Transcript File - Medical Nutrition Therapy Portfolio

Acute Hepatitis
Rachel Hart
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
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
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
Primary Complaint
“I just feel so tired. I can hardly
move, my joints ache so much, and
my muscles feel sore.”
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
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
Abnormal Chemistry
Bilirubin
 Normal: ≤ 0.3 mg/dL
 Terri: 1.5 mg/dL (high)
ALT (alanine aminotransferase)
 Normal: 4-36 U/L
 Terri: 340 U/L (high)
AST (aspartate aminotransferase)
 Normal: 0-35 U/L
 Terri: 500 U/L (high)
ALP (alkaline phosphatase)
 Normal: 30-120 U/L
 Terri: 303 U/L (high)
LDH (lactate dehydrogenase)
 Normal: 208-378 U/L
 Terri: 695 U/L (high)
HDL-C
 Normal: >50 mg/dL
 Terri: 50 mg/dL (low)
Abnormal Hematology
WBC (white blood cell)
 Normal: 4.8-11.8 x
10^3/mm^3
 Terri: 12.6 x 10^3/mm^3
(high)
HGB (hemoglobin)
 Normal: 12-15 g/dL
 Terri: 11.5 g/dL (low)
HCT (hematocrit)
 Normal: 37-47 %
 Terri: 36 % (low)
Platelet count

Normal: 140- 144 x
10^3/mm^3
 Terri: 140 x 10^3/mm^3
(low)
PT (prothrombin time)
 Normal: 11-16 sec
 Terri: 17 sec (high)
Abnormal Urinalysis
Protein
 Normal: NEG mg/dL
 Terri: 1+ mg/dL
Diagnosis and Treatment
Diagnosis
 Acute hepatitis C
Treatment
 Vitamin B-complex
supplement
 High-kcal, high-protein diet
 Bed rest
 Continued Allegra
 Alternative contraception
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.
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
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:
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
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Fever
Fatigue
Muscle aches
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine
Clay-colored bowel movements
Joint pain
Jaundice
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
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
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
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
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)= 65.9-79.1 grams of protein per
kilogram of body weight per day
 Range of: 66-79 grams per day
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
Questions??
References
 Hepatitis C. (2102). Lab Tests Online. Retrieved from
http://labtestsonline.org/understanding/analytes/hepatitis-c/tab/test
 Hepatitis C. (2102). National Institutes of Health [NIH]. Retrieved from
http://www.nlm.nih.gov/medlineplus/hepatitisc.html
 Hepatitis C information for the public. (2012). Center For Disease
Control and Prevention. Retrieved from
http://www.cdc.gov/hepatitis/c/index.htm
 Hepatitis C: Nutrition care. (2012). Dietitians of Canada. Retrieved
from http://ww.bccdc.ca/NR/rdonlyres/EA6145BC-FF7B-448A-B5E66EDED47D878C/0/Hep_Guidelines_HCVNutritionCare.pdf
 Interferon and ribavirin treatment side effects. (2012). Department of
Veteran Affairs. Retrieved from
http://www.hepatitis.va.gov/provider/reviews/treatment-sideeffects.asp