Question of the Week # 104

104) A 65 year old man presents to your office with increasing abdominal distension and bilateral leg swelling. He is accompanied by his daughter. He reports his symptoms started 3 months ago and progressively worsening. He smokes about one pack cigarettes per day and drinks one pint vodka every day. His last drink was 1 day ago. On examination, he is afebrile and he has abdominal distension and ascites with out any tenderness on palpation. Lab studies show  WBC 8k/µl, Hemoglobin of 10.2 gm%, Platelets 90k/µl, Total protein of 6.4, Albumin 2.2, SGOT 300, SGPT 130, Total Bilirubin 4.2 , Direct Bilirubin 3.3, Prothrombin time of 19 seconds and Creatinine 2.2. Ultrasound reveals cirrhosis of the liver and splenomegaly. The daughter asks  you if her father can be considered for Liver transplantation. The most common indication for liver transplantation in the United States :

A) Alcoholic Liver Disease

B)Chronic  Hepatitis B

C) Acute Liver Failure

D) Hepatitis C

E) Primary Biliary Cirrhosis


7 Responses

  1. d

  2. d

  3. Hepatitis C cannot be treated acutely and although everything looks normal even liver enzymes, if it the Hepatitis C viral PCR or antibody is detected then it’s best to start the patient on the 3 drug regimen, Ribavirin, interferon and a protease inhibitor, although there’s a monoclonal antibody that may be added as well.

    Most patients can only know the condition of the liver until the liver biopsy is done because the labs are normal and they may be asymptomatic for a while. Remember, Hepatitis C is transmitted more parenterally, through needles and blood transfusion than sex! If a person is in a monogamous relationship with his wife for 20 years and he is HCV+ and she is HCV- then, CDC does NOT recommend condom use.

    Most common cause of liver transplant in USA is hepatitis C, because before the 1989 no one really got screened for hepatitis C and approximately 170 million world wide are infected with Hep C. Hope this helps!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: