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Comprehensive Evaluation of Hepatitis C Patient Curtis Barry

Learn about key aspects of initial history and physical examination, recommended laboratory studies, immunizations for chronic HCV patients, screening for liver disease contributors, and essential summary elements for patient evaluation.

charlesperkins
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Comprehensive Evaluation of Hepatitis C Patient Curtis Barry

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  1. Initial Evaluation of Hepatitis C patient Curtis Barry ECHO January 6, 2017

  2. Disclosure Statement I have no potential conflicts of interests to report

  3. Key Aspects of History and Physical Examination • When and how diagnosed • Risk factors • Injection drug use: when, how long, rehab • Nasal cocaine • Blood transfusion • Tattoos and body piercing • Sexual exposures • Family exposures • Work-up to date • Prior treatment status • Comorbidities • Other known liver diseases, hepatotoxic drugs and alcohol • Psychiatric • Family history of liver disease • Current medications

  4. Key Aspects of History and PhysicalExamination (Continued) Scleral icterus Jaundiced Ascites Extrahepatic manifestations (will do separate didactic)

  5. Recommended Laboratory Studies AfterInitial Diagnosis • General • Hepatic profile • Renal profile • Complete blood cell count with differential • Disease-related • HCV RNA quantitative • HCV genotype • Hepatitis B profile • hepatitis A virus antibody (IgG) • Alpha fetoprotein or baseline ultrasound (optional) • HIV testing • Question advanced fibrosis (will do another didactic)

  6. Immunizations for Persons With Chronic HCV • Hepatitis A virus - Test for hepatitis A antibody IgG - Vaccinate twice, 6 months apart, or use • Hepatitis B virus - Test for HBsAb - Vaccinate 3 times (0, 1, and 6 months) or use - For immunosuppressed patients consider double-dose vaccine series combination vaccine

  7. Screening for Other Causes andContributors of Liver Disease • Evaluation of other diseases optional but recommended if advanced fibrosis or cirrhosis is present

  8. Summary • Key elements for evaluation of a patient with HCV: • Detailed liver-focused history • Liver-directed PE • Evaluation of lab tests that help stage liver disease and determine if comorbidites are present • Prevention of other liver diseases is important: • Vaccinate for Hep A and B if needed • Determine if advanced fibrosis or cirrhosis is present

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