Case Study Analysis: Bertha’s Hepatitis C Management

 

Case Study Analysis: Bertha’s Hepatitis C Management

Patient Overview

Patient: Bertha
Age: 58
Ethnicity: Hispanic
Presenting Issues: History of hepatitis C, elevated ALT levels, and mild tenderness in the right upper quadrant.

Clinical Background

– Past Medical History: Hypertension, dyslipidemia, hepatitis C.
– Family History: Unremarkable.
– Social History: Works as a case manager, married with two children, denies use of illegal drugs or alcohol, no tattoos.
– Medications: Hydrochlorothiazide (HCTZ) 12.5 mg daily, Atorvastatin 20 mg daily.
– Allergies: No known drug or food allergies.

Vital Signs

– Temperature: 96.8°F
– Pulse: 76 bpm
– Respiratory Rate: 25 breaths/min
– Oxygen Saturation (SaO2): 91%
– Blood Pressure: 138/80 mmHg
– Weight: 174 lbs
– Height: 63 inches

Diagnostic Studies to Confirm Diagnosis

To confirm the diagnosis of hepatitis C and assess the extent of liver damage, the following diagnostic tests should be considered:

1. HCV RNA Test (Polymerase Chain Reaction – PCR): This test quantifies the viral load in the blood and confirms active infection.
2. HCV Genotype Test: Determines the specific strain of HCV, which is essential for treatment planning.
3. Liver Function Tests (LFTs): To monitor liver function and look for any further elevation in liver enzymes.
4. HCV Antibody Confirmation Test: Given that Bertha’s lab results indicated a positive HCV antibody test, confirmation via a more specific test such as a recombinant immunoblot assay (RIBA) may be warranted.
5. Liver Biopsy or Imaging Studies (FibroScan or Elastography): To assess the degree of fibrosis or cirrhosis and evaluate the extent of liver damage.

Differential Diagnosis

The most likely differential diagnoses for Bertha’s condition include:

1. Chronic Hepatitis C Infection: Given her history of blood transfusion and positive HCV antibody test.
2. Non-Alcoholic Fatty Liver Disease (NAFLD): Considering her weight and mild ALT elevation; could be contributing to hepatic tenderness.
3. Chronic Hepatitis B Infection: Less likely as there are no reported risk factors or symptoms suggesting this.
4. Alcoholic Liver Disease: Although she denies alcohol use, this remains a differential until further evaluated.
5. Autoimmune Hepatitis or Other Chronic Liver Diseases: These may present similarly but are less likely given her history.

Plan of Treatment

1. Confirmatory Testing:

– Order HCV RNA PCR to confirm active infection and quantify viral load.
– Perform HCV genotype testing to determine treatment plan.

2. Management of Hepatitis C:

– If confirmed as chronic hepatitis C, initiate antiviral therapy as per guidelines (e.g., Direct-Acting Antivirals such as Sofosbuvir/Velpatasvir). The choice of medication will depend on genotype and presence of liver fibrosis.

3. Monitor Liver Function:

– Continue monitoring LFTs periodically to assess liver function.

4. Lifestyle Modifications:

– Discuss dietary changes to manage hypertension and dyslipidemia.
– Encourage weight loss to reduce risk of NAFLD.

5. Regular Follow-Up:

– Schedule follow-up appointments for ongoing assessment and monitoring of treatment efficacy.

Emergent Referrals Needed

1. Gastroenterology/Hepatology Referral:

– A referral to a specialist is recommended for further evaluation and management of chronic hepatitis C, particularly if advanced liver disease is suspected.

2. Dietitian Referral:

– Consider referring to a dietitian to assist with dietary modifications that can help manage her hypertension, dyslipidemia, and overall liver health.

3. Mental Health Evaluation (if needed):

– While her depression scale was negative, continuous mental health support may be beneficial considering the potential emotional impact of a chronic illness diagnosis.

Conclusion

This case highlights the importance of comprehensive evaluation and management strategies for patients with hepatitis C. Early confirmation through appropriate diagnostic tests, followed by timely referral and treatment, can significantly affect patient outcomes. Regular monitoring and support are vital components in managing chronic hepatitis C effectively.