Hey everyone. My name is Abby. We’re going to go through a case study for hepatitis together. Let’s get started. In this scenario, our patient Joanne is 71 years old, and she is a direct admit to the med-surg unit after being sent home from her physician’s office for further evaluation, with a diagnosis of weakness and failure to thrive. She is accompanied by Anthony, her spouse of 53 years. She’s a retired office manager with several adult children and prior to this admission, lived at home without medical assistance. Today, she’s presenting confused and cannot even stand even though she moves all extremities. Her speech is even slurred, but her husband reports, “The doctor said something about her liver. That’s weird to me because she doesn’t drink or take any medicine except for vitamins. How could there be anything wrong with her liver? I don’t understand. She stopped being able to walk a few days ago and really isn’t eating or drinking.” With this information, let’s take a look at our critical thinking checks number one, number two and number three below.

Perfect. Those lab results come back with the following values: Her blood alcohol content came back at 0%. Her urinary drug screening was negative for all controlled substances, like amphetamines, methamphetamines, benzos, barbiturates, marijuana, cocaine, PCP, methadone, and opioids. Her CBC showed her white blood cells at 14, a hemoglobin of 9.2, hematocrit 27.6, and platelets of 40,000.
Now, let’s take a little closer look at her liver specific labs: The LFTs or her liver function tests came back with her AST at 701, her ALT at 501, and her ALP at 380. Albumin came back at 2.6, ammonia 150 and her bilirubin of 5. Coagulation studies are also so important when looking at liver function, her PTT came back at 50 seconds. Her PT came back at 18 seconds and her INR 1.6. She was also tested for the Hep C virus antibodies, which came back as reactive. The abdominal ultrasound also resulted showing that she has an enlarged liver and an accumulation of fluid in the abdomen. Also known as ascites. Does any of this sound abnormal to you? Let’s take a look at our critical thinking checks number four and number five below.

Excellent. If you need any further clarification, go to the gastrointestinal course for some more info to supplement your knowledge. In this scenario, the hospital sees the patient and changes the admission diagnosis to hepatitis with liver failure. Anthony asks why she is confused and about the skin/eye color variances but states he does not understand what the doctor said. Joanne appears sedated, but she does wake with verbal stimuli. However, she is slow to answer and continues to be disoriented. Now that we have that information, let’s take a look at our critical thinking check number six below.

Great job. A new order is placed to administer a scheduled dose of lactulose. Lactulose was ordered 20 milligrams, every six hours the first dose to be given now. With this new order in mind, we can take a look at our critical thinking checks number seven and number eight below.

Great job, guys that wraps up this case study on hepatitis. Please take a look at the attached study tools and test your knowledge with a practice quiz. We love you guys, now go out and be your best self today. And as always, happy nursing!

References:

Sources: please note for all lab values, nursing.com data used. “Normal” values are not included, only abnormal.  For all meds pdr.net or rxlist.com used; for condition, uptodate.com Overview of the management of chronic hepatitis C virus infection
Authors:Sanjiv Chopra, MD, MACPPaul J Pockros, MDSection Editor:Adrian M Di Bisceglie, MD updated June, 2021 AND Acute liver failure in adults: Management and prognosis
Authors:Eric Goldberg, MDSanjiv Chopra, MD, MACPJonah N Rubin, MDSection Editor:Robert S Brown, Jr, MD, MPH last updated Sept, 2021