Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology

Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology

Mike, a 23-year-old Caucasian male, has been admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. The psychiatrist ordered liver function tests (LFTs) to monitor the valproate therapy. The LFTs revealed abnormalities: ALT 1178 u/L and AST 746 u/L. Surprisingly, Mike was asymptomatic, denying any fever, abdominal pain, nausea, vomiting, or jaundice. He also denied using other medications or alcohol but admitted to using illicit IV drugs for the past eight weeks. Additionally, he had never received a blood transfusion. Alongside Depakote, Mike is taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd.

Further blood work showed a direct bilirubin level of 1 mg/dL, alkaline phosphatase (alk phos) at 188 u/L, and an initial negative anti-HCV result on hospital day 1 but a positive result on day 3. HCV-RNA PCR confirmed the presence of hepatitis C.

Patient Diagnosis: Acute Hepatitis C.

1. Enumerate some common clinical manifestations of Hepatitis C and elaborate on primary treatment approaches.

Hepatitis C is a widespread viral infection affecting approximately 185 million individuals globally, with about 215,000 cases in the U.S. (Tang et al., 2016). It is linked to liver inflammation that can lead to severe liver damage. The transmission occurs through contaminated blood (Huether et al., 2020). Clinical signs of hepatitis C encompass reduced appetite, flu-like symptoms, fatigue, abdominal pain, jaundice, weight loss, and confusion. Notably, these symptoms may not manifest until the liver sustains significant damage.

The Cell, Inflammation, Repair, Regeneration, and Fibrosis discussion essays

The treatment regimen for chronic hepatitis C typically involves prescription antiviral drugs to combat the virus, monitoring for liver damage, and lifestyle modifications to mitigate disease severity. The cornerstone of treatment involves the use of direct-acting antiviral tablets (DAAs), recognized as the most effective and safest medications available (NHS, 2021). These medications are usually taken over 8 to 12 weeks and include options like simeprevir and sofosbuvir, either individually or in combination.

References:

– Tang, L., Marcell, L., & Kottilil, S. (2016). Systemic manifestations of hepatitis C infection. Infectious agents and cancer, 11(1), 1-8.
– Huether, S., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier.
– NHS. (2021). Treatment: Hepatitis C. NHS.us.

The initial clinical manifestation of hepatitis C often presents as a mixed cryoglobulinemic syndrome, impacting blood vessels and other organs like the kidneys and skin. B cell Non-Hodgkin’s lymphoma, which has a strong association with chronic HCV infection, is another common manifestation (Tang et al., 2016). Diabetes mellitus type 2 and kidney damage are also linked to HCV, potentially exacerbating insulin resistance. Additionally, hepatitis C can affect the brain, leading to neurological impairment. Other manifestations include sicca syndrome, thyroid abnormalities, Mooren’s corneal ulcers, Porphyria cutanea tarda, neuropsychiatric disorders, and cardiovascular disease.

The prevalence of chronic hepatitis C virus (HCV) infection is estimated to be between 1.2% and 1.7% in the adult global population, affecting 62 to 89 million people (Kish, Aziz, & Sorio, 2017). The disease often progresses to chronic hepatitis, hepatic fibrosis, liver cirrhosis, and hepatic carcinoma. Notably, most individuals with acute hepatitis C are asymptomatic until the infection becomes chronic (Zhao et al., 2018). Acute hepatitis C is defined as infection within 6 months of exposure, while chronic hepatitis C persists lifelong, leading to complications. Typical symptoms include abdominal pain, fatigue, sleep disturbances, depression, musculoskeletal pain, and jaundice (Evon et al., 2019).

In summary, hepatitis C can manifest with various clinical symptoms, and early diagnosis and treatment are crucial to prevent severe liver damage and complications.

References:

– Kish, T., Aziz, A., & Sorio, M. (2017). Hepatitis C in a New Era: A Review of Current Therapies. P & T: A Peer-Reviewed Journal for Formulary Management, 42(5), 316–329.
– Zhao, N., Zheng, W., Wu, D., Wang, X., Yang, W., Yuan, L., … Huang, F. (2018). Hepatitis C spontaneous clearance or treatment-induced clearance: Regulatory analyses and perspectives. Hepatology, 67(6),

2430-2448.
– Evon, D. M., Sarkar, S., Amador, J., Lok, A. S., Sterling, R. K., Stewart, P. W., … Naeger, L. (2019). Patient-reported symptoms during and after direct-acting antiviral therapies for chronic hepatitis C: The PROP UP study. Journal of Hepatology, 71(3), 486-497.

