Patient presentation
T.T., a 35 year old male, presented to the hospital inebriated,
complaining of right abdominal pain, fatigue, nausea and vomiting, and
itching of the skin. According to family, his past medical history
included chronic alcohol abuse, former drug use, hepatitis C, and HIV.
After being diagnosis with hepatitis C a few years back, T.T. attempted to
withdraw from his alcohol consumption. Unfortunately, a year and a half
ago, the patient lost his job and relapsed to his drinking habits,
drinking up to a bottle of vodka per day. Upon further examination, the
patient’s skin and sclera were mildly jaundiced, ascites was present, his
temperature was 102°F, and all other vital signs were normal. The patient
was transferred to the MICU for further management.
Diagnosis
Upon admission into the MICU, blood tests, including a hepatic panel,
ELISA, RIBA, and HCV RNA, and coagulation panel was taken. The ELISA,
RIBA, and HCV RNA all came back to be positive for hepatitis C antibodies.
AST/ALT ratio- 2:1, AST and ALT levels were elevated; prothrombin time was
prolonged; hyperbilirubinemia, hypoalbuminemia, and hyperammonemia were
all present. Through the lab values, physical examination, and past
medical history, these are all consistent of the patient having chronic
hepatitis secondary to HCV.
Prognosis
Many patients who are infected with hepatitis C will eventually develop
the chronic form of it. The chance of removing the hepatitis C virus from
the blood with treatment is over 90% for some people. Even if treatment
does not remove the virus, it can reduce the chance of severe liver
disease. Hepatitis C is one of the most common causes of chronic liver
disease in the United States today. People with this condition may have
cirrhosis of the liver and/or hepatocellular cancer. Despite liver
transplant, hepatitis C usually comes back and can lead to cirrhosis of
the new liver.
Treatment
After admitting the patient and receiving the lab values back, T.T. was
monitored for signs and symptoms of withdrawal. The patient was started on
PRN IV lorazepam 1mg q2-3hrs for withdrawal symptoms. Additionally, the
patient was started on pegylated interferon alfa and ribavirin, antiviral
medications. Electrolytes were also monitored daily and replaced according
to the hospital protocol. A liver biopsy was done. The patient’s fluid
status was monitored and maintained. Additionally, the patient had an
abdominal tap to relieve the pressure from the fluid that was building up
in his abdomen. The fluid was then sent to the lab for further assessment.
Outcome
After a few days of monitoring and care, the patient sobered up and was
stable. The patient was then downgraded and transferred to a monitored
floor.
Case created by Tina Thieu, 2011.