Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 97
• Abdominal hernias/lumbar lordosis in these clients may present symptoms that mimic musculoskeletal involvement Hepatic Encephalopathy (coma) Neuropsychiatric syndrome occurring secondary to acute/chronic liver disease; ammonia from intestine is increased due to liver dysfunction, which is directly toxic to CNS and PNS function • Early symptoms: Asterixis, parasthesia (r/o CTS), personality changes, slurred speech • Treatments/prescriptions: Antibiotics , fall prevention Liver Abscess Bacteria destroy hepatic tissue and produce a cavity that fills with infectious organisms and leukocytes • Relatively rare with a high mortality rate (30% to 50%); even higher with multiple abscesses or other complications • Symptoms: Chills, vomiting, fever, right upper abdominal pain, sudden dramatic weight loss (e.g., 10 pounds in a few weeks), dark-colored urine, whitish or clay- colored stool , diarrhea Liver Cancer The liver is one of most common sites of mets; lver tumors, therefore, are usually metastatic • May be caused by cirrhosis, chemical agents (arsenic, vinyl chloride), fungal infections, aflatoxins, viral hepatitis, trauma, excessive use of steroids (anabolic) Cholelithiasis Gallstones that form due to changes in normal components of bile; most stones are formed from a mixture of cholesterol, calcium, bile, and fatty acids • It is the fifth leading cause of hospitalization and accounts for 90% of all gallbladder/duct disease • Predisposing factors: Age 40 or older, female, fertile, fat , fair skin ; diet, DM,
and liver disease are also associated with cholelithiasis Cholecystitis Inflammation of gallbladder may be acute/ chronic due to impaction of gallstones in cystic duct, or neoplasm obstructing biliary tract; normal flow of bile is interrupted and gallbladder becomes distended and ischemic • Symptoms: Main symptom is abdominal pain—particularly after a fatty meal— that is located on upper right side of abdomen; occasionally, nausea and vomiting or fever may occur Guidelines for Physician Referral • Obvious signs of hepatic disease, especially with a history of previous CA or risk factors for hepatitis • Development of arthralgias of unknown cause in anyone with previous history of hepatitis (hepatitis A or C) • Presence of bilateral CTS accompanied by unknown (to the physician) asterixis • Presence of sensory neuropathy of unknown cause accompanied by signs and symptoms associated with hepatic system impairment RENAL & URINARY SYSTEM Upper Urinary Tract Consists of kidneys and ureters • Kidneys are positioned at vertebral levels of T12 through L2** • Upper portion in contact with diaphragm—referred pain can cause pain with breathing Lower Urinary Tract Consists of bladder and urethra • Bladder located directly behind pubis symphysis; functions to store and excrete urine • Males—Post part of urethra surrounded by prostate gland • Referred pain felt in subrapubic area • Voluntary control of urinary excretion based on learned inhibition of reflex pathways from walls of bladder
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