Reference no: EM132436643

Problem: Mr. Collins is a 55-year-old physician's assistant with a history of chronic hepatitis C. Past history was remarkable for a needle stick injury on the job that occurred two years ago. Following the injury, he initially experienced sporadic episodes of mild flu-like symptoms with fever, chills, and diaphoresis. Over the past six months, his complaints increased to include generalized muscle weakness, fatigue, and weight loss. Mr. Collins is 5'9" tall and weighs 150 pounds with a usual weight of 162. On examination he was noted to have hepatomegaly and be markedly pale with icteric (jaundiced) conjunctiva and skin. 

Mr. Collins complains of a poor appetite. He generally eats two meals a day and prefers meat, potatoes, salted snacks, and an occasional beer. He dislikes sweets, and some vegetables and fruits. He states that he often has nausea and feels bloated after eating, but is unable to pass the gas. He feels most comfortable when his stomach is empty.

1. What are the most common etiologies of hepatitis C virus (HCV)
2. What are the risks or complications of HCV?
3. Identify the physical symptoms that are consistent with Mr. Collins's diagnosis.
4. What advice would you give Mr. Collins about drinking alcohol?
5. What general dietary recommendations should be given to Mr. Collins?
6. Suppose Mr. Collins develops steatorrhea. Recommend daily energy (based on his EER; light activity), protein, and total fat intakes for him.