Hepatitis C Essays

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Hepatitis C Essays

Mike is a 23-year-old white male admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. His psychiatrist ordered LFT’s to follow the valproate therapy. LFT’s were abnormal: ALT 1178 u/L, AST 746 u/L. the patient was asymptomatic. He denies fever, abdominal pain, nausea, vomiting or jaundice. He denies using other medication or alcohol but admits using illicit IV drugs starting about 8 weeks ago and continuing to present. He never had a blood transfusion. Aside from Depakote he is presently taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd.
Other blood work: Direct bili 1 mg/dL, alk phos 188 u/L, anti-HCV negative on hospital day 1, positive on day 3. HCV-RNA PCR positive. Hep A, B, and D markers negative. Hepatitis C Essays

 

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Patient diagnosis: Acute Hepatitis C.

1. List some clinical manifestations typically seen in Hepatitis C and major treatment strategies.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.

 

    • Hepatitis C virus is responsible for approximately 15-20% of all acute hepatitis cases (Li & Lo, 2015).   Rates of infection are noted to be greater than 70 million worldwide for chronic Hepatitis C infections (World Health Organization, 2020),  which may lead to cirrhosis, hepatocellular carcinoma, insulin resistance, Type II Diabetes Mellitus, glomerulopathies, oral manifestations and death (Li & Lo, 2015).  The Hepatitis C virus is small, and enveloped, has many genotypes, of which all currently are hepatogenic and pathogenic (Li & Lo, 2015).  It  is important for healthcare providers to understand the risk factors, testing, and treatment of this contagious disease to improve clinical outcomes and decrease transmission rates.     The majority of patients diagnosed with Hepatitis C will be asymptomatic, like Mike in our case study.  Many will have elevated ALT levels, but some may not.  Direct and indirect tests are used to detect Hepatitis C virus in hosts.  Indirect tests include IgM for recent infection, and IgG for recent or past infection.  Direct tests will include virus isolation, detection of viral antigens and nucleic acids (Li & Lo, 2015).  Acute hepatitis is diagnosed when there is a presence of HCV RNA and an absence of anti-HCV antibodies (Li & Lo, 2015).  In certain subsets of patients including dialysis, immunocompromised, and agammaglobunemic individuals, HCV RNA maybe present without the presence of HCV antibodies (Li & Lo, 2015). Andrews, R. (2018). Family physicians can manage adults with chronic hepatitis C.  American Family Physicians, 98 (7).      Doi:  10.4254/wjh.v7.i10.1377.less0 UnreadUnread
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    • World Health Organization (2020).  Hepatitis C.  Retrieved from https://www.who.int/news-room/facr-sheets/detail/hepatitis-c.
    • Li, Hui-Chun, & Lo, Shih-Yen. (2020).  Hepatitis C virus: virology, diagnosis, and treatment.  World Journal of Hepatology, 7 (10).
    • References
    •      The World Health Organization (2020) suggests both testing and treatment guidelines that include pegylated interferon with ribavirin.  The American Academy of Family of Family Physicians has published guidelines ad sources to aide primary care physicians treat and monitor chronic hepatitis C infected individuals.  Since hepatitis C represents the only chronic viral illness curable by medication and most deadly (Andrews, 2018), it is imperative we recognize the risks, know the tests, and provide treatment to decrease morbidity and mortality from hepatitis C infection.
    •      Exposure to hepatitis C is through direct percutaneous exposure to blood from an infected individual; knowing risk factors can aid with prevention and detection.  At risk individuals include those with illicit injection of drugs, tattoo use, dialysis, born to infected mother, incarceration, intranasal illicit drug use, intercourse with infected partner, and blood transfusions before July 1992 (Li & Lo, 2015).  Prevention, through education, is essential to reducing hepatitis C infection rates.
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    • Melissa Morgan posted Feb 24, 2021 10:43 PM
    • Clinical manifestations. Hepatitis C symptoms can be mild to severe, and the onset is insidious (Huether, McCance & Brashers, 2020). There are 3 phases of hepatitis after the incubation phase: prodromal (preicteric) phase, icteric phase, and recovery phase. Prodromal phase: patients will experience jaundice, fatigue, anorexia, malaise, nausea, vomiting, headache, hyperalgia, cough, and low-grade fever about 2 weeks after exposure (Huether, McCance & Brashers, 2020). Icteric phase: jaundice, dark urine, clay-colored stools, liver is enlarged, fatigue, and abdominal pain (Huether, McCance & Brashers, 2020). Recovery phase: symptoms diminish after about 6-8 weeks, but “the liver remains enlarged and tender, and liver function returns to normal 2-12 weeks after the onset of jaundice” (Huether, McCance & Brashers, 2020, p. 904). Mike has a risk factor of illicit drug use and likely contracted hepatitis C from it using tainted needles. He will need counseling for his depression and education on bloodborne infections. ReferencesMontague, S., Agarwal, K., & Cannon, M. (2019). Exploring the emotions of patients undergoing therapy for hepatitis C. British Journal of Nursing, 28(13), 824–828. https://doi-org.wilkes.idm.oclc.org/10.12968/bjon.2019.28.13.824Sulkowski, M. S. (2019). New Options in the Treatment of Hepatitis C (HCV): Economic and Clinical Consideration for Improved Patient Outcomes. Journal of Managed Care Medicine, 22(2), 54–59.less0 UnreadUnread
