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40: HEPATITIS

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Hepatitis A

  • Hepatitis B

  • Hepatitis C

ICD-9-CM CODES

  • 573.3 Hepatitis, unspecified

  • Associated physical therapy diagnoses

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joint, pelvic region and thigh

    • 719.70 Difficulty in walking

    • 728.2 Muscular wasting and disuse atrophy

    • 728.89 Disorders of muscle, ligament, and fascia

    • 729.9 Other 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

ICD-10-CM CODE

  • K75.9 Inflammatory liver disease, unspecified

PREFERRED PRACTICE PATTERN

  • As of July, 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.

PATIENT PRESENTATION

A 62-year-old male is presented to the physician’s office for follow- up of some abnormal blood test results. Blood tests revealed that his liver enzymes were elevated by approximately three times the upper limits of normal. The patient says that to his knowledge he has never had abnormal liver tests before, and he has not been to a doctor in several years. He denies alcohol or drug use and is not taking any medications. He gives no history of jaundice. His past medical history is significant only for hospitalization at the age of 45 for a bleeding stomach ulcer. He required surgery and had transfusion of 4 units of blood. He recovered from this episode without further complication and has had no recurrences. Your completed physical examination 2 weeks ago was normal, and a focused physical examination on the day shows no signs of jaundice, no hepatosplenomegaly, and no physical examination findings suggestive of portal hypertension. You diagnose an infectious etiology for the laboratory findings (elevated liver enzymes).1

FIGURE 40-1

Hepatitis A diagnostic profile. (Based on data from Abbott Laboratories, Diagnostic Division, North Chicago, IL.)

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KEY FEATURES

Description

  • Inflammation of the liver

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

  • Pain, frequently referred to low back

  • May be viral or secondary to toxic agents

    • Types: A, B, C (D and E are rare forms)

  • Hepatitis A2

    • RNA enterovirus

    • Spread by contact with fecal matter or blood, often through ingestion of contaminated food

    • Rarely fatal

    • Treated with bed rest for 1 to 4 weeks, no alcohol consumption during that time

  • Hepatitis B2

    • Spread through blood, semen, vaginal secretions, saliva approximately 4 to 6 weeks after symptoms develop

    • May heal slowly

    • Leading cause of chronic liver disease and cirrhosis

  • Hepatitis C2

    • Remains in blood for years

    • Accounts for large percentage of cirrhosis, liver failure, liver cancer cases

    • Transmitted through blood transfusion, possibly sexual intercourse

  • Hepatitis D ...

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