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).

Question: What other symptoms might this patient present with to support the diagnosis of hepatitis?

Potential answers:

A. Bowel and gastrointestinal changes, low back pain, and weight loss.

B. Urinary and bowel changes, shoulder pain, and weight gain.

C. Low back pain, weight loss, and high blood pressure.

D. Orthostatic hypotension, shoulder pain, and urinary changes.

Answer with rationale: A. Bowel and gastrointestinal changes, low back pain, and weight loss. These changes come from either liver inflammation or issues with liver filtration.

For more information see Chapter 40: Hepatitis in The Color Atlas of Physical Therapy