Please help me answering the questions of this clinical case A 49-year-old man c

Question

Please help me answering the questions of this clinical case

A 49-year-old man comes to your office, requesting testing for hepatitis C. He recently attended his 25-year college reunion, where he heard from a mutual acquaintance that an old friend was seriously ill with cirrhosis due to hepatitis C. The patient became very concerned because he had "partied" with this friend during a brief period of experimentation with injection drugs while in college. The patient is otherwise healthy and denies any symptoms except for occasional fatigue after a long day at work. Physical examination of the patient is unremarkable. There are no stigmata of chronic liver disease. The patient returns several weeks later to discuss his test results. His HCV antibody test is positive. A liver panel obtained that day shows an ALT of 48 IU/L (normal range, 0-20) and an AST of 39 IU/L (0-31). His albumin and total bilirubin are within normal limits. He is extremely anxious about his liver, as he has been in contact with his old college friend and learned that his friend is now on the waiting list for a liver transplant.

Questions:

How do you interpret his tests (HCV Ab test, ALT, and ALS)? Which of them is more indicative of liver damages?

Having established that the patient has hepatitis C with elevated liver enzymes, the next step is to determine the severity of his liver disease. What are the only direct means to evaluate the extent of the liver injury?

What are the chances for this guy to develop cirrhosis?

The patient is concerned that he may transmit the virus to his wife or children. They are tested and are found to be negative for HCV antibody. He is relieved but asks for advice to prevent infecting them. What are you going to tell him?

The patient's liver biopsy shows mild to moderate inflammatory activity and portal and periportal fibrosis (Stage 2). He is relieved to find out that he does not have cirrhosis, but remains very concerned about his hepatitis and wants to do everything possible to "get rid of" the hepatitis C. He asks about treatment for his HCV. What do you recommend?

Explanation / Answer

Answer:

Based on the given information, the patients symptoms are:

1) How do you interpret his tests (HCV Ab test, ALT, and ALS)? Which of them is more indicative of liver damages?

A positive HCV Ab (Hepatitis C Virus antibody) test indicates infection with hepatitis C virus is due to the presence of hepatitis C antibodies in the bloodstream.

Alanine amino transferase (ALT test) and AST test (Aspartate aminotransferase test): Both of these tests (marker enzymes) are performed to detect and determine the extent of liver damage and are part of a comprehensive assessment of liver profile test to diagnose liver damage or as an initial screening for liver disease.

The levels of these enzymes are elevated in liver disease like hepatitis C. Very high levels of ALT (usually more than 10 times the normal level) are indicative of acute hepatitis due to viral infection.

Having established that the patient has hepatitis C with elevated liver enzymes, the next step is to determine the severity of his liver disease. What are the only direct means to evaluate the extent of the liver injury?

To evaluate the extent of liver injury, liver panel test (also called as liver function test) are performed which provides a complete medical evaluation about the severity of the disease. The tests include marker enzyme tests, blood tests, viral load tests, genotype tests and liver biopsy.

What are the chances for this guy to develop cirrhosis?

If Hepatitis is not treated immediately, then the hepatitis may progress to advance stage leading to irreversible scarring of the liver. Immediate treatment can prevent or delay further infection.

The patient is concerned that he may transmit the virus to his wife or children. They are tested and are found to be negative for HCV antibody. He is relieved but asks for advice to prevent infecting them. What are you going to tell him?

Since virus is carried in the blood, it could get transmitted within family members. Its important that mucous membrane shouldnot come in contact with body fluids containing this virus.

The patient's liver biopsy shows mild to moderate inflammatory activity and portal and periportal fibrosis (Stage 2). He is relieved to find out that he does not have cirrhosis, but remains very concerned about his hepatitis and wants to do everything possible to "get rid of" the hepatitis C. He asks about treatment for his HCV. What do you recommend?

Treatment for HCV:

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