Differential Diagnosis Drug Dependence and Abuse : The signs and symptoms displayed by a person depend on what substances the person has abused. Symptoms may include altered mental status, CNS suppression, nausea, vomiting, diarrhea, anxiety, hallucinations, chest pain, and abdominal pain. Most patients with substance abuse commonly exhibit behavioral symptoms that can cause harm to self or others and requires an emergent medical intervention. Though the patient has a history of substance abuse, the patient’s symptoms didn’t include behavioral, CNS suppression or altered mental status. The patient appears alert, and oriented, and so would rule it out as the major culprit. Spontaneous Bacterial Peritonitis : is an acute bacterial infection of ascitic fluid and is a complication in patients with liver cirrhosis. Symptoms include fever, chills, abdominal pain, diarrhea, worsening encephalopathy, ascites that does not improve with diuretic, new onset of renal failure, and ileus. There was no indication on the patient’s medical history of taking diuretics, and only symptom noted was diarrhea. The patient didn’t present with ascites or ileus, so would rule it out.
Gastroenteritis : is irritation/inflammation of the stomach and intestines caused by food contaminated with bacteria, viruses, parasites, or toxins. Symptoms may include cramping, nausea, vomiting, or diarrhea. The illness usually spreads easily from contact with a sick person or eating or drinking contaminated food or beverages also will spread the illness. Most people recover in a few days by drinking plenty of fluids and resting. Antibiotics treat gastroenteritis caused by bacteria or some parasites. In most cases, nausea, vomiting, and diarrhea get better within 24 to 48 hours. Plan and Treatment Recommendations According to the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (2016), the following are the recommendations for treatment and management per HCV Guidelines: Regular laboratory monitoring is recommended in the setting of acute HCV infection. Monitoring HCV RNA (e.g., every 4 weeks to 8 weeks) for 6 months to 12 months is also recommended to determine spontaneous clearance of HCV infection versus persistence of infection. If the practitioner and patient have decided that a delay in treatment initiation is acceptable, monitoring for spontaneous clearance is recommended for a minimum of 6 months. When the decision is made to initiate treatment after 6 months, treating as described for chronic hepatitis C is recommended. Treatment is determined by the
genotype of the HCV, there are six genotypes. Based on patient HL’s symptoms, and diagnostic workup, the patient most likely fall under the genotype 1a (without cirrhosis).
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- Fall '13
- Hepatitis C