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LEARNING OBJECTIVES

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

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

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

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

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

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

PATIENT PRESENTATION

Chief Complaint

“I’m here for my free hepatitis B screening.”

HPI

Ming Hui is a 36-year-old Chinese woman from Mainland China with no significant past medical history. Over the summer, she was required to obtain a physical exam prior to arriving to America. She does not recall the lab results but recalls someone telling her to seek a liver doctor. She is here for her first time in the free health clinic to be evaluated for liver disease.

PMH

HTN lifestyle controlled

Chronic hepatitis B

Surgical History

None

FH

Mother alive, with HCC secondary to HBV. Has one older brother and one younger sister; HBV status unknown for siblings. Father with MI, died at age 56.

SH

Not currently in a relationship. She does not smoke or use IV drugs. She drinks one glass of red wine daily for the heart for the past 3 years. She works as an administrative assistant.

Meds

Dong quai, three capsules PO daily for menstrual cramps

All

None

ROS

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.

Physical Examination

Gen

The patient is not in acute distress.

VS

BP 128/82, P 76, RR 20, T 37.6°C; Wt 127 lb (57.9 kg), Ht 5′1″ (155 cm)

Skin

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

HEENT

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

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