drug injections
  • acupuncture
  • tattoo, piercing
  • recent operation
  • hemodialysis
  • exposure to chemicals
  • severe alcoholism
  • travel to high risk areas
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14
Q

____ is acquired as kid and it looks like the flu. Also experience extreme fatigue, anorexia, fever, arthralgias, RU abdomen pain, clay stools, dark urine, jaundice, HA

A

Hepatitis A

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15
Q

_____ may be asymptomatic but symptoms include jaundice, rash, dark urine, anorexia, nausea, fever, painful bloating

A

Hepatitis B

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16
Q

______ is associated w/ prolonged inflammation of the liver after unresolved viral hepatitis generally 6 months or more

A

chronic hepatitis

-steroid therapy commonly chosen

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17
Q

______ ranges from asymptomatic to bedridden. Symptoms include fatigue, jaundice, abdominal pain, anorexia, arthralgia, fever, splenomegaly, weakness, ascites, hepatic encephalopathy

A

chronic active hepatitis

18
Q

S/S of RUQ pain, anorexia, mild fatigue, and malaise suggests _______

A

chronic persistent hepatitis

19
Q

______ has symptoms of anorexia, nausea, vomiting, fatigue, malaise, jaundice, dark urine, clay-colored stools, HA, fever, rash, arthralgias, epigastric and RUQ pain

A

Toxic and Drug-Induced Hepatitis

20
Q

______ has symptoms of RUQ pain, GI symptoms, anorexia, indigestion, weight loss, nausea, vomiting, diarrhea/constipation, dull abdominal ache, weakness, fever

A

Cirrhosis

21
Q

_____ refers to a chronic hepatic chronic disease characterized by destruction of liver cells and replacement of connective tissue causing scarring which alters blood and lymph flow

A

Cirrhosis

22
Q

______ refers to symptoms of ascites, dilated collateral veins, esophageal varices, hemorrhoids, splenomegaly, thrombocytopenia

A

portal HTN

-refers to elevated pressure in the portal vein

23
Q

_____ is an abnormal accumulation of fluid containing large amounts of protein and electrolytes in the peritoneal cavity as result of portal backup

A

Ascites

24
Q

_______ is connected with restlessness, pallor, tachycardia, cooling of the skin, hypotension

A

Hemorrhage associated w/ Esophageal Varices

25
Q

______ is a neurologic disorder resulting from the inability of the liver to detoxify ammonia in the intestine

A

Hepatic Encephalopathy (hepatic coma)

-need to protect from falling and seizure

26
Q

______ is rare and has a variable presentation. Common symptoms include right shoulder/abdominal pain, weight loss, fever, chills, malaise, diaphoresis, nausea, vomiting, anemia, tender hepatomegaly , jaundice

A

Liver Abscess

27
Q

______ is a serious and often fatal form of liver cancer and is the second most common form of hepatic malignancy

A

Cholangiocarcinoma (CCC)

-generally do not see liver interference until 80-90% of liver is replaced by metastic carcinoma

28
Q

______ are stone like masses called calculi that form in the gallbladder, possibly as a result of bile

A

Gallstones

-cholelithiasis is the 5th leadin cause of hospitalization among adults and accounts for 90% of all gallbladder and duct diseases

29
Q

_______ has been found to be the leading cause of sudden liver failure in adults in the US

A

Acetaminophen

-even a small overdose in some people can trigger sudden liver failure

30
Q

______ occurs when gallstone gets lodged in the neck of gallbladder and pain results as its pushed through

A

biliary colic

31
Q

Symptoms of jaundice (icterus), progressive health failure, anorexia, weight loss, muscular weakness, epigastric fullness, constant ache in epigastrium, early satiety

A

Liver Neoplasm

32
Q

______ is the blockage or impaction of gallstone in the cystic duct leading to infection/inflammation of the gallbladder

A

cholecystitis

-they may feel steady, sever pain that increases rapidly lasting several minutes to several hours

33
Q

Gallstones lodged further down in the system in the common bile duct can cause ______

A

Cholangitis

-will see spasm of the rectus abdominis muscle above umbilicus. there will be guarding and tendernesss

34
Q

______ presents with chills, low-grade fever, GI symptoms, nausea, anorexia, vomiting, tenderness over gallbladder, tenderness of 10th rib, severe RUQ pain radiating into shoulder

A

acute cholecystitis

35
Q

_____ may present with a vague sense of indigestion, abdominal discomfort, biliary colic in RUQ, pain in mid-back between scaps, nausea, abdominal fullness, heartburn, excessive belching, constipation/diarrhea

A

__Chronic Cholecystitis

36
Q

_____ presents as pruritus, jaundice, GI bleed, ascites, fatigue, RUQ pain, fatigue, sensory neuropathy, osteoporosis, osteomalacia, muscle cramping

A

Primary Biliary Cirrhosis

37
Q

_______ is a chronic, progressive, autoimmune disease of the liver that involves primarily the intrahepatic bile ducts and result sin impairment of bile secretion

A

Primary Biliary Cirrhosis

-two most common symptoms are fatigue and pruritus

38
Q

Gallbladder cancer generally has _____ outcome

A

poor

-this is due to delay in diagnosis

39
Q

Guideline for PT Referrals

A
  • obvious sign of hepatic disease
  • arthralgias
  • bilateral carpal tunnel syndrome
  • presence of sensory neuropathy
40
Q

Clues to Hepatic Disease Screening

A
  • right shoulder/scapular or/or upper mid-back pain
  • shoulder not limited by pain
  • presence of GI issues
  • bilateral carpal tunnel
  • previous history
  • statin history
  • recent operation
  • injection use, tattoo, acupuncture, heterosexual relationships
  • alcohol consumption lifestyle
  • contact w/ jaundiced persons

Differential Dx (12 decks)

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