health maintenance visit

Mr. James is a 62 year old male in a primary care practice being seen for a health maintenance visit (last visit was over 10 years ago).  His only complaint of note is fatigue but generally feels well.  He denies any limitations in “doing the things I like to do”, including yard work and fishing.  He works full time as a supervisor for a commercial construction company.  He is married and has 2 daughters.  His oldest daughter is expecting their first grandchild.

He has a history of “recreational” IV drug use when he was in his early 20s while he was in the military.  Denies any drug use since that time.  He indicates “minimal” alcohol use – generally no more than 2-3 beers or glasses of wine a week.  He has no chronic illnesses and does not take any medicines on a regular basis.

Physical exam:

Vitals: 38.1-97-18-183/139

Normocephalic.  Alert & Oriented x3.

Eyes: PERL. No nystagmus, no icterus.

Neck: Supple, no cervical lymphadenopathy

Cardiovascular: Normal Rate and rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. No jugular venous distension.  No edema.

Pulmonary: Lungs are clear. No dyspnea or orthopnea.

Abdomen: Soft and nontender, active bowel sounds. No liver enlargement; abdomen flat. No striae.

Skin: Warm and dry; no rashes.  Multiple tattoos on both arms.

Rectal exam: Stool is brown, no rectal masses.

Lab results:

CBC:  WBC 9,000; RBC 5.10; Hemoglobin 15.3 g/dL Hematocrit 46%; MCV 90; Platelets 152,000.

Electrolyte Panel:  Sodium  136 mEq/L; Potassium 3.7 mEq/L; Creatinine 1.1 mg/dL; BUN 12 mg/dL;  Glucose 115mg/dL

Alanine aminotransferase (ALT) 36

Aspartate aminotransferase (AST) 50

Bilirubin (total) 0.9 mg/dL

Hepatitis A IgM negative; IgG positive

Hepatitis B surface antigen negative; surface antibody positive; core antibody negative

Hepatitis C (HCV) antibody reactive (positive), Hepatitis C RNA positive with an undetectable viral load.

APA Format

Information is presented in a scholarly manner (clear, grammatically correct) and reflects synthesis of information from sources.  APA format is correctly used for citations and references. Submission follows assignment guidelines; does not exceed page limit (6 pages, excluding title and reference pages). (15 pts)

UTA Title page (5 pts)

Respond to the following questions regarding the Case Study

1. The clinical scenario is most consistent with which type of hepatitis? Please list your answer below using a bullet point format.  This does not have to be in a complete sentence.  A citation is not required. (10 pts)

2. What specific data in the clinical scenario supports your diagnosis? You may list your answers below using bullet point format.  This does not have to be in a complete sentence. A citation is not required. (10 pts)

3. What is the most likely cause of this patient’s diagnosis you noted in Question 1? You may list your answer below using a bullet point format. This does not have to be in a complete sentence.  A citation is not required. (10 pts)

4. Describe key pathophysiologic concepts that relate to the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.  ***Citations are required for each answer to each question using APA format.  You MAY NOT use direct quotes.

a. How does Hepatitis lead to an increased risk of hepatocellular carcinoma?  Describe how the virus affects the hepatocytes and may lead to cancer.  ( 10 pts)

b. How does Hepatitis lead to cirrhosis of the liver?  Describe the pathologic steps of how cirrhosis develops and how cellular changes can lead to liver failure.  ( 10 pts)

c.  One of the negative sequela of liver failure is increased bleeding.  Why do individuals with liver failure experience potentially life threatening bleeding?  Describe how liver failure leads to coagulopathy. ( 10 pts)

d.  Portal hypertension is also a negative sequela of liver failure.   Describe how liver failure leads to portal hypertension AND how portal hypertension manifests.  (10 pts)

5. Mr. James is concerned that he will transmit the virus to his new granddaughter after she is born.

What is the likelihood of transmitting the virus to his granddaughter?  Provide a single sentence that includes your rationale.  A citation is not required.  (10 pts)

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