Additionally, hepatitis C can be asymptomatic in many cases, making it crucial to screen individuals with high-risk behaviors, such as intravenous drug abuse, to improve healthcare outcomes. Treatment options have evolved over the years, with pan-genotype direct-acting antivirals (DAAs) becoming the preferred choice due to their high efficacy and tolerability (Harrington et al., 2018).

References:

– Harrington, P. R., Komatsu, T. E., Deming, D. J., Donaldson, E. F., O’Rear, J. J., & Naeger, L. H. (2018). Impact of hepatitis C virus polymorphisms on direct-acting antiviral treatment efficacy: Regulatory analyses and perspectives. Hepatology, 67(6), 2430-2448.

The clinical course of hepatitis C typically progresses through three phases following the incubation phase. The prodromal-preicteric phase, occurring approximately 2 weeks after exposure, is characterized by symptoms such as fatigue, anorexia, malaise, nausea, vomiting, headache, cough, and low-grade fever. During this phase, patients are highly contagious (Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology).

The icteric phase follows, beginning one to two weeks after the prodromal phase and lasting up to six weeks. It is marked by jaundice, dark urine, and clay-colored stools. Physical examination reveals an enlarged, smooth, and tender liver, with percussion or palpation causing pain. Fatigue and abdominal pain persist or intensify during this phase. However, patients with chronic HCV infection may not exhibit jaundice in this phase and may remain undiagnosed (Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology).

The recovery phase, the third phase, commences with the resolution of jaundice, typically six to eight weeks after the initial exposure. During this phase, overall symptoms diminish, but the liver remains enlarged and tender. Liver function and enzyme levels gradually return to normal, typically two to twelve weeks after the onset of jaundice (Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology).

Diagnosis of HCV infection relies on the presence of anti-HCV antibodies, and HCV RNA quantification is essential to assess viral load and guide antiviral therapy for chronic infection. Currently, no HCV vaccine is available in the USA, emphasizing the importance of early detection and treatment, especially in high-risk populations like intravenous drug users (Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology).

References:

– Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology.
– Horsley-Silva, J. L., & Vargas, H. E. (2017). New Therapies for Hepatitis C Virus Infection. Gastroenterology & Hepatology, 13(1), 22–31.

In conclusion, acute HCV infection can have severe consequences, often going undiagnosed, and leading to chronic hepatitis C and liver failure. Many infected individuals remain asymptomatic, and the symptoms can be vague and nonspecific. Recent advancements in antiviral treatments, particularly the introduction of direct-acting antivirals, have significantly improved the efficacy and tolerability of hepatitis C therapy.

References:

– Horsley-Silva, J. L., & Vargas, H. E. (2017). New Therapies for Hepatitis C Virus Infection. Gastroenterology & Hepatology, 13(1), 22–31.
– Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology.

Hepatitis C Discussion – NSG-530-IKC – Advanced Pathophysiology

Mike is a 23-year-old white male admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. His psychiatrist ordered LFT’s to follow the valproate therapy. LFT’s were abnormal: ALT 1178 u/L, AST 746 u/L. the patient was asymptomatic. He denies fever, abdominal pain, nausea, vomiting or jaundice. He denies using other medication or alcohol but admits using illicit IV drugs starting about 8 weeks ago and continuing to present. He never had a blood transfusion. Aside from Depakote he is presently taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd.
Other blood work: Direct bili 1 mg/dL, alk phos 188 u/L, anti-HCV negative on hospital day 1, positive on day 3. HCV-RNA PCR positive. Hep A, B, and D markers negative Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology.

Patient diagnosis: Acute Hepatitis C.

1. List some clinical manifestations typically seen in Hepatitis C and major treatment strategies.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.

 

