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Sample Essay Paper on Hepatitis Case Study

Hepatitis Case Study

Hepatitis is an inflammation of the liver owing to a variety of causes, leading to damage to hepatocytes and cell death. Viral infections are a major factor in this inflammation, and they lead to significant levels of morbidity and mortality. Viral hepatitis could result from infections with any of five known viruses that target the liver - Hepatitis A, B, C, D, and E. The symptoms or clinical manifestations of infection with the viruses are highly similar, although they differ in terms of the modes of spread and models of prevention. Healthcare practitioners have to conduct thorough assessments of symptoms and clinical manifestations in patients based on subjective information from the patient and objective data from laboratory tests to understand the problem and develop an effective course of treatment.

In the case study, John presents a number of symptoms. He has jaundice, yellow color of skin and mucous membranes owing to an accumulation of bile pigments in blood and the deposition of these pigments in body tissue. Jaundice is not a disease but a sign of underlying disease that occurs when the serum bilirubin level exceeds 3mg per dL (Fargo et al., 2017). Acute jaundice is often a sign of intrahepatic disorders, including viral hepatitis, but other diseases such as drug-induced liver injury or alcoholic liver disease are also important causes. John also reports nausea for the past two weeks, loss of weight, fatigue, and clay-colored stools. It is imperative to obtain more subjective and objective data to understand John’s problem, hence decide the best course of treatment. The subjective data that is necessary relates to the patient’s lifestyle and history of health issues. This information includes:

§  Whether the patient uses drugs, alcohol, or other toxic substances

§  Travel habits

§  Sexual practices and lifestyle

§  Personal and family history, including history of inherited disorders of hemolytic disorders

§  Duration of the jaundice

§  Observations of co-occurring symptoms and signs, such as joint aches, myalgia, rash, and changes in stool and urine

§  Experiences of chills, fever, and right upper quadrant abdominal pain

Objective data from the patient in the diagnosis process would involve conducting laboratory tests. These tests are important to determine the etiology of jaundice. Objective data is necessary to eliminate other possible causes of jaundice and establish accuracy in the diagnosis of the patient’s problem. These tests include (Fargo et al., 2017):

§  A complete blood count to help identify hemolysis and evaluate for anemia and thrombocytopenia (which is common in cirrhosis)

§  Fractionated bilirubin test to differentiate between conjugated and unconjugated hyperbilirubinemia

§  Tests for alanine transaminase and aspartate transaminase enzymes to assess possible indications for hepatocellular damage.

§  Tests for alkaline phosphatase levels to test for biliary obstruction and parenchymal liver disease, or other physiologic or nonbiliary pathologic processes in kidney, bone, or intestines.

§  Tests for y-glutamyltransferase levels for possible indications of biliary obstruction and hepatocellular damage, or pancreatic disorders, renal disease, myocardial infarction, and diabetes mellitus.

John has then reluctantly revealed that he has a history of intravenous (IV) drug abuse. Despite undergoing rehabilitation therapy and stopping drug use for several years, he acknowledges that he had relapsed recently. This information raises the need for the initial evaluation process to diagnose John’s problem to include the laboratory tests mentioned above to rule out other potential causes of observed jaundice. The purpose of these initial tests was to yield clarity about the patient’s jaundice symptoms and the possible diagnosis of the patient. Nonetheless, the tests have to yield such clarity, thereby raising the need to conduct additional tests to identify the possibility of hepatitis. The following are the observations and outcomes of the laboratory tests:

§  VS: T-100.2, P-92, R-18. Skin and sclera icteric, diffuse lymphadenopathy, liver dullness 10.5 cm below the right costal margin at the midclavicular line. The liver is tender to palpation.

§  WBC of 15,000, T. Bili 21 ALT 1750 HbsAG +, HbsAB-, HbcAB+, anti HAV-, antiHCV+

These outcomes from the tests indicate a diagnosis of acute hepatitis C. The combination of subjective information from the client and objective information from laboratory tests has yielded adequate evidence to identify hepatitis C as the patient’s diagnosis. The patient’s lifestyle, featuring injection-drug use, presents heavy risks for infection with the virus. New infections of the virus are usually asymptomatic, and recent infections with the virus are difficult to diagnose (WHO, 2020). Infection is also usually undiagnosed even when patients develop chronic disease until symptoms develop into secondary, serious liver damage (WHO, 2020). The fact that the patient has experienced a significant range of symptoms indicates that he has sustained considerable liver damage from the infection. The laboratory tests, specifically the anti-HCV serological test, returned an anti-HCV+ result, indicating the presence of HCV (hepatitis C virus) antibodies in the patient.

Following the positive anti-HCV test result, an additional nucleic acid test for HCV ribonucleic acid (RNA) is necessary to confirm the chronic infection. The World Health Organization (2020) notes that almost a third (30%) of people infected with HCV clear the infection spontaneously through a strong immune response without the need for treatment. Despite lacking the infection after the immune response, these individuals may continue to show a positive test result for anti-HCV antibodies (WHO, 2020). In this context, the extra nucleic acid test for HCV ribonucleic acid (RNA) is appropriate to indicate whether the chronic infection with HCV is still present. Nonetheless, it is also important to note the observable symptoms in the patient (jaundice) and his complaints of nausea for the past two weeks, loss of weight, fatigue, and clay-colored stools in the assessment.

