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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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  • Outline a pharmacologic and nonpharmacologic regimen for patients with chronic hepatitis B.

  • Determine clinical and laboratory end points for treatment of chronic hepatitis B.

  • Assess the efficacy and adverse effects of chronic hepatitis B treatment with interferon, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir.

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

  • Provide patient education on interferon, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir treatment.

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PATIENT PRESENTATION

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Chief Complaint

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“I’m here for my hepatitis B disease.”

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HPI

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Trong Pan is a 21-year-old Chinese woman with no significant past medical history except for acquiring hepatitis B infection at birth from her mother. Over the summer, she was required to obtain a physical exam prior to entering her first year of nursing school. Laboratory test results indicated a positive HBsAg. She was referred to the liver clinic for further evaluation and possible treatment.

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PMH

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  • Seasonal allergies

  • Chronic hepatitis B

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Surgical History

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None

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FH

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Mother and father alive, both positive for HBsAg. Father has HCC. Has one younger sister, HBV status unknown.

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SH

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Single. She does not smoke or use IV drugs. She drinks socially on the weekends. She is in her first year of nursing school.

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Meds

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  • Phenylephrine 10 mg PO Q 4 H PRN for allergies

  • Dong quai three capsules PO daily for menstrual cramps

  • Calcium with vitamin D PO daily

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All

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None

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ROS

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Denies any symptoms. Her weight is stable with no loss of appetite. No nausea, vomiting, diarrhea, abdominal pain, or constipation. No melena or hematochezia. No changes in urine or stool color and no history of icteric sclerae.

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Physical Examination

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Gen
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The patient is not in acute distress

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VS
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BP 128/82, P 76, RR 20, T 37.6°C; Wt 52.1 kg, Ht 5′5″

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Skin
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Warm and dry; no signs of jaundice. Good turgor

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HEENT
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Head is normocephalic, atraumatic. Sclerae are anicteric bilaterally. Neck is supple. No masses or palpable lymphadenopathy. PERRLA. Funduscopic exam normal

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Cor
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RRR, S1, S2 normal; no S3 or S4

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Lungs
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Clear to P & A

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Abd
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Good bowel sounds, soft, nontender; ...

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