Question

Mr. Collins is a 55-year-old physician’s assistant with a history of chronic hepatitis C. Past history was remarkable for a needle stick injury on the job that occurred two years ago. Following the injury, he initially experienced sporadic episodes of mild flu-like symptoms with fever, chills, and diaphoresis. Over the past six months, his complaints increased to include generalized muscle weakness, fatigue, and weight loss. Mr. Collins is 5’9” tall and weighs 150 pounds with a usual weight of 162. On examination he was noted to have hepatomegaly and be markedly pale with icteric (jaundiced) conjunctiva and skin.

Mr. Collins complains of a poor appetite. He generally eats two meals a day and prefers meat, potatoes, salted snacks, and an occasional beer. He dislikes sweets, and some vegetables and fruits. He states that he often has nausea and feels bloated after eating, but is unable to pass the gas. He feels most comfortable when his stomach is empty.

1. What are the most common etiologies of hepatitis C virus (HCV)?

2. What general dietary recommendations should be given to Mr. Collins?

3. Suppose Mr. Collins develops steatorrhea. Recommend daily energy (based on his EER; light activity), protein, and total fat intakes for him.

Answer 1

Answer: 1 The most common etiologies of Hepatitis C virus (HCV)

Hepatitis C is a liver infection caused by the hepatitis C virus. The virus is transmitted through blood contact. It is possible that Mr. Collins has exposed to any infected individual during needle stick injury on the job, which occurred two years back.

The symptoms exhibited by Mr. Collins are related to infective stages of HCV like fatigue, weight loss, muscle weakness, poor appetite itchy skin, jaundice (yellow discoloration of the skin and eyes)

If this infection continues for next few years, he may face significant complications like liver cancer or liver failure or cirrhosis (scarring of the liver)

Answer 2 The general dietary recommendations

1. Eating regularly with small chunks of meals or snacks with small intervals (at least for every 3 to 4 hours)
2. Go easy on fatty, salty, and sugary foods.
3. Balanced diet meal with the combination of below listed food products:

• Whole-grain breads, cereals, and grains
• Dairy products
• Vegetables, fruits, dried beans, nuts, soya
• Meat, fish and eggs.

Answer 3

Steatorrhea is a medical condition of having excess fat in feces. Stools may be foul smelling, bulky, pale, oily and sometimes difficult to flush.

In case, Mr. Collins develops steatorrhea, she is recommended to

• Reduce intake of dietary fat, alcohol, and dietary fiber
• Increase dietary intake of proteins (180 gm per day), carbohydrates (336 gm per day) and stay hydrated