Patient: Mrs. Elizabeth Shoe Age: 37 years and 3 months Doctor: Dr. Swetha Vishwanath Hospital: St. John s Hospital Date: December 10, 2004

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1 Patient: Mrs. Elizabeth Shoe Age: 37 years and 3 months Doctor: Dr. Swetha Vishwanath Hospital: St. John s Hospital Date: December 10, 2004 Diagnosis: Symptoms Patient experiences extreme fatigue and fainting Frequent nausea, abdominal pain and reported weight loss o No unusual food intake was reported or found o Patient is not pregnant and not on any hormone pills o Irregular menstruation with heavy flow when on period o Pre-menstrual Syndrome increase o No symptoms of menopause Patient has had a loss of sleep, intended diagnosis of Insomnia Patient shows a yellow colouring to the eyes and skin Patient has had frequent fever-like symptoms o Interval of these symptoms is 3-4 days approx. o Days for recovery 2 days Report of diarrhoea with a burning sensation at the rectum. Frequent Symptoms of Edema (swelling in feet area) Patient shows signs of a loss of appetite: Diet Deficiency Symptoms of Cryoglobulinemia are exhibited: o Blood contains abnormal amount of antibody lymphocytes (cryoglobuline) o Skin rashes- essentially inflammation of vessels (vasculitis) o Joint and muscle aches Medical History Patient has a history of low-moderate arthritis Gallstones diagnosis on November 22 nd 1997 Patient quit smoking approx. 4 years ago Alcoholism rehabilitation attended for 6 months from January 1999 Drugs rehabilitation attended for 1 year from January 1999 Previous blood transfusion due to loss of blood on July1987 Patient has used needles for tattoos and piercing dated in year of 2000 Previous Tests/Scans Results Scan for Spleen Inflammation: Positive Scan for Inflammation of Liver: Positive Scan for Kidney Inflammation: Positive (glomerulonephritis) Urine Testing: Abnormal colour: Yellow/orange tint Stools Testing: Grey/White coloured stools (light-coloured) Test for Cancer: Positive Location: Abdomen and Kidneys Test for Jaundice: Positive Blood Test: Type AB Contains high levels of copper and iron Swetha Page 1 26/01/2006

2 Modern Procedures/Technologies Hepatitis C is a disease of the liver that affects over 200 million people worldwide per year. The only way that it can be spread is through the transmission of blood and body fluids from an infected person or object, such as syringes. Hepatitis C patients are, most of the time, asymptomatic and to be able to conclude for certain that a person is infected with the virus, proper medical procedures and tests are needed to determine that. A very reliable procedure that could determine whether a person is infected with HCV is the liver biopsy. The procedure involves the examination of a small piece of tissue from the liver, removed with a special needle. However, this biopsy only takes place after the doctor has reports indicating that there is a problem with the functions of the liver. (Fig. 1) HCV in Liver cells In order to begin the process, preparations to ensure the patient s best health are taken. Blood tests are required to determine if clotting is sufficient and all medications should be listed to the doctor so that there are no fatal side effects after the procedure. No food or water intake for 8 hours before the biopsy. The procedure itself begins with the patient at the hospital, lying in the normal position, with the right hand above the head and the doctor will then make a small incision near the rib cage, and insert a needle to retrieve a sample of the liver. You are conscience throughout the whole procedure and it is very dangerous because a slight mistake could mean that the lung or gallbladder could be damaged. It takes about 20 min to complete the process. Two other methods that help in the liver biopsy are laparoscopic biopsy and transvenous biopsy. Laparoscopic biopsy is when a special tube, called the laparoscope, is inserted through an incision in the abdomen. This sends images to the monitor, for which the physician can take samples of specific parts of the liver. Transvenous biopsy is when a catheter, a special tube that goes down you vein in the neck, travels all the way to the liver. The physician inserts a needle through the catheter samples are removed from there. This is usually the procedure for patients who have problems with blood clotting or fluid in the abdomen. Another test is the antibody tests, ELISA (enzyme-linked immunosorbent assay) and RIBA (recombinant immunoblot assay). ELISA is a blood test that is also referred to as EIA. It searches for antibodies that are related to HCV and if these are present, then it is confirmed that the patient is diagnosed with HCV. For there to be a false-negative test result, which is rare in the testing of ELISA, the patient probably has to have an immune system that don t produce enough antibodies, like those on haemodialysis (treatment for kidney failure) or people with immune disorders. Antibodies from the past disease which have been cured now can still result in a positive result, however that doesn t necessarily mean that you have HCV. If the patient is tested positive, the doctor will have to perform an HCV RNA test to determine if the patient is still contaminated. RIBA tests are usually to confirm positive ELISA tests and are usually used in blood banks to determine if a certain donor or the blood that is donated is susceptible to the Hepatitis C virus. If the ELISA testing tested positive, to have a more precise test is to perform the HCV RNA testing. This test directly measures the presence of the HCV virus. There are two benefactors for this test, qualitative and quantitative. Qualitative determines if the Swetha Page 2 26/01/2006

