NURS 6501 Knowledge Check: Gastrointestinal and Hepatobiliary Disorders
The case study depicts patient HL who presents with complaints of nausea, vomiting and diarrhea. HL has a history of drug abuse and possible Hepatitis C and is currently on Synthroid 100 mcg daily, Nifedipine 30 mg daily, and Prednisone 10 mg daily. This paper aims to discuss the probable diagnosis and the drug therapy plan for this patient.
Reflection on Patient’s History
HL has a history of drug abuse which is a major cause of Hepatitis C due to the use of non-sterile needles. Individuals who administer illicit drugs using non-sterile needles have the highest risk of Hepatitis C virus (HCV) transmission (Nawaz, Zaidi, Usmanghani & Ahmad, 2015). The patient is on Synthroid, which is a Thyroid product used in the treatment of hypothyroidism. The drug is associated with side effects of Diarrhea (Manthen, 2017). HL is also taking Nifedipine, a calcium channel blocker prescribed in the management of hypertension and associated with nausea. Prednisone is a corticosteroid that acts by controlling inflammation and may cause nausea. Based on the medications, it is highly likely he has a history of hypertension and hypothyroidism.
Hepatitis C Virus (HCV) infection: HCV affects the liver and causes inflammation (Nawaz et al., 2015). HCV infection affects multiple body systems, including the respiratory, cardiovascular, neurological, and digestive systems (Cacoub et al., 2016). It is transmitted via parenteral contact from contaminated blood and mucosal contact with other body fluids. Common symptoms of HCV infection include fatigue, arthralgia, myalgia, lymphadenopathy, chills fever, night sweats, pruritus, and spider nevi (Cacoub et al., 2016). Symptoms occurring in the abdomen and digestive system include abdominal pain, jaundice, diarrhea, nausea, appetite changes, and indigestion (Cacoub et al., 2016). Pertinent positive findings include nausea, vomiting, and diarrhea. Besides, the patient has a history of drug abuse which is highly linked to HCV infection. The patient’s condition is likely related to the gastrointestinal and hepatobiliary system due to inflammation of the liver and the gastrointestinal organs, especially intestines. Nevertheless, the symptoms can also be attributed to the current medications, for instance, Synthroid causing diarrhea, while Nifedipine and prednisone could be causing nausea.
Drug Therapy Plan
The drug therapy will aim to attain a sustained eradication of HCV and to prevent the progression of the infection to hepatocellular carcinoma, cirrhosis or decompensated liver disease. The drug therapy will comprise of a combination of Sofosbuvir/ Peginterferon/ Ribavirin for 12 weeks. According to a study by Hojati et al. (2019), combination drug therapy is associated with high treatment response in HCV patients with a history of drug abuse. Furthermore, the study revealed that this combination therapy had minima adverse effects and a low discontinuation rate and is effective in drug abusers to lower the risk related to self-injection (Hojati et al., 2019).
Alternative drug therapy would be a combination of Ledipasvir/sofosbuvir for 12 weeks. The drugs are classified under Genotype 1and are used in the treatment of newly diagnosed HCV patients regardless of cirrhosis (Chung et al., 2018). The combination is also used in the treatment of newly diagnosed, with no cirrhosis, non-black, HIV negative, and in HCV with RNA of less than 106 IU/mL (Chung et al., 2018). In addition, it is recommended for patients with a history of HCV medication use with no cirrhosis.
In conclusion, the probable diagnosis in the case study is Hepatitis C virus infection based on presenting symptoms of diarrhea, nausea and vomiting as well as a history of drug abuse. The disorder is likely related to the gastrointestinal and hepatobiliary system due to irritation of the liver and GI tract lining. The drug therapy that can be prescribed is a combination of Sofosbuvir/ Peginterferon/ Ribavirin for 12 weeks or, a combination of Ledipasvir/sofosbuvir for 12 weeks.
Cacoub, P., Comarmond, C., Domont, F., Savey, L., Desbois, A. C., & Saadoun, D. (2016). Extrahepatic manifestations of chronic hepatitis C virus infection. Therapeutic advances in infectious disease, 3(1), 3-14.
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E., Aronsohn, A.I., Bhattacharya, D., Broder, T., Falade-Nwulia, O.O., & Fontana, R. J. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases.
Hojati, S. A., Maserat, E., Ghorbani, M., Safarpour, A., & Fattehi, M. R. (2018). Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective? Medical archives (Sarajevo, Bosnia and Herzegovina), 72(5), 325–329. doi:10.5455/medarh.2018.72.325-329
Manthen, S. (2017). Adherence to Thyroid Hormone Replacement Therapy. Endocrine Practice, 23, 246.
Nawaz, A., Zaidi, S. F., Usmanghani, K., & Ahmad, I. (2015). Concise review on the insight of hepatitis C. Journal of Taibah University Medical Sciences, 10(2), 132-139.