• • Hepatitis C is a long-term viral infection that affects about 185 million people globally. Approximately 215,000 people have this disease in the U.S.  (Tang et al. 2016). It is associated with liver inflammation, which may sometimes lead to serious and severe liver damages. The disease spread through contaminated blood (Huether et al. 2020). Some of the major signs and symptoms of this condition include loss of appetite, flu-like symptoms, fatigue, abdominal pain, jaundice, weight loss, and confusion. These symptoms can sometimes be mistaken for other conditions since the disease doesn’t show noticeable symptoms until it damages the liver.The treatment plan for individuals with chronic hepatitis c involves taking prescription drugs to fight the virus, testing for liver damages, and lifestyle changes to reduce the disease’s severity Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology. Treatment involves taking direct-acting antiviral tablets (DAA), which are believed to be the most effective and safest medicines available in the healthcare system. Patients should take these medications between 8 and 12 weeks (NHS, 2021). Some of these drugs include simeprevir, sofosbuvir, and their combinations.Huether, S., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7^th ed. Elsevier Mosby.Tang, L., Marcell, L., & Kottilil, S. (2016). Systemic manifestations of hepatitis C infection. Infectious agents and cancer, 11(1), 1-8. https://core.ac.us/download/pdf/81269554.pdf less1 UnreadUnread2 ViewsViews
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  • NHS, (2021). Treatment: Hepatitis C. NHS.us. https://www.nhs.us/conditions/hepatitis-c/treatment/
  • References
  • The first clinical manifestation seen in hepatitis c is a mixed cryoglobulinemic syndrome, which can affect the patients’ blood vessels and manifest on other body organs including the kidney and skin. The second manifestation is B cell Non-Hodgkin’s lymphoma, which is highly associated with chronic HCV infection since 1994 (Tang et al. 2016). The other manifestations are diabetes mellites type 2 and kidney damage. Several researchers have proved that there is an association between HCV, diabetes and increased insulin resistance. HCV can also affect the brain leading to neurological impairment Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology. The other manifestations include sicca syndrome, thyroid abnormalities, Mooren’s corneal ulcers, skin manifestations such as Porphyria cutanea tarda, Neuropsychiatric disorders, and Cardiovascular disease.
  • Hepatitis C the silent chronicitySubscribe
  • Caroline Otto posted Feb 25, 2021 6:26 PM
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  • The overall prevalence of chronic hepatitis C virus (HCV) infection has been estimated at between 1.2% and 1.7% in the adult global population. This suggests that 62 -89 million people are affected by this disease (Kish, Aziz, & Sorio, 2017).People who are exposed to HCV have an estimated 75% to 85% likelihood of developing chronic infection. The Clinical Manifestations for hepatitis C are similar with all the different strains because they all cause inflammation of the liver, thereby causing symptoms that are similar. These similar symptoms include jaundice, nausea, dark urine, and right upper quadrant pain (Huether, McCance, & Brashers. 2020). Patients who are acutely infected will have moderate to high serum; aminotransferase elevations, and aspartate transaminase (AST), and alanine transaminase (ALT) levels.The first phase is known as the Prodromal -preicteric phase beginning about 2 weeks after exposure and ending with jaundice, often marked with fatigue, anorexia, malaise, nausea, vomiting, headache, a cough, and a low-grade fever. It is during this phase that the patient has the highest ability to transmit the virus to others Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology.The recovery phase is the third phase beginning with the dissolution of the jaundice, six to eight weeks after the initial exposure. The overall symptoms dissipate; however, the liver remains enlarged and tender. It is during this phase that the liver function and enzymes return to normal, two to twelve weeks after the onset of jaundice.The diagnosis of HCV infection is based on the presence of anti-HCV antibodies. HCV RNA quantification is important for assessment of the viral load to evaluate antiviral therapy for chronic HCV infection. To date there is no HCV vaccine in the USA. Primary health care is paramount. Individuals who exhibit high risk behaviors such as intravenous drug abuse should be identified and screened to improve overall healthcare outcomes. Treatment is costly. The overall management of this dreadful disease depends on an easily accessible health system that is available to everyone.        Horsley-Silva, J. L., & Vargas, H. E. (2017). New Therapies for Hepatitis C Virus Infection. Gastroenterology & hepatology, 13(1), 22–31 Kish, T., Aziz, A., & Sorio, M. (2017). Hepatitis C in a New Era: A Review of Current Therapies. P & T : a peer-reviewed journal for formulary management, 42(5), 316–329.less1 UnreadUnread3 ViewsViews
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  •            Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology 7^th ed. Elsevier Mosby
  • References:
