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
Assessment

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 po qd
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
Range of movement
Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them.

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 ALP (alkaline phosphatase)
Normal: ≤ 0.3 mg/dL
Normal: U/L
Terri: 1.5 mg/dL (high)
Terri: 303 U/L (high)
ALT (alanine aminotransferase)
LDH (lactate dehydrogenase)
Normal: 4-36 U/L
Normal: U/L
Terri: 340 U/L (high)
Terri: 695 U/L (high)
AST (aspartate aminotransferase)
HDL-C
Normal: 0-35 U/L
Normal: >50 mg/dL
Terri: 500 U/L (high)
Terri: 50 mg/dL (low)

9. Abnormal Hematology WBC (white blood cell)
Normal: x 10^3/mm^3
Normal: x 10^3/mm^3
Terri: 140 x 10^3/mm^3 (low)
Terri: 12.6 x 10^3/mm^3 (high)
PT (prothrombin time)
HGB (hemoglobin)
Normal: sec
Normal: g/dL
Terri: 17 sec (high)
Terri: 11.5 g/dL (low)
HCT (hematocrit)
Normal: %
Terri: 36 % (low)
Platelet count

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

11. Diagnosis and Treatment
Acute hepatitis C
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.
Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

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 has hepatitis
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
Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.

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
A multivitamin containing some vitamin A, vitamin C, vitamin E, selenium and zinc, B-vitamins.

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)= grams of protein per kilogram of body weight per day
Range of: 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
Taken from the CDC

21. Questions??

22. References
Hepatitis C. (2102). Lab Tests Online. Retrieved from
Hepatitis C. (2102). National Institutes of Health [NIH]. Retrieved from
 Hepatitis C information for the public. (2012). Center For Disease Control and Prevention. Retrieved from
Hepatitis C: Nutrition care. (2012). Dietitians of Canada. Retrieved from 6EDED47D878C/0/Hep_Guidelines_HCVNutritionCare.pdf
Interferon and ribavirin treatment side effects. (2012). Department of Veteran Affairs. Retrieved from effects.asp