Disorders of the Gastrointestinal System, 2nd Edition
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bodily fluids. Hepatitis D (HDV) is con - tractible only if a person is already infect- ed with HBV, as the virus is incomplete and requires a complete virus to repli- cate (World Health Organization, 2019). Hepatitis A, B, and C viruses can also be passed from a mother to an infant during pregnancy, during the birth process, or after birth. HAV and HBV can remain as- ymptomatic for several years or even de- cades, delaying diagnosis and increasing the risk of accidental transmission (Kim, 2019). Although the rates of HAV and HBV are decreasing, rates of HCV remain high, likely because of the opioid epidemic and rising rates of IV drug use (Kim, 2019). HAV infections, although potentially severe, are self-limiting and do not cause chronic infections. But the same is not true of the other hepatitis viruses (Murakami, 2021). All viral hepatitis infections can cause general fatigue, a rash with itching, flu-like symptoms, loss of appetite, and jaundice. In chronic cases, the infection can cause cirrhosis, hepatic encephalop- athy (altered mental status related to liver dysfunction), and electrolyte imbalanc- es. A liver transplant may be required to ensure survival (Dhawan, 2019). Patients with jaundice have higher than normal bilirubin levels, which causes dark-col- ored urine and clay-colored stools, and skin and sclera to turn yellow (Joseph & Samant, 2022). Most cases of viral hepati - tis can be diagnosed with lab work, which typically includes assessment of bilirubin levels, liver function, renal function, gen- eral overall blood counts, hepatitis anti- gens and antibodies, and bleeding times (Dhawan, 2019). Treatment of viral hepatitis depends on the virus’s strain and the infection’s sever- ity. Most patients do not require hospital stays or aggressive interventions. But in
CASE STUDY 8 Evelyn is a 50-year-old former intravenous drug user. She has not used drugs for 20 years and lives at home with her husband and two teenage girls. She feels she has a case of the flu because she has nausea, vomiting, and diarrhea. Her symptoms are still present two weeks later, and she notices her skin is turning yellow and her urine is very dark. She makes an appoint- ment with her primary care provider, who suspects Evelyn may have hepatitis C, and orders lab work. Her doctor explains that although Evelyn has not had any ob- vious symptoms of hepatitis C up until this point, she may have had it for many years and could be developing liver cir- rhosis due to the infection. Question Which of the following would be a cause of hepatitis C? Answer/Rationale: Answer is b. Hepatitis C is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood. Hepatitis Hepatitis is a liver inflammation most often caused by a virus (World Health Or- ganization, 2019). Viral hepatitis has five forms—hepatitis A, B, C, D, and E—and has different routes of infection and se- verity. Hepatitis A (HAV) and E (HEV) can be caused by ingesting contaminated food or water containing fecal contami- nation. Hepatitis B (HBV) and C (HCV) are transmitted via contaminated blood and a. Fecal-oral transmission. b. Sharing drug-injection equipment. c. Eating contaminated food or drink. d. Using a public toilet and not washing hands afterward.
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