  • In short, Acute HCV has devastating consequences, as it often goes undiagnosed, and causes irreparable damage often resulting in Chronic Hepatitis C and Liver Failure Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology. Patients who are infected often do not realize they have the disease and are not tested. Furthermore, the symptoms are vague and are not disease specific.
  • In the past HCV was treated with pegylated-interferon (PEG-IFN) alpha plus ribavirin (RBV) which was historically given for 24 or 48 weeks. However, this combination was not that successful and had some nasty side effects such as hemolytic anemia, flu-like symptoms, and psychiatric disturbances. There have been other treatments since then, but it was through a paradigm shift which occurred in late 2013 that Simeprevir (Olysio, Janssen) and sofosbuvir (Sovaldi, Gilead Sciences); which were released within weeks of one another, created the first oral once-daily treatments that were well tolerated and were able to produce sustained virologic response SVR rates greater than 90% either together in combination or with PEG-IFN plus RBV in select genotypes (Horsley-Silva & Vargas, 2017).
    The second phase is known as the Icteric phase and it begins one to two weeks after the prodromal phase and lasts up to six weeks, with jaundice, dark urine, and clay-colored stools. On physical examination the patient’s liver will be found to be enlarged, smooth, and tender, and percussion or palpation of the livers causes pain. The patient will still have fatigue as well as abdominal pain which will be persistent or will increase in severity. This phase is seen as the actual phase of the illness. Patients who develop chronic HCV infection will not exhibit signs of jaundice here and may never actually be diagnosed Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology.
  • The clinical course of hepatitis usually has three phases which follows through after the incubation phase.
  • If it were not for Mikes severe depression that caused him to seek out medical care, his Hepatitis C diagnosis would probably have gone unnoticed. Most patients who are acutely infected with HCV are asymptomatic (Huether, McCance, & Brashers, pg. 904).
  • Discussion 6Subscribe
  • Alfonsina Perez posted Feb 24, 2021 3:54 PM
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  • Hepatitis C is defined as an inflammatory process of the liver caused by the hepatitis C virus (Dirchwold et al., 2017. Patients with hepatitis C have an increased level in their Alaine Aminotransferase (ALT) of over ten times what is considered within normal limits (Dirchwold et al., 2017). Complications associated with chronic infection of the hepatitis C virus include hepatic fibrosis, liver cirrhosis, and hepatic carcinoma (Zhao et al., 2018). Unfortunately, many patients, about 85% of those with acute hepatitis, will develop chronic hepatitis. The high risk of developing chronic hepatitis is due to the fact that many patients with acute hepatitis do not show any symptoms until infection has developed into a chronic one (Zhao et al., 2018). Acute hepatitis C is when the infection occurs within 6 months of exposure (Huether et al., 2020). Chronic hepatitis C is lifelong, often leading to complications. Some of the symptoms associated with hepatitis C infection include abdominal pain, fatigue, sleep disturbance, depression, musculoskeletal pain and jaundice (Evon et al., 2019).    Petta, N. G., Borzi, S., Tanno, F., Ridruejo, E., Barreyro, F., Shulman, C., Plaza, P.,Evon, D. M., Sarkar, S., Amador, J., Lok, A. S., Sterling, R. K., Stewart, P. W., Reeve, B. B.,Harrington, P. R., Komatsu, T. E., Deming, D. J., Donaldson, E. F., O’Rear, J. J., & Naeger, L.Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Zhao, N., Zheng, W., Wu, D., Wang, X., Yang, W., Yuan, L., Niu, Z., Jiang, X., Huang, F., &hepatitis C spontaneous clearance or treatment‐induced clearance Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology. Journal of Medicalless1 UnreadUnread5 ViewsViews
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  • Virology, 90(12), 1787-1792. https://doi.org/10.1002/jmv.25256
  • Li, Z. (2018). Clinical value of hepatitis C virus core antigen levels in monitoring acute
  •             Pathophysiology 7^th ed.  Elsevier Mosby.
  • K. (2018;2017;). Impact of hepatitis C virus polymorphisms on direct‐acting antiviral treatment efficacy: Regulatory analyses and perspectives. Hepatology (Baltimore, Md.), 67(6), 2430-2448. https://doi.org/10.1002/hep.29693
  • Serper, M., Reau, N., Rajender Reddy, K., Di Bisceglie, A. M., Nelson, D. R., Golin, C. E., Lim, J. K., & Fried, M. W. (2019). Patient-reported symptoms during and after direct-acting antiviral therapies for chronic hepatitis C: The PROP UP study. Journal of Hepatology, 71(3), 486-497. https://doi.org/10.1016/j.jhep.2019.04.016
  • Carbonetti, R., Tadey, L., Schroder, T., & Fainboim, H. (2017). Clinical epidemiology of acute hepatitis C in south america. Journal of Medical Virology, 89(2), 276-283. https://doi.org/10.1002/jmv.24588
  • Dirchwolf, M., Marciano, S., Mauro, E., Ruf, A. E., Rezzonico, L., Anders, M., Chiodi, D.,
  • References
  •             Although hepatitis C may not always require treatment as the person’s immunity may be able to clear the infection, antiviral medication may be prescribed in instances when treatment is required. Pan- genotype direct-acting antivirals (DAA’s) are the treatment of choice of hepatitis C (Harrington et al., 2018) Hepatitis C discussion essays – NSG-530-IKC – Advanced Pathophysiology.