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Initial Evaluation of Hepatitis C patient

Initial Evaluation of Hepatitis C patient. Curtis Barry ECHO January 6, 2017. Disclosure Statement. I have no potential conflicts of interests to report. Key Aspects of History and Physical Examination. When and how diagnosed Risk factors Injection drug use: when, how long, rehab

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Initial Evaluation of Hepatitis C patient

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  1. Initial Evaluation of Hepatitis C patient Curtis Barry ECHO January 6, 2017

  2. Disclosure Statement I have no potential conflicts of interests to report

  3. Key Aspects of History and Physical Examination • When and how diagnosed • Risk factors • Injection drug use: when, how long, rehab • Nasal cocaine • Blood transfusion • Tattoos and body piercing • Sexual exposures • Family exposures • Work-up to date • Prior treatment status • Comorbidities • Other known liver diseases, hepatotoxic drugs and alcohol • Psychiatric • Family history of liver disease • Current medications

  4. Key Aspects of History and PhysicalExamination (Continued) Scleral icterus Jaundiced Ascites Extrahepatic manifestations (will do separate didactic)

  5. Recommended Laboratory Studies AfterInitial Diagnosis • General • Hepatic profile • Renal profile • Complete blood cell count with differential • Disease-related • HCV RNA quantitative • HCV genotype • Hepatitis B profile • hepatitis A virus antibody (IgG) • Alpha fetoprotein or baseline ultrasound (optional) • HIV testing • Question advanced fibrosis (will do another didactic)

  6. Immunizations for Persons With Chronic HCV • Hepatitis A virus - Test for hepatitis A antibody IgG - Vaccinate twice, 6 months apart, or use • Hepatitis B virus - Test for HBsAb - Vaccinate 3 times (0, 1, and 6 months) or use - For immunosuppressed patients consider double-dose vaccine series combination vaccine

  7. Screening for Other Causes andContributors of Liver Disease • Evaluation of other diseases optional but recommended if advanced fibrosis or cirrhosis is present

  8. Summary • Key elements for evaluation of a patient with HCV: • Detailed liver-focused history • Liver-directed PE • Evaluation of lab tests that help stage liver disease and determine if comorbidites are present • Prevention of other liver diseases is important: • Vaccinate for Hep A and B if needed • Determine if advanced fibrosis or cirrhosis is present

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