3 patient has to be diagnosed with HCV. It could take up to 1-2 weeks to understand the results of the test and when positive, it means that the patient is contaminated with HCV. Quantitative HCV RNA tests means to determine the intensity of the virus in the bloodstream. The measurement is called the viral load and it is measured by units per millilitre. These measurements can vary but a patient with a high viral load doesn t mean that the infection is more severe (severity in regard to the intensity of symptoms), but it does help the doctors have an understanding of how well the patient s body will react to treatment. Testing the HCV RNA during treatment allows the physician to know if the medications and the treatments are actually helping the patient fight the virus. If the viral load remains the same, it is an indication that the treatments have no effect on the patient. (Fig. 2) Hepatitis C Transmission Routes Swetha Page 3 26/01/2006

4 Treatment and Prognosis To treat Hepatitis C, drug usage is the most essential way to cure the disease, since it is what affects the liver and essentially the bloodstream. A drug known as interferon is usually the basic of the conventional treatment and there are many types of it. Alpha interferon is a protein that is naturally regulated by the body in order to regulate the functions of the cells in the immune system. This drug is, in turn, synthetically made in order to reach the standards of the original one s natural functions just so as to treat the chronic HCV. The molecule doesn t kill the virus directly, rather it seeks out healthy cells and creates more of them so that the HCV cannot replicate itself in the RNA and destroy the healthy cells by multiplying itself through these agents. Alpha interferon is a type of biologic therapy (biotherapy). This drug can be used alone (monotherapy) or with Ribavirin (combination therapy). Ribavirin is an antivirus (virus-fighting) that stops the virus from multiplying but it is not effective against Hepatitis C alone. Pegylated Alpha interferons are made with alpha interferons, except they have large-water soluble molecules made with polyethylene glycol. The size of this molecule makes it harder to break down so it stays longer in the body to help get rid of the virus. There are two types of interferons: alfa-2a (regardless of weight) and alfa-2b (individualized on weight). 54 percent of people who took peginterferon- alfa-2b or alfa- 2a with ribavirin compared to 47 percent of people who took only the standard medication noticed a lowered level of the virus to the point of it not being detectable within 6 months. This medication, in standard forms (alpha interferon with ribavirin), will take up to 6 months to 1 year to work. Overall, with the use of this medication, only 55 percent of the patients will attain the sustained goal and response after 1 year of continuous treatment. Usually, it would take from 6 months to 2 years for a patient to see progress and to be completely cured of the virus, however, the virus does have a chance to return after a few years. The side effects of the use of this standard treatment for HCV can include flu-like symptoms (body aches, fever, chills and fatigue), nausea, gastrointestinal problems, hair loss, emotional changes, and skin reactions. For more severe cases, the patient can experience depression, organ damage, mental health problems, blood conditions and many other major problems. In addition, combination therapy of ribavirin can cause serious anaemia (low count of red blood cells) and it is also known to cause birth defects and should be avoided while pregnancy. Surgery is the last alternative when the liver has reached the end-stage failure. The only way to help save the patient is to get a liver transplant. After the transplant, constant follow-up care should be taken with medications (immunosuppressant) to help the body get used to the new tissue and this can lead to a whole new case of side effects. Other medications that can be taken in accordance with CAM (complimentary and alternative medications like interferon and ribavirin) are herbal dietary supplements like milk thistle, licorice root, ginseng, thymus extract, schisandra, and colloidal silver. It is said that they help aid side effects and reduce inflammation of the liver. Patients that are contaminated with Hepatitis C should take precaution in their daily lives by eating healthy and staying fit but also knowing when to stop strenuous activities. Swetha Page 4 26/01/2006

5 Nutrition is a problem for HCV patients since they experience nausea and loss of appetite, however, it is important to get as much adequate nutrition as possible. Proteinrich and high-calorie diets are recommended but aren t as beneficial especially since it is not an appeal to the patient to induce in such foods. Alcohol should be avoided at all times since it is what has a major impact on the liver. Plenty of fluids like water should be drank in order to keep the body hydrated. In order to overcome the symptoms that affect a person s diet and appetite, it is suggested to make a journal to enlist all the foods that would make the patient nauseous and to avoid such foods in the future. It also helps keep track of the amount of calories and nutrition the patient is getting everyday. Regular eating is very important and variety of foods should be the intake. Regular activities also help the body circulate blood and to help ease symptoms of medications like depression. Aerobics exercising is most beneficial since it has a slow and steady pace and can help the patient feel stronger when muscles have cramped or fatigue has taken over. Swetha Page 5 26/01/2006

6 Bibliography Schering Corporation. All About Hepatitis C Antibody Tests: The ELISA and RIBA. Copyright 2002 < Australian and New Zealand Society of Nephrology. ANZSN: Members & Commitees: DNT Subcommittees. Copyright 1999 < NCCAM, National Institutes of Health. Hepatitis C and Complementary and Alternative Medicine: 2003 Update. Copyright November 23, 2004 < US Department of Health and Human Services. Hepatitis C:Fact Sheet CDC Viral Hepatitis. Copyright November 1, 2004 < The NDDIC. Liver Biopsy. Copyright December 6th, 2004 < WebMD Inc. Hepatitis C Treatment Overview. Copyright < Swetha Page 6 26/01/2006