Jackie Dillman Hep C

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Jackie Dillman Hep C

  1. 1. November 2009 Case 2
  2. 2. Patient History : <ul><li>62 year old female </li></ul><ul><li>Asian descent </li></ul><ul><li>Status post Paracentesis 7/4/2009 another location </li></ul><ul><li>Abdominal ultrasound ordered for abdominal pain and bloating. </li></ul>
  3. 3. Ultrasound findings <ul><li>Ascites has returned to all four quadrants </li></ul><ul><li>Splenomegaly – 14.9 cm - moderate </li></ul><ul><li>Liver has irregular contour and is echogenic </li></ul><ul><li>Contracted gall bladder contains stones - cholelithiasis </li></ul><ul><li>No biliary dilatation seen </li></ul><ul><li>Bulky, hypoechoic pancreatic head </li></ul><ul><li>Visualized portions of aorta, IVC, and kidneys are within normal limits </li></ul>
  4. 9. CT recommended from US one month later:
  5. 12. CT findings <ul><li>Cirrhosis of the liver : shrunken, nodular, nutmeg enhancement, portal hypertension, portal vein hypertrophy </li></ul><ul><li>Distal esophageal and gastric varices, umbilical recanalization </li></ul><ul><li>Diffuse massive ascites throughout the abdomen </li></ul><ul><li>Thickened gall bladder wall and stones noted </li></ul>
  6. 13. Differentials <ul><li>Autoimmune Hepatitis – high levels of serum immunoglobulins, specifically IgG, hepatomegaly, splenomegaly, jaundice, signs and symptoms of chronic liver disease. Antimitochondrial antibody may present, antinuclear antibodies and anti-AKLM1 are often positive tests </li></ul><ul><li>Hepatitis C – progressive liver fibrosis leading to cirrhosis and end-stage liver disease, hepatocellular carcinoma. HCV has a specific serum titer and has antibody tests </li></ul>
  7. 15. <ul><li>Diagnosis: Hepatitis C </li></ul><ul><li>Treatment and follow-up: </li></ul><ul><li>Another paracentesis to treat the ascites </li></ul><ul><li>Future CT evaluation of the liver: recommendation for both arterial phase as well as delayed phase imaging to better evaluate the liver secondary to the hepatic venous congestion altering liver perfusion. </li></ul><ul><li>Current treatment is a combination of Pegylated interferon alpha 2a or Pegylated interferon alpha 2b with the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype </li></ul>
  8. 16. References <ul><li>Porth C.M., Matfin G., Pathophysiology Concepts of Altered States Eighth edition 2009. Lippincott and Williams pp 962-965 . </li></ul><ul><li>http://en.wikipedia.org/wiki/Hepatitis_C </li></ul><ul><li>http://www.merck.com/mmpe/sec03/ch023/ch023b.html </li></ul><ul><li>Middleton W.D., General and Vascular Ultrasound Case Review Studies Second Edition 2007 pp 175-176 </li></ul><ul><li>Kawamura D.M., Diagnostic Medical Sonography A Guide to Clinical Practice Abdomen and Superficial Structures Second edition 1997. Lippincott and Williams pp 146-156. </li></ul>

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