Reference no: EM131538540

Please help me answering the questions of this clinical case

A 49-year-old man comes to your office, requesting testing for hepatitis C. He recently attended his 25-year college reunion, where he heard from a mutual acquaintance that an old friend was seriously ill with cirrhosis due to hepatitis C. The patient became very concerned because he had "partied" with this friend during a brief period of experimentation with injection drugs while in college. The patient is otherwise healthy and denies any symptoms except for occasional fatigue after a long day at work. Physical examination of the patient is unremarkable. There are no stigmata of chronic liver disease. The patient returns several weeks later to discuss his test results. His HCV antibody test is positive. A liver panel obtained that day shows an ALT of 48 IU/L (normal range, 0-20) and an AST of 39 IU/L (0-31). His albumin and total bilirubin are within normal limits. He is extremely anxious about his liver, as he has been in contact with his old college friend and learned that his friend is now on the waiting list for a liver transplant.

Questions:

• How do you interpret his tests (HCV Ab test, ALT, and ALS)? Which of them is more indicative of liver damages?
• Having established that the patient has hepatitis C with elevated liver enzymes, the next step is to determine the severity of his liver disease. What are the only direct means to evaluate the extent of the liver injury?
• What are the chances for this guy to develop cirrhosis?
• The patient is concerned that he may transmit the virus to his wife or children. They are tested and are found to be negative for HCV antibody. He is relieved but asks for advice to prevent infecting them. What are you going to tell him?
• The patient's liver biopsy shows mild to moderate inflammatory activity and portal and periportal fibrosis (Stage 2). He is relieved to find out that he does not have cirrhosis, but remains very concerned about his hepatitis and wants to do everything possible to "get rid of" the hepatitis C. He asks about treatment for his HCV. What do you recommend?