Liver and Gallbladder Disease
Intro
Disease in the liver or gallbladder may refer pain to the abdomen. Conditions of the liver include hepatitis, cirrhosis, a tumor or abscess. Conditions of the gallbladder include gallstones, cancer, or inflammation.
Risk Factors
S&S
Referral Patterns
Special Tests
Asterixis test- this test can be used to test for peripheral neuritis caused by impaired liver function. The patient is screened for a tremor occurring with wrist extension. An alternate test can be done with the patient in hooklying and a tremor is looked for when the legs drop into abduction.
Red flag
Constitutional symptoms combined with spinal muscle tenderness and guarding.
Video of asterixis test:
Intro
Disease in the liver or gallbladder may refer pain to the abdomen. Conditions of the liver include hepatitis, cirrhosis, a tumor or abscess. Conditions of the gallbladder include gallstones, cancer, or inflammation.
Risk Factors
- Personal or Family history of liver or gallbladder disease.
- Risk of hepatitis- occupational, recent needle use (piercing, tattoo, acupuncture, etc.)
S&S
- Pain in right upper quadrant (Pain in this area after a meal is a strong sign)
- Pain in right shoulder and thoracic vertebrae (liver)
- Jaundice after surgery (liver)
- Pain between scapulae and right shoulder (gallbladder)
- Nausea and pain after a meal (one to three hours)
- Right sided rib pain
- GI disturbance
- Inflammation of peripheral nerves (asterixis or bilateral carpal tunnel symptoms)
- Skin changes (Include jaundice, green hue, itching)
- Changes in skin in hands and feet (redness for light skin tones, gray/tan for darker skin tones)
Referral Patterns
- Pain in right upper quadrant. Pain in this area after a meal is a strong sign
- Pain in right shoulder and thoracic vertebrae (liver)
- Pain between scapulae and right shoulder (gallbladder)
Special Tests
Asterixis test- this test can be used to test for peripheral neuritis caused by impaired liver function. The patient is screened for a tremor occurring with wrist extension. An alternate test can be done with the patient in hooklying and a tremor is looked for when the legs drop into abduction.
Red flag
Constitutional symptoms combined with spinal muscle tenderness and guarding.
Video of asterixis test:
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References:
Goodman, MBA, PT, C. C., & Snyder, MN, RN, OCN, T. E. (2007). Differential Diagnosis PHYSICAL THERAPISTS Screening for Referral (4thth ed.). St. Louis, MO: Saunders Elsevier
Riley, T. R., & Koch, K. (2003). Characteristics of upper abdominal pain in those with chronic liver disease. Digestive Diseases And Sciences, 48(10), 1914-1918.