Hepatitis C Case Study

Author/s

Sean Fizer, Patrick Fleming, Grant Idlewine, Kyle Kelley from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.

Abstract

100 word limit, non-structured description

Patient Characteristics

• Demographic Information: 52 year old female Medical Laboratory Scientist  (occupation/vocation, gender, age, etc.)
• Medical diagnosis: Hepatitis C (diagnosed 6 years ago)
• Co-morbidities: Diabetes, Hypertension, Alcoholism
• Previous care or treatment
• Medication: Ribavirin BID
  

Examination

• Upon examination, Brandt Widelline reported constant fatigue and muscle aches throughout the day, accompanied by mild pain in her right upper quadrant. She also reports intermittent nausea^1,2. Her medical history shows that she has been diagnosed with Hepatitis C, Type II DM1, hypertension (HTN), and alcoholism¹. A Fibro Test/Acti Test (FT-AT) was performed four years ago to determine the stage of liver fibrosis^2,5, which concluded a Metavir fibrosis score of 2, meaning scarring has occurred and extends outside the areas in the liver that contain blood vessels⁶. The patient’s current treatment for the Hepatitis C and associated comorbidities consists of vitamin D supplements beginning 2 years after the diagnosis of Hepatisis C, Ribavirin², Sofosbuvir³ and insulin. She began treatment with pegylated interferon treatment two years the Hepatitis C diagnosis, which was a 48 week treatment, but it was replaced with Sofosbuvir beginning in January of 2014³.
  The patient reported goals for her treatment are to achieve sustained viral responses (SVR) near 80%², weight loss to improve her quality of life, improve fitness and decrease fatigue, and decrease the risk of osteoporis⁴.
  
• Self Report Outcome Measures:  SF36 QOL measure (Sean's article); depression/anxiety, fatigue, flu-like symptoms, cognitive function, insomnia are the five key concepts looked at in:  http://www.ncbi.nlm.nih.gov/pubmed/22871087
• Physical Performance Measures  6 minute walk test
• Objective : Physical Examination Tests and Measures
  

Summarization of Examination Findings

Working Diagnosis and Targeted Interventions

Intervention

• No vaccine or postexposure prophylaxis is currently available.  Thus main focus of management is prevention awareness. 
• First 6 months (acute phase) may be asymptomatic so goes unnoticed most of the time. 
• In the chronic phase, pharmacological interventions include pegylated interferon and ribavirin, which sustains the viral response. 
• All of the above was found at http://cid.oxfordjournals.org/content/50/11/1505.long
  
• All below was found at http://www.em-consulte.com/showarticlefile/198936/main.pdf
• Physical activity and education was also found to be helpful in QOL measures for patients with hepatitis C. 
• Groups participated in these 3 physical activities and educational program: 
• Individual physical activity for 90 minutes (walking, running, swimming, etc.)
• Physical activity in a team setting for 90 minutes (frisbee, volleyball, racket ball, etc.)
• Recreational activity for 90 minutes (ballroom dancing, archery, etc.)
• Lectures on topics such as hepatitis and treatment, history of jaundice, and evaluation in sports medicine. 
• These patients experienced increased QOL measures 1 month after participating in these events 5 days a week. 
• (Article from Pat) claims these increases in QOL measures can be attributed due to decreases in pain and disability because of improvements in cardiovascular fitness and musculoskeletal function. 

Outcomes

Findings Over time

Discussion

Summary Statement which should include related findings in the literature, potential impact on clinical practices

Related Pages

Hepatitis A, B, C General Information

Center for Disease Control 

References

References will automatically be added here, see adding references tutorial.

Center for Disease Control and Prevention. Hepatitis C Information for the public. http://www.cdc.gov/hepatitis/c/cfaq.htm (accessed 18 March 2015).

1. Poll R. Screening for and diagnosing hepatitis C. Practice Nursing [serial online]. 2015; 26(1):22-26. Available from: CINAHL with Full Text, Ipswich, MA. Accessed March 18, 2015.

2. Malnick S, Maor Y, Melzer E, Tal S. Chronic Hepatitis C in the Aged: Much Ado About Nothing or Nothing to Do?. Drugs & Aging [serial online]. May 2014; 31(5):339-347. Available from: CINAHL with Full Text, Ipswich, MA. Accessed March 18, 2015.

3. Sturm D, Gurevitz S, Davidson C, Fritchley A, Wagaman A. Chronic Hepatitis C Infection. Clinician Reviews [serial online]. November 2014; 24(11):24-32. Available from: Academic Search Complete, Ipswich, MA. Accessed March 18, 2015.

4. McKenna O, Blake C. Management of hepatitis C: the potential benefits of exercise. Physical Therapy Reviews [serial online]. December 2007;12(4):271-276. Available from: Academic Search Complete, Ipswich, MA. Accessed March 21, 2015.

5. Poynard T, Imbert-Bismut F, Benhamou Y, et al. Biomarkers as non-invasive assessment of hepatic fibrosis in chronic hepatitis C. Journal Of Gastroenterology & Hepatology [serial online]. December 3, 2004;19:S236-S245. Available from: Academic Search Complete, Ipswich, MA. Accessed March 22, 2015.

6. HCV Diagnostic Tools: Grading & Staging a Liver Biopsy. HCV Advocate website. http://www.hcvadvocate.org/hepatitis/factsheets_pdf/grade_stage.pdf. Published October 2007. Accessed March 22, 2015.