Hepatic Pathology and Physical Therapy Implications

What are the primary functions of the liver?

1. Energy metabolism (glucose production and consumption, cholesterol synthesis) 2. Protein synthesis (albumin, clotting factors, bile) 3. Transport and storage (detoxification, vitamin storage) 4. Protection and clearance (detoxification, clearance of damaged cells) 5. Conversion and excretion of bilirubin.

What are common signs and symptoms of liver disease?

Edema/ascites, dark colored urine, light colored stools, RUQ abdominal pain, skin changes (jaundice, spider angiomas, palmar erythema), neurological symptoms (asterixis, confusion), coagulopathy, hepatic bone issues.

What is jaundice and what causes it?

Jaundice is a symptom, not a disease, characterized by yellowing of the skin and eyes due to increased bilirubin levels. Causes include increased bilirubin production, defects in metabolism, liver disease, and obstruction to bile flow.

What are the types of hepatitis?

1. Viral (contagious) 2. Chronic 3. Fulminant 4. Toxic (drug-induced).

What are the classic symptoms of viral hepatitis?

Many acute cases are asymptomatic, but common symptoms include malaise, fatigue, mild fever, nausea/vomiting, anorexia, RUQ discomfort, and jaundice.

What are the transmission methods for Hepatitis A, B, and C?

Hep A: fecal-oral route; contaminated food and water. Hep B: parenteral and sexual contact. Hep C: parenteral (needle), sexual contact, vertical.

What is the treatment for Hepatitis A, B, and C?

Hep A: supportive care. Hep B: interferon, supportive care. Hep C: interferon, with improving treatments and potential cure.

What is fulminant hepatitis?

Fulminant hepatitis is an acute liver failure characterized by rapidly progressing liver injury/inflammation, occurring without prior liver disease, and may require transplantation.

What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is the most prevalent chronic liver disease, associated with obesity and diabetes, and related to systemic insulin resistance.

What are the main causes of cirrhosis?

Cirrhosis is primarily caused by Hepatitis C, alcohol abuse, and nonalcoholic fatty liver disease.

What is portal hypertension?

Portal hypertension is an increase in hepatic sinus pressure, leading to reversed blood flow in the portal vein and resulting in GI and esophageal varices.

What are the implications of hepatic encephalopathy?

Hepatic encephalopathy can cause neuropsychological symptoms ranging from subtle changes to coma and death, related to increased ammonia levels.

What are the physical therapy implications for patients with liver disease?

Monitor skin integrity, adapt education for cognitive impairment, avoid intense exercise while jaundiced, and promote lifestyle modifications.

What are the lab values associated with liver dysfunction?

ALT, AST, ALP, and bilirubin levels increase with liver dysfunction; albumin levels decrease with nutritional compromise.

What is the role of the liver in drug metabolism?

The liver detoxifies drugs and poisons, affecting drug distribution and metabolism, which may require dosage adjustments in older adults.

What are the signs and symptoms of cirrhosis?

Signs include bleeding, edema (ascites), weight loss, impaired drug metabolism, and portal hypertension.

What is the significance of asterixis in liver disease?

Asterixis is a neurological symptom indicating liver dysfunction, often associated with hepatic encephalopathy.

What are the effects of ascites in patients with cirrhosis?

Ascites can limit activities that increase intra-abdominal pressure and may require careful management in physical therapy.

What is the importance of monitoring WBC and platelet counts in patients on interferon?

Monitoring is crucial for managing potential side effects and ensuring safe treatment for hepatitis.

What are the potential complications of jaundice?

Jaundice indicates liver dysfunction and can lead to complications if not managed, including cognitive impairment and the need for rest.

What lifestyle modifications can physical therapists promote for patients with NAFLD?

Physical therapists can promote exercise and lifestyle changes to manage obesity and diabetes associated with NAFLD.

What are the implications of hepatic bone issues in liver disease?

Hepatic bone issues can complicate physical therapy interventions and require careful assessment of patient mobility and safety.

What is the significance of hypoalbuminemia in liver disease?

Hypoalbuminemia indicates nutritional compromise and can affect fluid balance, requiring monitoring and intervention.

What is the role of lactulose in hepatic encephalopathy?

Lactulose is used to treat hepatic encephalopathy by reducing ammonia levels, but it can cause diarrhea.

What are the implications of edema in patients with liver disease?

Edema can mask muscle wasting and complicate physical therapy interventions, requiring careful monitoring.