Posted: December 13th, 2022
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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 clinical manifestations and treatment strategies essays.
Patient diagnosis: Acute Hepatitis C.
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Thank you for your thorough post. As a provider, there are many resources available to help us treat this population. You may want to look at the ECHO project and keep this resource for clinical: https://www.hcvguidelines.org/
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The clinical manifestation of Acute infection with Hep C can be deceptive as most patients are typically asymptomatic as seen with our patient Mike who denied any abdominal pain, nausea, vomiting or jaundice. These symptoms are typically notable in chronic hepatitis once the disease has progressed causing liver damage and injury. Hepatitis C virus is responsible for most persistent viral infections of the liver, chronic hepatitis, liver cirrhosis and/ or hepatocellular carcinoma. (Vashakidze et al 2016). Other manifestations of liver damage caused by hepatitis C virus (HCV) are fatigue, anorexia, headache, poor appetite, dark urine, jaundice, clay-colored stool, and liver pain upon palpation in the icteric phase which begins about 1 to 2 weeks after the prodromal phase (Huether et al., 2020). More advanced manifestations include fluid buildup in your abdomen (ascites), Confusion, drowsiness and slurred speech (hepatic encephalopathy). The strategies important to curtailing the rising prevalence of disease include the efficient diagnosis of acute hepatitis through adequate history taking and laboratory values and most importantly the management and treatment of the disease. The major treatment strategies for hepatitis C include direct-acting antiviral (DAA) therapy which is both low cost and effective (Shiha et al., 2020). The use of interferon-free, direct acting antiviral (DAA) agents for chronic HCV essentially result in sustained virologic response [SVR] and this is considered a functional cure for hepatitis. (Tang et al 2016)
References
Gayam, V., Mandal, A. K., Khalid, M., Shrestha, B., Garlapati, P., & Khalid, M. (2018).Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case reportand literature review. Journal of community hospital internal medicine perspectives, 8(5),311–314 Hepatitis C clinical manifestations and treatment strategies essays. https://doi.org/10.1080/20009666.2018.1514933
Hepatitis C questions and answers for health professionals. (2020, September 8). Centers forDisease Control and Prevention. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#c3Huether, S., McCance, K., and Brashers, V. (2020). Understanding
Shiha, G., Soliman, R., Mikhail, N. N. H., & Easterbrook, P. (2020). An educate, test and treateffectiveness in 73 villages. Journal of Hepatology, 72(4), 658– infection. Infectious agents and cancer, 11, 29. https://doi.org/10.1186/s13027-016-0076-7Vashakidze, E., Mikadze, I., & Pachkoria, E. (2016). EPIDEMIOLOGY OF CLINICALLY(258), 37–39.less0 UnreadUnread
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