The initial plan in treatment and care for the patient relates to the risks for the development of chronic hepatitis C and cirrhosis. Li and Lo (2015) note that 50-80% of patients with acute hepatitis C develop chronic infections and life-threatening complications, including cirrhosis and hepatocellular carcinoma. Hepatocellular carcinoma is the most common type of primary liver cancer, occurring most commonly in individuals with chronic liver diseases, such as cirrhosis caused by infections with hepatitis C or B. Epidemiological studies have also indicated that hepatitis C is associated with other clinical manifestations outside the liver, such as insulin resistance, glomerulopathies, and type 2 diabetes mellitus (Li & Lo, 2015). The nature of the patient’s condition, as discussed above, indicates an acute stage of the infection, hence a high risk for cirrhosis, end-stage liver disease, and hepatocellular carcinoma. In effect, the focus of the initial treatment should be to treat the patient’s condition and prevent the development of these serious complications that could undermine the quality of John’s life and potentially lead to death.

It is necessary to assess the degree of liver damage in the patient to achieve this goal of preventing the development of these serious complications. This assessment should target damage relating to cirrhosis and fibrosis. A variety of non-invasive tests, such as those described earlier in the diagnosis phase, or liver biopsy, could help in this objective. The results of these assessments are important to guide decision-making on the course of treatment that is vital to apply in the patient’s case to manage the disease effectively and prevent the complications. The focus of initial treatment for the patient's condition to prevent the complications should be on the administration of direct-acting antivirals (DAAs). Koustenis et al. (2020) note that DAAs are highly effective in the treatment of hepatitis C virus infections. The application of DAA therapy has illustrated high rates of sustained virological response. DAAs can cure most patients with HCV, and they are especially convenient because of the short duration of treatment (about 12-24 weeks) (WHO, 2020). Nonetheless, the presence or absence of cirrhosis is an important factor in the effectiveness of this treatment. At the end of week 24, following administration of the DAAs, it is necessary to assess the virologic response to the therapy in the patient.

In the longer-term, the plan for treatment of the patient and effective management of his condition may involve a broader range of options, including a liver transplant and lifestyle and behavioral changes. These options are necessary when the initial plan of care and subsequent efforts to manage the disease are ineffective in preventing the development of complications such as cirrhosis, end-stage liver disease, and hepatocellular carcinoma. A liver transplant is necessary when HCV causes serious damage to the liver, influencing a high risk for liver failure (Proeschold-Bell et al., 2018). It involves the surgical removal of an injured or damaged liver with a healthy one from a donor.

Besides a liver transplant, other behavioral and lifestyle changes are essential to incorporate in the management of HCV to improve the patient’s quality of life and prevent morbidity and mortality. It is important to educate the patient on the importance of self-care to minimize risks for the development of complications and recurrence of the disease. Some important changes in the lifestyle of the patient to manage the condition include the avoidance of alcohol and drugs, watching body weight to avoid overweight and obesity, hydration, physical exercise, and good nutrition. Alcohol is toxic to the liver, especially with cirrhosis, because it makes it harder for the treatment to rid the body of HCV. It worsens the condition and functioning of the liver and hence undermines the effectiveness of the management of HCV (Proeschold-Bell et al., 2018). Hydration is important in helping the body to remove toxins in the body. Overweight and obesity influence the deposit of fat in the liver, promoting the risk of fatty liver disease and worsening the condition and function of the liver. Good nutrition and physical activity are essential to help in weight loss and general improvements in health, which are essential in aiding the body’s immune response and the treatment to manage HCV effectively (Burnham et al., 2014). Good nutrition and physical activity also help in improving the functioning and health of the liver, thereby helping to manage HCV more effectively.

This paper illustrates the need for a complex and comprehensive series of tests to eliminate all possible causes of the primary presenting symptoms in the patient, including jaundice, nausea, loss of weight, fatigue, and clay-colored stools, and narrow down the possible causes to an accurate diagnosis of hepatitis. A comprehensive evaluation and understanding of both subjective data from the patient and objective data from lab tests are critical in this effort. The effectiveness of this process of identifying a diagnosis is critical because it lays the foundation for an appropriate plan of care and effective prescriptions to manage the patient’s condition and prevent complications.

 

References

Burnham, B., Wallington, S., Jillson, I., Trandafili, H., Shetty, K., Wang, J., & Loffredo, C. (2014). Knowledge, attitudes, and beliefs of patients with chronic liver disease. American Journal of Health Behavior 38(5): 737-744.Retrrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504206/

Fargo, M., Grogan, S., & Saguil, A. (2017). Evaluation of jaundice in adults. American Academy of Family Physicians. Retrieved from https://www.aafp.org/afp/2017/0201/afp20170201p164.pdf    

Koustenis, K., Anagnostou, O., Kranidioti, H., Vasileiadi, et al. (2020). Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting. Annals of Gastroenterology 33(2): 195-201. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049240/

Li, H., & Lo, S. (2015). Hepatitis C virus: Virology, diagnosis and treatment. World Journal of Hepatology 7(10): 1377-1389. Retrieved from https://www.wjgnet.com/1948-5182/full/v7/i10/1377.htm

Proeschold-Bell, R., EvON, d., Makarushka, C., Wong, J., Datta, S. ET AL. (2018). The Hepatitis C-Alcohol Reduction Treatment (Hep ART) intervention: Study protocol of a multi-center randomized controlled trial. Contemporary Clinical Trials 72: 73-85. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711183/

World Health Organization (WHO) (2020). Hepatitis C. WHO. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-

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