Hepatic/Renal Exam Questions With Complete Solutions
PT implications for hepatic encephalopathy?
PT--AMS (patient has difficulty following commands, history is
not accurate, poor safety awareness), asterixis (graded 1-4,
bilateral if metabolic encephalopathy, unilateral >> brain
pathology)
How common is liver cancer?
Incidence is increasing, mainly from metastasis to the liver;
leading cause of deaths worldwide but not as common in US
What is the most common risk factor for liver cancer?
Hep B/C infection that leads to cirrhosis; in US hep C is more
common; risk increases if both Hep B and C and even more with
heavy drinks (more than 6 drinks per day)
What are symptoms of liver cancer?
RUQ pain, R scap/back pain, unexplained weight loss, hard
lump under ribs on the R side of body, overall muscle weakness,
feels full, constant ache mid back, progressive poor health
When does liver function become impaired?
Liver function does not become impaired until more than 80%
of the liver is replaced with cancer
What is a treatment option for end stage liver disease?
Liver transplant
What is the 5 year survival rate for liver transplant?
,75%
What are side effects of immunosuppressive therapy?
Diabetes, HTN, high cholesterol, osteoporosis, kidney, GI issues
What are some common infections that occur post liver
transplant?
Viral infections, fungal infections, bacterial infections, hygiene
and limiting exposure to high-risk activities is important
What is the primary focus following liver transplant?
Infection/rejection, contact precautions fo immunocompromised
patients
Which infection is most common post op following a liver
transplant?
Bacterial infections
Which types of infections are common months after liver
transplant?
Viral infections occur more frequently post op
What are symptoms of infection following liver transplant?
Headache, shortness of breath, cough, n/v, diarrhea, fatigue,
burning with urination, sore throat
What are signs of rejection post liver transplant?
Abdominal pain, fever, fatigue, gray stools, tea-colored urine,
dark yellow/orange urine, decreased exercise tolerance, yellow
eyes
,What are common complications in post op liver transplant
patients?
Commonly get post-op respiratory complications
What are some neurologic complications that can present post
liver transplant?
Hemorrhage, seizures, altered mental status
What are some inpatient precautions post liver transplant?
Lifting restrictions (reduce possibility for herniation/dehiscence
of surgical site), <20 lbs for 6 weeks, proper abdominal splinting
for effective cough, diaphragmatic breathing, log roll with bed
mobility
What are some environmental precautions to consider post liver
transplant?
Standard precautions of all equipment brought into patient room
and hand washing to reduce infection risk, assess location of
drains and catheter prior to mobility, vitals for risk of orthostatic
hypotension, monitor for altered mental status, valsalva, if
cognition or safety awareness is a concern express to
family/patient to not get out of bed without supervision
What are some outpatient focuses following liver transplant?
Postural correction (poor posture, kyphosis), scar adhesions
(abdomen may contribute to flexed postures), functional
activities to restore independence with ADL's, may exhibit poor
balance, coordination, endurance,
What are some outpatient precautions following liver transplant?
, HTN, immunosuppression, osteoporosis, lifting restrictions may
still be present, may see <30 lbs x 6 months, depression,
delirium/AMS
What are some general PT considerations for transplant
recipients?
Coordinate with RN staff for best time of day for PT session;
analyze daily labs, caution with pulmonary percussion in
patients with low platelet count, anemia can contribute to low
activity tolerance; balance may be altered by fluid retention in
abdomen or LE/feet, WB may be painful--short intermittent
walking episodes are best; always monitor vitals pre/post/during
activity; posture education, optimal body mechanics, exercise
technique, education for comborbidities; instructions for daily
home program--regular walking, stretching, strengthening
(transplant team may have protocols that are preferred)
When is an immediate MD referral warranted post liver
transplant?
New onset myopathy, especially in older adults with history of
statin use (look for other s/s of liver or renal impairment);
obvious signs of hepatic disease, especially with prior cancer or
risk factors for hepatitis; develop arthralgia of unknown cause
and prior history of hepatitis or risk factors; presence of bilateral
carpal tunnel syndrome and tarsal tunnel syndrome (bilateral
ankle/wrist pain) unknown to MD, asterixis; neuropathy of
unknown cause and s/s associated with liver disease
What are some screening clues for liver issues?
