44 year old male with abnormal LFTs and abdominal pain - PowerPoint PPT Presentation

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44 year old male with abnormal LFTs and abdominal pain

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44 yr old male with h/o DM, HTN, GERD. 4 days of cramping generalized abdominal pain ... Meds: Toprol XL, lisinopril, HCTZ, ASA, lantus, metformin, protonix ... – PowerPoint PPT presentation

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Title: 44 year old male with abnormal LFTs and abdominal pain


1
44 year old male with abnormal LFTs and abdominal
pain
  • Thomas Huang
  • January 4, 2008

2
HPI
  • 44 yr old male with h/o DM, HTN, GERD
  • 4 days of cramping generalized abdominal pain
    acute in onset, not related to PO intake
  • Nausea, vomiting, fever, chills
  • No sick contact, recent travel history
  • No OTC meds, herbal supplements
  • No raw seafood

3
  • PMH DM, HTN, GERD, OSA, HBV vaccine
  • All PCN
  • Meds Toprol XL, lisinopril, HCTZ, ASA, lantus,
    metformin, protonix
  • SocHx works in group home, quit tobacco 2 years
    ago, rare alcohol, no illicits
  • FamHx DM, HTN, no liver disease
  • SurgHx none

4
PE
  • T98.5, P86, RR16, BP131/84, 99RA
  • Gen AOx3, in no acute distress
  • Heent scleral icterus, no oral lesions, no LAD
  • CV RRR, s1s2
  • Resp clear bilaterally
  • Abd BS, soft, periumbilical tenderness, no
    rebound, no HSM
  • Ext no edema, no palmar erythema
  • Neuro nonfocal, no asterixis

5
Lab
  • AST 1550 tylenol lt1
  • ALT 2460 tox screen neg
  • AP 309 Protein 7.3
  • DB 5.95 Albumin 4
  • TB 8.41
  • WBC 5.1
  • HCT 47.7
  • Plt 177
  • INR 1.45

6
Imagining
  • RUQ u/s heterogeneous liver, no focal masses,
    no intrahepatic biliary ductal dilatation, CBD
    0.5cm, normal GB, no GB stone/sludge
  • CT abd/pel normal liver, spleen, pancreas,
    unremarkable bowel, no lymphadenopathy

7
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8
Lab
  • CMV Ag neg ANA lt140
  • CMV IgG, IgM neg A1 antitrypsin 140
  • EBV IgM neg ceruloplasmin 37
  • EBV IgG pos AMA neg
  • HAV neg ASMA neg
  • HBsAg neg HIV neg
  • HBsAb pos HCV Ab pos
  • HBcAb neg HCV VL 2.76 mil
  • HEV Ab neg genotype 1

9
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10
Acute HCV
  • anti-HCV serum conversion, positive HCV-RNA PCR,
    elevated aminotransaminases
  • Spontaneous clearance ranges from 10 to 50
  • Factors favoring clearance
  • Symptomatic icteric clinical presentation
  • Rapid decline in HCV RNA levels
  • Low quasispecies
  • Strength of HCV-specific CD4 cell response

11
Early Monotherapy with Pegalated Interferon
alpha-2b for Acute Hepatitis C the HEP-NET Acute
HCV II Study
  • 89 patients with acute HCV
  • Genotype 1 59
  • Median RNA 2.35 mil IU/ml
  • 1.5ug/kg/wk peginterferon alfa-2b subcutaneous
    for 24 weeks
  • Median time from symptom to Rx 27 days (5-131)
  • Adherence to treatment 70
  • End of treatment response 82
  • Sustained virologic response 71

Wiegand et al, Hepatology 2006, 43(2), 250-256
12
Follow up 3 months
  • Asymptomatic
  • AST 23, ALT 29, AP 142, DB 0.5, TB 1.09
  • HCV VL undetectable
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