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CONDITION/DISORDER SYNONYM

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  • Cirrhosis of the liver

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ICD-9-CM CODES

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  • 571.5 Cirrhosis of liver without mention of alcohol

  • Associated physical therapy diagnoses

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joint, pelvic region and thigh

    • 719.70 Difficulty in walking involving joint site unspecified

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.9 Other and unspecified disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

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ICD-10-CM CODES

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  • K74.0 Hepatic fibrosis

  • K74.60 Unspecified cirrhosis of liver

  • K74.69 Other cirrhosis of liver

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PREFERRED PRACTICE PATTERN

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  • As of June, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

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PATIENT PRESENTATION

A 38-year-old man comes into the emergency department presenting with fatigue and abdominal swelling. For several months, he has noticed that his abdomen has been growing larger and that his skin has turned yellow. He denies any medical problems but admits to drinking alcohol almost every day. On examination, his skin clearly has a yellow hue indicative of icterus. His palms have some redness. His abdomen is markedly distended and tense, and a fluid wave is present. On the surface of the abdomen there are prominent vascular markings.

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FIGURE 34-1

CT of a patient with a cirrhotic, nodular liver (white arrow), splenomegaly (yellow arrow), and ascites (arrowheads). (From Longo DL, et al., [eds.]. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill, 2012.)

Graphic Jump Location
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KEY FEATURES

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Description
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  • Destruction of liver, liver disease

  • May result from excessive alcohol use over time

  • Complaints often include changes in bowel habits: Constipation, diarrhea, urgency, incontinence, cramping

  • Pain is frequently referred to lower back

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Essentials of Diagnosis
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  • Abdominal pain or tenderness (constant, intermittent)

  • Nausea, vomiting

  • Changes in bowel habits: Diarrhea, constipation

  • Bloating

  • Acute drop in blood pressure, may cause decreased blood flow to intestines

  • Lack of appetite, unexplained weight loss

  • Abdominal pain upon ingesting food

  • Joint pain possible

  • Malaise, fatigue

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General Considerations
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  • While PT may not manage GI disorders specifically, clients may receive care for secondary problems: Weakness, gait abnormalities, limited aerobic endurance, sarcopenia, musculoskeletal/neuromuscular problems, weight loss/gain.

  • Symptoms may be characteristic of multiple GI disorders, confounding medical diagnosis.

  • PT should recognize possible GI pathology in differential diagnosis, especially when findings are inconsistent with conditions commonly treated.

  • Diagnosis for occult problems may take time, require intensive diagnostic testing.

  • GI disorders frequently refer pain to other body areas; ...

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