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    • Perazzo, H., Castro, R., Luz, P. M., Banholi, M., Goldenzon, R. V., Cardoso, S. W., Grinsztejna, B., & Velosoa, V. G. (2020). Effectiveness of generic direct-acting agents for the treatment of hepatitis C: systematic review and meta-analysis. Bulletin of the World Health Organization, 98(3), 188–197J. https://doi-org.wilkes.idm.oclc.org/10.2471/BLT.19.231522
    • Huether, S., McCance, K., and Brashers, V.  (2020).  Understanding Pathophysiology (7th ed.).  Elsevier
    • Treatment. Mike will need treatment to prevent his hepatitis from becoming chronic. It is estimated that 70 million people are affected chronically with hepatitis C, and approximately 1 million of them die from cirrhosis and hepatocellular carcinoma (Perazzo, et al., 2020). “Direct-acting antiviral (DAA) therapy has revolutionised the treatment of hepatitis C (HCV). Current treatment regimens are highly efficacious, with almost all patients receiving DAA therapy achieving a sustained virologic response (SVR) or ‘cure’” (Montague, Agarwal, & Cannon, 2019, p. 1). Other drugs in the treatment of Hepatitis C include polymerase inhibitors, protease inhibitors, and nonstructural protein 5A (NS5A) inhibitors (Sulkowski, 2019). Some of these other drugs are not available or not in use, and not all patients tolerate these drugs well. The success of treatment depends on the patient’s adherence to the drug regimen, which is about 6-12 weeks for DAA therapy (Sulkowski, 2019). Successful treatment of hepatitis C is 95% effective for patients (Sulkowski, 2019). Hepatitis C Essays
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    • Jennifer Bryant posted Feb 24, 2021 1:00 PM
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    • Hepatitis C is a leading cause of liver-related deaths, cirrhosis, and hepatocellular carcinoma (Millman et al, 2017). Early diagnosis and timely treatment of acute hepatitis C helps the prevention of complications of chronic hepatitis C. Brian was anti-HCV negative on hospital day 1 and positive on day 3, which would put him in the incubation phase. Acute infection with HCV is frequently asymptomatic; however, 25–30% of those acutely infected may have symptoms including fever, jaundice, and abdominal pain (Millman et al, 2017). The prodromal phrase occurs 2 weeks after exposure, the infection is highly transmissible, and includes symptoms of fatigue, nausea, vomiting, cough (Heuther et al, 2020). The icteric phase follows 1-2 weeks after the prodromal phase and last for 2-6 weeks. During this phase jaundice, dark urine are common and the liver is enlarged. The recovery phase occurs as the resolution of jaundice in which the liver is still enlarged and tender but LFT’s return to their normal range (Huether et al, 2020).ReferencesPathophysiology (7th ed.).  Elsevier.test for screening and early diagnosis of hepatitis C virus infection in at‐risk populationsMillman, A. J., Nelson, N. P., & Vellozzi, C. (2017). Hepatitis C: Review of the Epidemiology,Zeuzem S. (2017). Treatment Options in Hepatitis C. Deutsches Arzteblatt international, 114(1- less2 UnreadUnread7 ViewsViews
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    • 02), 11–21. https://doi.org/10.3238/arztebl.2017.0011
    • Clinical Care, and Continued Challenges in the Direct Acting Antiviral Era. Current epidemiology reports, 4(2), 174–185. https://doi.org/10.1007/s40471-017-0108-x
    • and immunocompromised hosts. J Med Virol. 2020; 1– 6
    • Kumar, R, Chan, KP, Ekstrom, VSM, et al. Hepatitis C virus antigen detection is an appropriate
    • Heuther, S., McCance, K., and Brashers, V.  (2020).  Understanding
    • Only early diagnosis of hepatitis C can lead to timely treatment and prevention of complications of chronic hepatitis C, as well as effectively disrupt hepatitis C virus transmission (Kumar et al, 2020). Treatment strategies depend on the viral load. Brian’s HCV-RNA PCR is positive but needs a quantitative test to measure and monitor the viral load. The treatment of HCV has been revolutionized by the recent introduction of potent direct antiviral agents.  These drugs are safe and well-tolerated and result in sustained virological response rates between 90% and 100% (Zeuzem, 2017). As with all viruses, bed rest, fluids and a healthy diet also promote recovery.
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    • Joanne Hogan posted Feb 23, 2021 4:59 PM
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    • Module 6An early manifestation of Hepatitis C is elevated AST and ALT values which may indicate liver inflammation (Huether et al., 2020). Often there is a three phased manifestation followed by an incubation period in which the virus is dormant (Huether et al., 2020). Phase 1 or the prodromal phase occurs about 2 weeks after exposure to the virus and is where the symptoms of fatigue, malaise, nausea, low grade fever, and headache occur (Huether et al., 2020). Huether et al. (2020) goes on to describe phase 2 or the icteric phase as a 2–6-week period where symptoms progress to include an enlarged, tender liver with more pronounced fatigue and abdominal pain. Phase 3 or the recovery phase is when symptoms dissipate but the enlarged liver remains (Huether et al., 2020). A noticeable difference in HCV patients compared to other hepatitis patients is that jaundice does not occur (Huether et al., 2020). HCV becomes chronic when liver enlargement and abdominal pain persist after the acute infection phases and liver enzymes remain elevated (Falade- Nwulia et al., 2017).ReferencesFalade-Nwulia, O., Suarez-Cuervo, C., Nelson, D. R., Fried, M. W., Segal, J. B., & Sulkowski, M. S. (2017). Oral direct-acting agent therapy for hepatitis c virus infection. Annals of Internal Medicine, 166(9). https://doi.org/10.7326/m16-2575less2 UnreadUnread5 ViewsViews