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Acute Hepatitis

Acute Hepatitis . Rachel Hart. Client Background. Teresa (Terri) Wilcox 22-year-old female Education: Full time college graduate student during the day Hours of work: An exotic dancer in the evenings to early morning Ethnic back ground: European American

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Acute Hepatitis

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  1. Acute Hepatitis Rachel Hart

  2. Client Background • Teresa (Terri) Wilcox • 22-year-old female • Education: Full time college graduate student during the day • Hours of work: An exotic dancer in the evenings to early morning • Ethnic back ground: European American • Religious affiliation: Unitarian

  3. Anthropometric Data • Height: 5 feet 9 inches • Current weight: 130 pounds • Usual body weight: 145 pounds • Percent usual body weight: 90% • Moderate to severe malnutrition • BMI: 19.2 kg/m2 • Just within normal weight range

  4. Patient History • Relatively good health all her life, does have seasonal allergies, non smoker, non drug user, does drink 1-2 glasses of wine per week • Family history: hypertension, diverticulitis, cholecystitis, diabetes, peptic ulcer disease, bilateral breast cancer, leukemia, cirrhosis, amyotrophic lateral sclerosis • Medications: • YAZ, 1 tab po daily • Allegra, 60 mg poqd • Complains of fatigue, aches, and pains, vague right upper quadrant pain, and nausea and anorexia

  5. Primary Complaint “I just feel so tired. I can hardly move, my joints ache so much, and my muscles feel sore.”

  6. Physical Exam • General appearance: Tired-looking, college-aged female • Eyes: Wears contact lenses to correct myopia, PERRLA • Extremities: Normal muscle tone, normal ROM • Abdomen: Pierced umbilicus; upper right abdomen guarding

  7. Nutrition History • General: Appetite usually good, but has not had one in the last few weeks • 24 –hour recall showed that she had not consumed adequate nutrition • Usual dietary intake: • Breakfast: Usually cereal and orange juice • Lunch: Takes lunch to eat on campus or gets fast food at the Student Union • Dinner: Eats at work, usually carryout (Chinese food) • Vitamin and mineral intake: • 400 mg vitamin E qd • 500 mg calcium multivitamin/ mineral qd

  8. Abnormal Chemistry Bilirubin • Normal: ≤ 0.3 mg/dL • Terri: 1.5 mg/dL (high) ALT (alanineaminotransferase) • Normal: 4-36 U/L • Terri: 340 U/L (high) AST (aspartateaminotransferase) • Normal: 0-35 U/L • Terri: 500 U/L (high) ALP (alkaline phosphatase) • Normal: 30-120 U/L • Terri: 303 U/L (high) LDH (lactate dehydrogenase) • Normal: 208-378 U/L • Terri: 695 U/L (high) HDL-C • Normal: >50 mg/dL • Terri: 50 mg/dL (low)

  9. Abnormal Hematology WBC (white blood cell) • Normal: 4.8-11.8 x 10^3/mm^3 • Terri: 12.6 x 10^3/mm^3 (high) HGB (hemoglobin) • Normal: 12-15 g/dL • Terri: 11.5 g/dL (low) HCT (hematocrit) • Normal: 37-47 % • Terri: 36 % (low) Platelet count • Normal: 140- 144 x 10^3/mm^3 • Terri: 140 x 10^3/mm^3 (low) PT (prothrombin time) • Normal: 11-16 sec • Terri: 17 sec (high)

  10. Abnormal Urinalysis Protein • Normal: NEG mg/dL • Terri: 1+ mg/dL

  11. Diagnosis and Treatment Diagnosis • Acute hepatitis C Treatment • Vitamin B-complex supplement • High-kcal, high-protein diet • Bed rest • Continued Allegra • Alternative contraception

  12. What is Acute Hepatitis C? • Means inflammation of the liver. • Acute hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. • For most people, acute infection leads to chronic infection. • Hepatitis A, B, C, D, E are diseases caused by five different viruses.

  13. Etiology • People can become infected with the hepatitis C virus during such activities as: • Sharing needles, syringes, or other equipment to inject drugs • Needle stick injuries in health care settings • Being born to a mother who hashepatitis • Less commonly, a person can also get hepatitis C virus through: • Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes • Having sexual contact with a person infected with the hepatitis C virus

  14. Symptoms • Approximately 70%–80% of people with acute hepatitis C do not have any symptoms. • Some people, however, can have mild to severe symptoms soon after being infected, including: • Fever • Fatigue • Muscle aches • Loss of appetite • Nausea • Vomiting • Abdominal pain • Dark urine • Clay-colored bowel movements • Joint pain • Jaundice

  15. Diagnostic Measures • Acute hepatitis is often tested for because of the appearance of symptoms • Blood tests: • Anti-HCV: • Looks for and measures antibodies to HCV • HCV RNA: • Qualitative test: detects the presence or absence of HCV RNA • Quantitative test: measures the number of copies of HCV RNA in the blood

  16. Diagnostic Measures • Blood tests may help to: • Determine whether a person has the hepatitis C virus • Measure the quantity of the hepatitis C virus in the blood • Evaluate the genetic makeup of the virus, which helps determine treatment options

  17. Treatment • Primary medical treatments: • Regenerate liver cells and prevent and delay formation of chronic hepatitis with drugs • 3-MU interferon alfa-2b sq qd • Ribavirin (Rebetol) 200 mg po bid • Bed rest • Medical nutrition therapy • High calorie, high protein diet • Micronutrient supplementation

  18. Medical Nutrition Therapy • Doctors usually recommend rest, adequate nutrition and fluids. • Want to avoid further damage of the liver and regenerate cells. • Consult dietitian: • Increased energy needs • 30-35 kcal/kg body weight • Adequate protein • 1-1.2 g/kg body weight • 30-40% of kilocalories from fat • Multivitamin • Abstain from alcohol

  19. Client Energy and Protein Needs • Kilocalorie needs: • 30-35 (kcal) x 65.9 (kg)= 1,977 to 2,307 kilocalories per kilogram of body weight per day • Range of: 2,000-2,300 kilocalories per day • Protein needs: • 1-1.2 (grams) x 65.9 (kg)= 65.9-79.1 grams of protein per kilogram of body weight per day • Range of: 66-79 grams per day

  20. Prognosis • Out of every 100 people infected with the Hepatitis C virus: • About 75–85 people will develop chronic Hepatitis C virus infection; of those, • 60–70 people will go on to develop chronic liver disease • 5–20 people will go on to develop cirrhosis over a period of 20–30 years • 1–5 people will die from cirrhosis or liver cancer

  21. Questions??

  22. References • Hepatitis C. (2102). Lab Tests Online. Retrieved from http://labtestsonline.org/understanding/analytes/hepatitis-c/tab/test • Hepatitis C. (2102). National Institutes of Health [NIH]. Retrieved from http://www.nlm.nih.gov/medlineplus/hepatitisc.html •  Hepatitis C information for the public. (2012). Center For Disease Control andPrevention. Retrieved from http://www.cdc.gov/hepatitis/c/index.htm • Hepatitis C: Nutrition care. (2012). Dietitians of Canada. Retrieved from http://ww.bccdc.ca/NR/rdonlyres/EA6145BC-FF7B-448A-B5E6-6EDED47D878C/0/Hep_Guidelines_HCVNutritionCare.pdf • Interferon and ribavirin treatment side effects. (2012). Department of Veteran Affairs. Retrieved from http://www.hepatitis.va.gov/provider/reviews/treatment-side-effects.asp

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