Chapter 50: Viral Hepatitis A: Going on Vacation Level II

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LEARNING OBJECTIVES

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

• 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.

PATIENT PRESENTATION

Chief Complaint

“My family and I are going on vacation.”

HPI

Lorenzo is a 37-year-old white man, born and raised in Italy who now resides in New York. He married his Taiwanese wife 2 years ago. He was diagnosed with NASH and hepatitis C at the age of 34 while undergoing a physical exam. He and the family will be going to China to celebrate Chinese New Year. Lorenzo was instructed to go to the Travel Clinic for vaccinations before leaving the United States in the next 3 weeks.

PMH

NASH diagnosed at age 34

Hepatitis C diagnosed at age 34

Diabetes

Hypertriglyceridemia

HTN

Surgical History

Several surgeries after a motor vehicle accident that required blood transfusions in the early 90s.

FH

Mother with no medical complaints. Father is alive with alcoholic liver disease. One younger sister with DM and older brother with HTN.

SH

Married for 2 years and lives with wife and 2-year-old son. He had smoked in his early 20s, one ppd then quit at age 26. He does not drink (or ever drank, fearing he would end up like his father). He had a tattoo placed professionally 2 years ago. There is no history of IV drug use, cocaine use, or abuse of prescription drugs. He has worked as a banker for the past decade.

Meds

Glipizide 10 mg PO twice daily

Gemfibrozil 600 mg PO twice daily

Enalapril 5 mg PO once daily

Fish oil—OTC, PO once daily

All

Sulfa, ciprofloxacin

ROS

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.

Physical Examination