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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Determine which patient populations are at greatest risk for contracting hepatitis A.

  • Recommend hepatitis A immunization for appropriate individuals based on current guidelines of the Centers for Disease Control and Prevention (CDC).

  • Assess the efficacy and adverse effects of hepatitis A vaccines.

  • Counsel eligible patients on the benefits of hepatitis A vaccination and the possible adverse effects associated with its use.

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PATIENT PRESENTATION

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Chief Complaint

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“My doctor sent me to follow up on my liver disease.”

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HPI

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Hector is a 39-year-old Hispanic man, born and raised in Arizona, who will be visiting his family in Mexico in the next 2 weeks. He will be seeing his grandmother for her 90th birthday with his wife and daughter. He was diagnosed with NAFLD at the age of 32. He also has hepatitis C secondary to several blood transfusions in 1991 after having multiple surgeries following a motorcycle accident. Hector’s PCP referred him to see the hepatologist again before traveling for vaccinations and follow-up as he has not seen the liver specialist in the last 5 years.

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PMH

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  • NAFLD diagnosed at age 32

  • Hepatitis C diagnosed at age 32

  • Hypercholesterolemia

  • HTN

  • Depression

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Surgical History

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Several surgeries after a motorcycle accident that required blood transfusions between 1991 and 1992

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FH

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Mother died at 57 secondary to breast cancer and father is alive with hepatitis B; one brother with gout, HTN, and DM

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SH

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Married for 13 years and lives with wife and daughter. He smokes tobacco; one ppd, and drinks two to three glasses of wine daily. He has several large tattoos that were done professionally. There is no history of IV drug use, cocaine use, or body piercings. He has worked as a chef since the age of 24.

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ROS

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Positive for fatigue, decrease in appetite. Denies weight loss/gain, fevers, chills, headaches, shortness of breath, and coughing. He does have some abdominal pain intermittently, also constipation off and on. No black stools or obvious blood in stools.

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Meds

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  • Multivitamin tablet PO once daily

  • Simvastatin 40 mg PO once daily

  • Lisinopril 40 mg PO once daily

  • Escitalopram 10 mg PO daily

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All

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PCN, sulfa

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Physical Examination

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Gen
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The patient is a Hispanic-American man in no apparent distress

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VS
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BP 127/74, P 70, RR 22, T 36.9°C; Wt 121.8 kg, Ht 5′9″

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Skin
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Warm and dry. Spider angiomas are not ...

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