PT implications for hepatic encephalopathy?
PT--AMS (patient has difficulty following commands, history is
not accurate, poor safety awareness), asterixis (graded 1-4,
bilateral if metabolic encephalopathy, unilateral >> brain
pathology)
How common is liver cancer?
Incidence is increasing, mainly from metastasis to the liver;
leading cause of deaths worldwide but not as common in US
What is the most common risk factor for liver cancer?
Hep B/C infection that leads to cirrhosis; in US hep C is more
common; risk increases if both Hep B and C and even more with
heavy drinks (more than 6 drinks per day)
What are symptoms of liver cancer?
RUQ pain, R scap/back pain, unexplained weight loss, hard
lump under ribs on the R side of body, overall muscle weakness,
feels full, constant ache mid back, progressive poor health
When does liver function become impaired?
Liver function does not become impaired until more than 80%
of the liver is replaced with cancer
What is a treatment option for end stage liver disease?
Liver transplant
What is the 5 year survival rate for liver transplant?
,75%
What are side effects of immunosuppressive therapy?
Diabetes, HTN, high cholesterol, osteoporosis, kidney, GI issues
What are some common infections that occur post liver
transplant?
Viral infections, fungal infections, bacterial infections, hygiene
and limiting exposure to high-risk activities is important
What is the primary focus following liver transplant?
Infection/rejection, contact precautions fo immunocompromised
patients
Which infection is most common post op following a liver
transplant?
Bacterial infections
Which types of infections are common months after liver
transplant?
Viral infections occur more frequently post op
What are symptoms of infection following liver transplant?
Headache, shortness of breath, cough, n/v, diarrhea, fatigue,
burning with urination, sore throat
What are signs of rejection post liver transplant?
Abdominal pain, fever, fatigue, gray stools, tea-colored urine,
dark yellow/orange urine, decreased exercise tolerance, yellow
eyes
,What are common complications in post op liver transplant
patients?
Commonly get post-op respiratory complications
What are some neurologic complications that can present post
liver transplant?
Hemorrhage, seizures, altered mental status
What are some inpatient precautions post liver transplant?
Lifting restrictions (reduce possibility for herniation/dehiscence
of surgical site), <20 lbs for 6 weeks, proper abdominal splinting
for effective cough, diaphragmatic breathing, log roll with bed
mobility
What are some environmental precautions to consider post liver
transplant?
Standard precautions of all equipment brought into patient room
and hand washing to reduce infection risk, assess location of
drains and catheter prior to mobility, vitals for risk of orthostatic
hypotension, monitor for altered mental status, valsalva, if
cognition or safety awareness is a concern express to
family/patient to not get out of bed without supervision
What are some outpatient focuses following liver transplant?
Postural correction (poor posture, kyphosis), scar adhesions
(abdomen may contribute to flexed postures), functional
activities to restore independence with ADL's, may exhibit poor
balance, coordination, endurance,
What are some outpatient precautions following liver transplant?
, HTN, immunosuppression, osteoporosis, lifting restrictions may
still be present, may see <30 lbs x 6 months, depression,
delirium/AMS
What are some general PT considerations for transplant
recipients?
Coordinate with RN staff for best time of day for PT session;
analyze daily labs, caution with pulmonary percussion in
patients with low platelet count, anemia can contribute to low
activity tolerance; balance may be altered by fluid retention in
abdomen or LE/feet, WB may be painful--short intermittent
walking episodes are best; always monitor vitals pre/post/during
activity; posture education, optimal body mechanics, exercise
technique, education for comborbidities; instructions for daily
home program--regular walking, stretching, strengthening
(transplant team may have protocols that are preferred)
When is an immediate MD referral warranted post liver
transplant?
New onset myopathy, especially in older adults with history of
statin use (look for other s/s of liver or renal impairment);
obvious signs of hepatic disease, especially with prior cancer or
risk factors for hepatitis; develop arthralgia of unknown cause
and prior history of hepatitis or risk factors; presence of bilateral
carpal tunnel syndrome and tarsal tunnel syndrome (bilateral
ankle/wrist pain) unknown to MD, asterixis; neuropathy of
unknown cause and s/s associated with liver disease
What are some screening clues for liver issues?
