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Abstract: A 51-year-old middle-aged male patient presented to our hospital with the complaints of “nausea, anorexia of oil for more than 10 days, yellow eyes, and yellow urine for 1 week”. After examination, the patient was positive for hepatitis C antibody, with high level of hepatitis C virus replication and obvious abnormal liver function, and was diagnosed with acute viral hepatitis C (jaundice type), which is a type of acute hepatitis C. After active drug treatment, the patient’s liver function improved, and the indicators were basically normal.
Basic information】Male, 51 years old
Disease Type】Acute viral hepatitis C (jaundice type)
Hospital】Liaoning Provincial People’s Hospital
Time of consultation】June 2018
【Treatment plan】Medication (compound dichloroacetate diisopropylamine tablets, polyene-phosphatidylcholine injection, magnesium isoglycyrrhizate injection, injectable ornithine menthylate, silymarin capsules)
Treatment period】4 weeks of inpatient treatment, followed by outpatient treatment in half a month
Treatment effect] The indexes were basically normal and the condition was stable.
I. Initial consultation
The patient is a 51-year-old middle-aged male, complaining of “nausea and anorexia of oil for more than 10 days, yellow eyes and yellow urine for one week”. The patient reported that he had nausea, anorexia of oil and stomach discomfort with no obvious cause more than 10 days ago, and he took domperidone tablets twice by himself, but his condition did not improve significantly, and then he developed yellow eyes and yellow urine, the color of strong tea, without fever, abdominal pain, epistaxis and gum bleeding, etc. He lost about 10 pounds in the past six months, so he came to our hospital. Liver function tests were performed on the patient, and his test results were obviously abnormal: ghrelin: 773 U/L, ghrelin: 486 U/L, total bilirubin: 83.6 μmol/L, and glutamyl transpeptidase: 1164 U/L. The preliminary diagnosis was acute viral hepatitis, and hospitalization was recommended to further improve the examination and clarify the pathogenic diagnosis, and the patient and his family agreed to be admitted.
II. Treatment process
After the patient was admitted to the hospital, the patient was cared for according to the routine of infectious diseases, and before the pathogenesis was clarified, the patient was isolated in a single room and instructed to rest in bed, and hepatitis antibody tests and quantitative tests for hepatitis C virus were improved. the test results showed that the patient’s liver function was still significantly abnormal, hepatitis C antibody was positive, hepatitis A, hepatitis B and hepatitis E antibodies were negative, alpha-fetoprotein: 30.52 ng/mL. the CT scan of the upper abdomen revealed: fatty liver. Increased density of gallbladder and sediment-like stones. Therefore, an enhanced CT examination of the abdomen was recommended. The results suggested: slight dilatation of intrahepatic bile ducts and the possibility of small cysts in the left kidney. Combined with the characteristics of the patient’s case, consistent with the characteristics of acute viral hepatitis, at present, excluding hepatitis A, hepatitis B, hepatitis E, alcoholic hepatitis, etc., the diagnosis of acute viral hepatitis C (jaundice type) was confirmed, and he was treated with drugs for liver protection, enzyme lowering and yellowing, and the applied drugs included compound dichloroacetate diisopropylamine tablets, polyenyl phosphatidylcholine injection, magnesium isoglycyrrhetinate injection, injectable menthol Ornithine for injection, etc.
Third, the effect of treatment
After the symptomatic treatment of liver protection, enzyme reduction and elimination of yellow, the patient’s symptoms of nausea, oil aversion, abdominal distension, weakness, yellow urine and yellow eyes were significantly improved, and his appetite was enhanced. Weekly recheck of liver function showed that his liver function gradually improved and jaundice decreased. At 3 weeks of hospitalization, the patient was RNA negative for hepatitis C virus, indicating that the hepatitis C virus had cleared and he entered the recovery phase. At 4 weeks of hospitalization, the patient’s liver function improved further and all indicators were basically normal.
IV. Notes
We are glad that after a series of active treatment, the patient’s discomfort was relieved and the indexes basically returned to normal, and he was finally discharged from the hospital. However, in daily life, the patient still needs to pay attention to the following situations.
1. Since the patient’s liver function was basically normal at the time of discharge, but the liver cells had not yet fully recovered and the recovery period often takes 1-3 months, he needs to continue to take silymarin capsules orally for liver-protective treatment and, half a month after discharge, to have an outpatient follow-up to recheck liver function and hepatitis C virus quantification.
2. patients need to pay attention to rest and not to drink alcohol after discharge to avoid abnormal liver function and recurrence of the disease, while daily diet should be light and not too oily, otherwise post-hepatitis fatty liver and hyperlipidemia can occur.
3, patients in daily life should pay attention to appropriate exercise, but do not carry out strenuous exercise, and the amount of exercise should be gradual, gradually increase, in order not to appear weakness as the standard.
V. Personal insight
In clinical practice, the incidence of acute viral hepatitis C is lower compared with acute viral hepatitis B. It is mainly because there is a part of acute viral hepatitis C that is missed when patients present with clinical symptoms after acute hepatitis C virus infection, so when it is clear that patients have acute viral hepatitis, they need to pay attention to the possibility of acute hepatitis C if the pathogen is not clearly diagnosed. The patient in this case belongs to acute viral hepatitis C. However, because the patient was lucky enough to have a clear pathogenic diagnosis in time, the follow-up treatment was relatively smooth and the prognosis was good. It is worth noting that there is no consensus in clinical practice regarding the need for antiviral therapy for acute hepatitis C and the timing of antiviral therapy. In my personal opinion, in acute viral hepatitis C, hepatitis B viral RNA should be monitored regularly and reviewed every 3-4 weeks, and if the viral load decreases progressively or even the virus clears, antiviral therapy is usually not necessary. The feasibility of this view is also demonstrated by the fact that the patient in this case was not treated with antiviral therapy, but still had a good prognosis.