Cirrhosis

• Cirrhosis of the liver

• 571.5 Cirrhosis of liver without mention of alcohol

• K74.0 Hepatic fibrosis
• K74.60 Unspecified cirrhosis of liver
• K74.69 Other cirrhosis of liver

• As of November 2012, 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.

• 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

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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; individuals may be inappropriately referred to PT
• GI problems commonly related to stress, constipation
• More serious problems include autoimmune conditions: Crohn’s, appendicitis (acute pain)
• May indicate inguinal or umbilical hernia
• In females, GI complaints may indicate gynecological problems: cancer/tumors in reproductive organs, endometriosis, uterine fibroids, ectopic pregnancies
• History of heartburn or indigestion may indicate GI or cardiac problems
• Chronic or episodic diarrhea, loss of bowel control (incontinence or urgency), blood in stool may be symptomatic of inflammatory disease, pre-cancerous condition, or cancer

Demographics

• Affects adults; higher rate among alcoholics
• Familial

Signs and Symptoms

• Jaundice
• Itching
• Spiderlike vessels on the skin
• Extremity edema
• Splenomegaly
• Hepatic encephalopathy
• Sensitivity to medications
• Insulin resistance
• Pain
  • Abdominal/stomach pain, cramping (constant or intermittent, severe)
  • Pain upon ingesting food or liquid
    • May be cardiac in nature
  • Lower abdominal pain
  • Pain with defecation
  • Pain after ingesting fatty foods (gallbladder sign)
  • Joint pain
• Bowel changes
  • Diarrhea (acute, chronic)
  • Constipation (acute, chronic)
  • Blood in stool, dark or fresh-bleeding
  • Rectal bleeding
  • Change in stool odor or ...