5-75
Plan:
Treatment
Primary: Supportive care for acute infection
Patient Education
General: The natural history of chronic hepatitis C is currently not clear. All patients may not need specific
therapy, but some will benefit from Interferon therapy.
Activity: As tolerated.
Diet: Refrain from all alcohol products.
Prevention and Hygiene: Sexual partners and children should be tested. Patient should not donate blood,
tissues or semen. Sexual transmission likely occurs at a very low rate. Those infected should inform all
sexual partners. Use of condoms in long-term monogamous couples is not absolutely required. Avoid sharing
toothbrushes and razors.
Follow-up Actions
Return evaluation/ Consultation Criteria: All patients suspected to have chronic hepatitis C should be
referred to a specialist.
NOTES: Other diseases associated with HCV infection include cryoglobulinemia, porphyria cutanea tarda
and glomerulonephritis.
ID: Hepatitis E
LTC Duane Hospenthal, MC, USAIntroduction: Hepatitis E virus (HEV) causes infection that is spread by fecal contamination of water or food.
Infection is endemic to India, Southeast and Central Asia, the Middle East, northern Africa and Mexico, with
increased incidence in developing nations. Incubation period averages 4-5 weeks. Virus is excreted into the
stool of infected individuals prior to the development of symptoms. Most individuals recover spontaneously
and completely in 1-4 weeks. No “carrier state” exists.
Subjective: Symptoms
General: Flu-like illness with fever, nausea, anorexia and malaise. Jaundice usually develops a few days
later, often accompanied by resolution of the flu-like symptoms. Pruritus may accompany jaundice.
Local: Right upper quadrant abdominal pain, dark urine, light-colored stool
Focused History: When did you notice you were turning yellow? (In acute hepatitis E, jaundice develops
several days after the other symptoms. In chronic liver disease, jaundice may develop more slowly, usually
without fever or other acute symptoms.) Is anyone else ill? (Hepatitis E can occur in outbreaks from common
source contamination.) Is your urine darker than usual? Are your stools lighter than usual? (typical symptoms)
Have you injected drugs or had unprotected sex with a new partner? (Hepatitis B is associated with parenteral
exposures, hepatitis E is not.)
Objective: Signs
Jaundice and tender hepatomegaly.
Using Basic Tools:
Vital signs: Low grade fever
Inspection: Jaundice of skin, sclerae, and mucous membranes under tongue
Palpation: Smooth, tender, liver edge beyond costal margin; may also have splenomegaly