Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 95
Liver Pathologies Referred right shoulder pain may be only symptom of hepatic/biliary dysfunction— sympathetic fibers from biliary system account for intercostal/interscapular pain Neurological Disorders • Liver dysfunction can increase levels of ammonia and urea • Ammonia not excreted—goes to the brain and reacts with glutamate, causing symptoms of parasthesia, asterixis, CTS Jaundice Symptom from hepatic/biliary disorders that produce yellowness of skin, mucous membranes, and excretions due to staining by bile pigment bilirubin • Newborn—immature bilirubin builds up in blood (50%) • Norms: 0.1 to 1.0 mg/dL • Sclera of eye: 2 to 3 mg/dL Acute Viral Hepatitis Acute viral hepatitis—acute infectious inflammation of liver • Widespread public health problem due to mild symptoms, no drug treatment; has increased in relation to illicit drug use • Caused by five identified viruses (hep A through E and G) • 60% to 90% underreported • History: Alcohol abuse, Mediterranean— fibrosing/environmental SE, African American, Far East origin • Heavy exercise contraindicated—hepatic blood flow diminishes with moderate exercise Hepatitis A Caused by virus from enterovirus family transmitted by oral–fecal route—ingestion or sex • Highly contagious • Two- to seven-week incubation period; client is asymptomatic • Daycares, underdeveloped countries
• Change in bowel and bladder habits • Chronic cough or hoarseness, change in voice • Proximal muscle weakness, especially when accompanied by change in one or more deep tendon reflexes Guidelines for Immediate Physician Referral • Presence of recently discovered lumps or nodules or changes in previously present lumps, nodules, or moles • Detection of palpable, fixed, irregular mass in the breast, axilla, or suspicious lymph node enlargement or lymph node changes • Presence of any of the early warning signs of cancer, including idiopathic muscle weakness accompanied by decreased DTR • Any unexplained bleeding from any area HEPATIC AND BILIARY SYSTEM Signs and Symptoms • Feeling of abdominal fullness, ascites • Asterixis (muscle tremors) • Change in urine color • Light-colored stools • Change in skin color • Skin changes (rash, itching, purpura, spider angiomas, palmar erythema) Physiology Both liver and gallbladder produce symptoms in scapula, mid-back, and right shoulder Liver • Formation and secretion of bile (bilirubin) • Detoxification • Production of clotting factors • Storage of vitamins • Metabolization of carbs, proteins, and fat Gallbladder Lies on the underside of liver • Receives blood from hepatic artery • Principle function is concentration and storage of bile
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