Comprehensive Management and Treatment of Acute Hepatitis C Infection Essay

The patient LA is a 35-year-old female of Pacific Islander origin presenting with features suggestive of a substantial hepatic pathology. The first differentials are Hepatitis C infection, alcoholic hepatitis, NAFLD, drug-induced liver injury, cholelithiasis/cholecystitis, hemolysis, and hepatocellular carcinoma. These differentials are based on her chief complaints of fatigue, abdominal pain, nausea, vomiting, intermittent fever, change in bowel movement color to light and change in urine color to dark and yellow skin tone, and inflammatory markers in the vital signs. Comprehensive Management and Treatment of Acute Hepatitis C Infection Essay

To reduce differential diagnoses, additional history taking and review of systems (ROS) are necessary (Liu et al., 2020). This includes assessing the duration and dynamics of symptoms, the patient’s substance use history, recent travels, contacts with jealous people, and history of liver diseases or hepatitis vaccinations. ROS should also contain complaints referring to the gastrointestinal, musculoskeletal, neurological, and hematologic systems. Patient LA has features of acute Hepatitis C infection supported by jaundice, fatigue, dark urine, pale stool, elevated liver enzymes, and Hepatitis C core antigen test. The AASLD guidelines will assist in implementing the management strategies for hepatitis C, including pharmacologic and non-pharmacologic ones. For pharmacology, DAAs such as Sofosbuvir/Velpatasvir are recommended for 8-12 weeks, depending on the patient’s genotype and liver status. Acetaminophen is advised for symptom control but should avoid NSAIDs as they are toxic to the liver.

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This means that non-pharmacologic treatments should focus on changing the required lifestyles. To manage patient LA’s symptoms, they should go for fiber-rich foods low in fats and processed sugars, drink plenty of water, and abstain from alcohol and drugs (Kaul, 2023). These are some of the lifestyle adjustments that are crucial in handling Hepatitis C and preventing more damage to the liver. The other critical approach in the management plan is patient enlightenment. Patient LA needs to be informed about Hepatitis C, how it is contracted, and that it is a chronic disease. Therefore, it is important to stress that the virus must be eradicated after the infection antiviral therapy. On the same note, measures to be taken, such as abstaining from alcohol, observing a healthy diet, and exercising, should also be highlighted. Patient LA should also be educated on how to prevent passing the virus to other people, for example, safe sex and not sharing needles.

A review is advised after four weeks to check on the patient’s adherence to the medications and effects. If there is an enhancement, the existing management strategy should be continued. However, liver function tests and viral load should be repeated after twelve weeks of the above treatments. If there is no change after two weeks, one should consider resistance or noncompliance and switch to a different antiviral agent. If improvement is seen, treatment should be continued. However, LFTs and VL should be repeated at the end of treatment. If no alteration is made, the following should be performed: resistance evaluation, review of compliance, and consultation with a specialist on alteration of antiviral regimen (Eriksen et al., 2020). Comprehensive Management and Treatment of Acute Hepatitis C Infection Essay

Hence, based on clinical features and laboratory analysis, it can be concluded that Patient LA has an acute Hepatitis C infection. She should be put on direct-acting antivirals because of her chronic HCV infection, together with other management interventions that may include alteration of her lifestyle and regular follow-up to avoid complications (Salama et al., 2022). Explaining to her the need to strictly follow the doctor’s prescriptions on the medications she should take and other alterations in her behavior is crucial if the desired outcome and proper management of Hepatitis C infection are to be achieved.

References

Eriksen, J., Carlander, C., Albert, J., Flamholc, L., Gisslén, M., Navér, L., … & Sönnerborg, A. (2020). Antiretroviral treatment for HIV infection: Swedish recommendations 2019. Infectious Diseases, 52(5), 295-329. https://www.tandfonline.com/doi/abs/10.1080/23744235.2019.1707867

Kaul, L. (2023). Multidisciplinary Approach to the Management of Obesity. Fulton Books, Inc.. https://books.google.com/books?hl=en&lr=&id=W-_nEAAAQBAJ&oi=fnd&pg=PP4&dq=To+manage+patient+LA%E2%80%99s+symptoms,+they+should+go+for+fiber-rich+foods+low+in+fats+and+processed+sugars,+drink+plenty+of+water,+and+abstain+from+alcohol+and+drugs&ots=RDUBT57HZg&sig=YNoUH-HeviCuCYAKX78Ww35pkc0 Comprehensive Management and Treatment of Acute Hepatitis C Infection Essay

Liu, Y., Jain, A., Eng, C., Way, D. H., Lee, K., Bui, P., … & Coz, D. (2020). A deep learning system for differential diagnosis of skin diseases. Nature medicine, 26(6), 900-908. https://www.nature.com/articles/s41591%E2%80%90020%E2%80%900842%E2%80%903

Salama, I. I., Raslan, H. M., Abdel-Latif, G. A., Salama, S. I., Sami, S. M., Shaaban, F. A., … & Fouad, W. A. (2022). Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection. World Journal of Hepatology, 14(6), 1053. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258264/

Case Study:

Patient LA is a Pacific Islander female, 35 years of age, presenting to the primary care physician with complaints of fatigue, abdominal pain, N/V, fever (intermittent temperature of 100 at home), light-colored stool, and dark colored urine. She attributes the fatigue to working at nighttime in her new job at a warehouse. She has also noticed a yellow tinting to her skin. Patient reports that she occasionally drinks at least 1-2 glasses of wine a week. She reports recreational drug use occasionally and states that she went to a party with her best friend about three weeks ago, where she injected an unknown substance in her right upper arm. She is 5 feet 1 inch tall and weighs 170 pounds, with a calculated BMI of 32.2 kg/m2. Vitals Signs: BP 150/99, HR; 87, RR, 18, Oxygen Saturation: 99%, Temperature: 100.8 Comprehensive Management and Treatment of Acute Hepatitis C Infection Essay

What are your initial differentials?
What additional HPI and ROS findings are your seeking or ruling in or ruling out?
What are common symptoms (what the patient says) (per system) for the differentials you are considering?

Patient LA

CMP- Pertinent levels

BUN-8

Creat-1.1

ALT: 400

AST: 300

ALBUMIN: 25

Hep C core antigen: reactive

GGT: 150

To gain additional information, Patient LA is referred for fasting blood work. The results of this blood work indicate:

HbA1c: 5.8%
Fasting blood glucose: 94 mg/dL
Total Cholesterol- 250
HIV test: negative
Hepatitis BsAg- non-reactive
What is your actual diagnosis(es) (Most pertinent)?
What assessment data/signs are common with this type of patient/diagnosis
What guidelines will you use to assist in your planning?
What is your initial treatment plan for each diagnosis (pharmacologic, nonpharmacologic, etc.)?
What is your initial education for each diagnosis?
When do you recommend follow up? What is your plan upon follow up? (if improvement/ If no improvement) Comprehensive Management and Treatment of Acute Hepatitis C Infection Essay