Hepatitis
What are the causes of hepatitis?
virus, chemical, drug reaction, ETOH abuse
How is HepA transmitted? What is the treatment and prognosis?
Fecal/oral route, often through contaminated food/water, highly contagious
Treatment: treat symptoms, avoid ETOH
Prognosis: good, does not lead to cirrhosis, chronic hepatitis or acute liver failure, most recover fully
What is acute pancreatitis, what causes it?
Inflammatory process of the pancreas that can involve surrounding organs
Etiology: Gallstones, alcohol abuse
What are the risk factors for pancreatic cancer?
4th leading cause of CA mortality
Fam Hx, diet, obesity, race, smoking, men>women, age, diabetes, pancreatitis
What are the risk factors for gallstone disease (cholelithiasis)?
Increasing age, obesity, white/native americans > blacks, obesity, women>men, rapid weight loss, pregnancy, estrogen
What is the difference between acute liver failure/hepatitis and chronic hepatitis?
Acute liver failure/hepatitis: rapidly progressing form of liver inflammation, severity of encephalopathy determines outcome, short term prognosis is poor, transplant is best option
Chronic hepatitis: chronic inflammation, injury >6 months, asymptomatic to start, 5 yr survival= 90% if compensated, poor if decompensated
How is HepB transmitted, what is the treatment and prognosis for HepB?
Parenteral, percutaneous (puncture), sexual contact
Treatment:
- Acute: treat sxs
- Chronic: antiviral meds, interferon
Prognosis: normal immune status: 94-98% recovery
What is chronic pancreatitis and what are its causes?
Irreversible changes in the pancreas secondary to the chronic inflammation
Etiology: chronic alcohol consumption (>50%), Hx of acute pancreatitis, hereditary, autoimmune
What is the prognosis for pancreatic cancer?
Not good, lowest 5 year survival rate of any cancer
What is the the PT role for hepatitis?
Use proper safety when handling body fluids or blood, PPE, WASH HANDS!!
Balance of activity and resit is important to monitor tolerance to exercise
How is HepC transmitted, what is the treatment and prognosis?
Parenteral, blood transfusions
Treatment:
- Acute: supportive care
- Chronic: cure possible with therapy
Prognosis: overall good prognosis, 75-85% become chronic, 10-20% progress to cirrhosis
What are the chief symptoms of acute pancreatitis and chronic pancreatitis?
Acute: cardinal sign is abdominal pain with N/V- dull at first, increases to sharp, severe- triggered by fatty meals or alcohol
Chronic: Most common sign is epigastric pain that radiates to back
Based on stage
Stage 1: resectable (better prognosis)
Stage 2: locally advanced- XRT, chemo
Stage 3: metastatic- XRT, chemo
What are the sxs that a PT should be aware of?
PTs should be aware that pain can refer to the shoulder and thoracic spine, Exercise can prevent symptomatic gallstones, post surgical care
What are the classic sxs of viral hepatitis?
Asymptomatic, malaise, fatigue, N/V, fever, RUQ discomfort, jaundice, dark urine
What is cirrhosis of the liver and what is the most common etiology?
Chronic, progressive inflammation of the liver, normal tissue replaced by fibrosis, NOT REVERSIBLE
ETOH abuse is the most common etiology
What is the role of PT in treating a patient with acute/chronic pancreatitis?
Early presentation is back pain, positioning to help patient: leaning forward, sitting up, LEFT side lying, MAKE SURE PATIENT STAYS NPO- don't give water/food/ice chips
Make sure to monitor vitals and glucose levels, screen for osteoporosis
What are the sxs of pancreatic cancer that PTs should be aware of?
Troisier's sign: palpation of supraclavicular lymph node (virchow node)--> sign of metastasis
What is acute cholecystitis, what are sxs? And what is the prognosis?
Inflammation of the gallbladder, acute or chronic, as result of impacted gallstones causing obstruction to bile and distension of gallbladder
Sxs: prolonged abdominal pain in RUQ longer than 6 hrs
MURPHY'S SIGN: interruption of deep breathing with palpation under right costal arch
Prognosis: good with medical intervention
What vaccines are available for Hepatitis?
HepA and HepB vaccines
NO HepC VAX
What is the role of PT in treating patients with liver cirrhosis?
What is the treatment for Acute and Chronic pancreatitis?
Acute: let pancreas rest, NPO, IV fluids
Chronic: prevent further injury, pain relief, replace loss of function, cessation of alcohol and smoking
What are the clinical manifestations of pancreatic cancer?
What is the role of PT in biliary system dysfunction?
Lack of results and/or progression of symptoms requires follow up