Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 96
Hepatitis G (HGV) Recently discovered and resembles HCV • The virus and its effects are under investigation, and its role in causing disease in humans is unclear Chronic Hepatitis Prolonged inflammation of liver for six months or more (HBV, HCV, HDV) • Divided into chronic aggressive (CAH) and chronic persistent (CPH) • CAH seriously destructive with high mortality • CPH usually asymptomatic with good prognosis Nonviral Hepatitis Occurs secondary to exposure to chemicals or drugs such as acetaminophen, aspirin, chloroform, alcohol, tetracyclines • Most clients recover without serious complications Cirrhosis Chronic hepatic disease causing destruction of liver cells, which are replaced by fibrous bands • Scarring causes impairment of blood and lymph flow • Alcohol most common cause
• Three stages 1. Initial: One to three weeks
■ Symptoms: GI symptoms, light- colored stools, fatigue, jaundice 2. Icteric ■ Symptoms: Jaundice, enlarged spleen 3. Recovery: Three to four months ■ Symptoms: Fatigue easily • Symptomatic treatment; usually full recovery • Vaccine Hepatitis B Transmitted through needle sticks, sex, IV drug use, blood transfusions, and perinatal transmission—blood serum most common route • Considered an STD and one of the most underreported diseases • Can live on surfaces up to one week • High mortality rate—those people at high risk should be vaccinated with hep B vaccine Hepatitis C (non-A/non-B) Accounts for 60% to 90% of posttransfusion hepatitis • Primary transmission is blood/blood products • Similar to hep B, but no vaccine available • Association between presence of HVC and liver CA • 50% progress to chronic hepatitis Hepatitis D Occurs in some cases of hep B as coinfection • Only clients with hep B are at risk for HDV • Requires hep B surface antigen for replication • Fulminant—high mortality rate • No vaccine Hepatitis E: (enteric non-A/non-B) Transmitted through fecal contamination of water • Nonfatal except for pregnant women • Rare in U.S. • No vaccine available
LEARNING TIP! Clients must avoid straining and stress, since hepatic blood flow diminishes with moderate exercise
Ascites Abnormal accumulation of fluid within peritoneal cavity; portal/venous hypertension leads to movement of plasma infiltrate into hepatic lymphatics and if high enough, into peritoneal cavity • Edema flows to dependent locations (e.g., ankles) and abdomen • Signs/symptoms—low back pain, increased lordosis
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