NURS 6512 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

NURS 6512 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

NURS 6512 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

The case study depicts a 46-year-old female patient with a chief complaint of RUQ pain for the last 24 hours. The RUQ pain began an hour after dinner, and she had nausea and vomiting x1 before the pain started. The abdomen is non-distended but has mild tenderness. Lab results revealed a high WBC count and Direct bilirubin. The purpose of this paper is to discuss the patient’s diagnosis and treatment plan.

Diagnosis

Hepatitis A is the identified diagnosis for this case. It is caused by the hepatitis A virus (HAV) transmitted via the fecal-oral route through person-to-person contact and ingesting contaminated food or water. The classical presentation in adults includes anorexia, RUQ pain, jaundice, and hyperbilirubinemia (Abutaleb & Kottilil, 2020). Hepatitis A is the presumptive diagnosis based on pertinent positive symptoms of nausea, vomiting, RUQ pain, abdominal tenderness, and high direct bilirubin levels. Besides, an elevated WBC count indicates an underlying infection.

Drug Therapy Plan

Treatment of Hepatitis A is usually supportive. I would recommend Acetaminophen 500 mg per oral twice daily to relieve pain. Pain relief is important to promote quality patient care in the acute phase of Hepatitis A (Ntouva et al., 2019). In addition, I would recommend Metoclopramide 10 mg PRN. Metoclopramide is an antiemetic and will be important to alleviate nausea and vomiting. In addition, inactivated Hepatitis A vaccine will be administered for active immunization against diseases associated with HAV (Ntouva et al., 2019).

Conclusion

The patient presented with symptoms consistent with Hepatitis A, such as nausea, RUQ pain, mild abdominal tenderness, hyperbilirubinemia, and an elevated WBC count. Hepatitis A could be due to transmission of HAV from contaminated food or water. The treatment plan will include supportive measures such as pain control and alleviating nausea and vomiting using an analgesic and antiemetic.

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References

Abutaleb, A., & Kottilil, S. (2020). Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterology clinics of North America, 49(2), 191–199. https://doi.org/10.1016/j.gtc.2020.01.002

Ntouva, A., Sibal, B., Balogun, K., Mandal, S., & Harding, N. (2019). Hepatitis A in primary care: working in partnership for diagnosis, management, and prevention of outbreaks. The British journal of general practice : the journal of the Royal College of General Practitioners, 69(687), 521–522. https://doi.org/10.3399/bjgp19X705965

In the case study offered, the patient’s primary symptoms are diarrhea, nausea, and vomiting. The patient also discloses a history of drug usage and a potential hepatitis C infection. The patient’s prescription medication points to a history of hypertension and hypothyroidism. The most likely diagnosis, based on the available subjective data, is Hepatitis C. (Patel & Flamm, 2022). This diagnosis is supported by the patient’s symptoms. As a result, substance abuse is a common risk factor for this illness since patients who inject drugs using needles and syringes might develop it (Teti, 2020). Research has also revealed that untreated hepatitis C can have harmful repercussions on the body, including congestive heart failure and hypothyroidism, as the patient has shown (Terrault, 2019). Nonetheless, an HCV antibody test is necessary to confirm this diagnosis.

            The diagnosis will determine the patient’s treatment strategy. Direct-acting antiviral (DAA) tablets, such as simeprevir 150 mg orally once daily in conjunction with ribavirin and PEG-IFN, are indicated for 12-week pharmaceutical treatment for the management of hepatitis C. (Heffernan et al., 2019). Nonetheless, loperamide will be used to treat diarrhea, and antiemetics such as ondansetron to treat nausea and vomiting as part of the patient’s symptomatic care at this time (Terrault, 2019). To control the accompanying issues, such as hypothyroidism and hypertension, the patient should keep taking the prescribed medications, such as Synthroid 100mcg, Nifedipine 30mg, and prednisolone 10 mg. Given that the patient has a history of substance use, prompt treatment is required to prevent future consequences such as liver cirrhosis (Paul & Davis, 2018). The patient should be educated on the importance of complying with the treatment plan. Monitoring of the treatment outcome is necessary to promote appropriate alteration of medication for a desirable outcome. The significance of adhering to the treatment plan should be explained to the patient. It is important to keep track of treatment results to modify medicine in a way that will provide the desired results.

References

Heffernan, A., Cooke, G. S., Nayagam, S., Thursz, M., & Hallett, T. B. (2019). Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model. The Lancet, 393(10178), 1319–1329. https://doi.org/10.1016/s0140-6736(18)32277-3

Patel, P., & Flamm, S. (2022). Screening, Diagnosis, and Treatment of Alcohol-Related Liver Disease and Alcohol-Associated Hepatitis. Gastroenterology & Hepatology, 18, 409. https://www.gastroenterologyandhepatology.net/files/2022/06/0722-Patel-Flamm_final-1.pdf

Paul, S., & Davis, A. M. (2018). Diagnosis and Management of Nonalcoholic Fatty Liver Disease. JAMA, 320(23), 2474. https://doi.org/10.1001/jama.2018.17365

Terrault, N. A. (2019). Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research, 8, 54. https://doi.org/10.12688/f1000research.15892.1

Teti, E. (2020). Hepatitis C management and treatment among people who inject drugs in Italy: an exploratory pilot survey. MISSION, 54. https://doi.org/10.3280/mis54-2020oa9744