A 34-year-old man presents to your office for follow up on lab results which were completed...

A 34-year-old man presents to your office for follow up on lab results which were completed to evaluate an elevated AST and ALT. He is sexually active and engages in sex with both men and women. He uses condoms inconsistently. He denies regular alcohol abuse but states he used to inject heroin. Currently, he reports some fatigue but says he feels well otherwise. His hepatitis serology results are as follows: HBsAg-positive, anti-HBs-negative, and anti- HBc-positive IgG, Anti-HDV and anti-HCV test results are both negative.

Questions

1. The clinical scenario is most consistent with which diagnosis?

2. What data in the clinical scenario supports your diagnosis?

3. What are this patient’s risk factors for acquiring the disorder identified in question 1?

4. Describe the key pathophysiologic concepts of the diagnosis in question 1.

5. For what actual or potential complications related to the diagnosis in question 1 does he need to be monitored?

a. What would a positive serology test indicate for each test below?

Hepatitis A IgM (HAV-Ab/IgM)
Hepatitis A IgG (HAV-Ab/IgG)
Hepatitis B Surface Antigen (HBsAg)
Hepatitis B Surface Antibody (HBsAb or Anti-HBs)
Total Hepatitis B core antibody IgG (HBcAb or anti-HBc)
Hepatitis B core antibody IgM (IgM anti-HBc)
Hepatitis C Antibody (HCV-Ab)
HDV-Ab (Hepatitis D antibody IgM)
Total HDV-Ab

b. What percentage of patients with the acute hepatitis B infection develop chronic HBV infection?

c. What is the significance of hepatitis D superinfection?

d. What two hepatitis B serologies must be present to diagnose an acute infection?

Solutions

Expert Solution

1.HBsAG (HBV) is the clininal disease because of elevated liver functions test and occasionally these patients seems like healthy who are a persistent carriers of the same. 2. Elevated liver function test, alcohol consumption, drug usage, homosexual and bisexual activity, HBsAg positive and anti- HBc negative. 3. sexual intercourse ( homosexual and bisexual activity are incresed risk for HBV). 4. Hepadna virus 5. Hepatitis shows coplications like FIBROSIS(caused by liver scarring), CIRRHOSIS OF LIVER, CANCER OF THE LIVER, LIVER FAILURE, HEPATIC ENCEPHALOPATHY, PORTAL HYPERTENSION.

a) Hepatitis A IgM -indicates Hepatitis A Hepatitis A IgG -indicates immunity to Hepatitis A Hepatitis B surface Antigen - Acute Hepatitis B infection HEpatitis B surface Antibody - immunity to Hepatitis B from either exposure to virus or from vaccination. Total Hepatitis B core antibody IgG -indicates either has or had Hepatitis B Hepatitis B core antibody IgM- indicates acute or recent infection with Hepatitis B Hepatitis C Antibody - indicates recent or past infection with Hepatitis C virus HDV - indicates exposure to Hepatitis B. b) 10% of patient with acute Hepatitis B are prone to have chronic infection. c)POLYMERASE CHAIN REACTION(PCR) is the significant of Hepatitis D virus due to HDV RNA rate compared with chronic hepatitis. d) anti- HBc-antibody and anti-HBs-antibody

Nightingale answered 1 year ago

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