Question

Mr. Collins is a 55-year-old physician's assistant with a history of chronic hepatitis C. Past history was remarkable for a needlestick injury on the job that occurred two years ago. Following the injury, he initially experienced sporadic episodes of mild flu-like symptoms with fever, chills, and diaphoresis. Over the past six months, his complaints increased to include generalized muscle weakness, fatigue, and weight loss. Mr. Collins is 5'9" tall and weighs 150 pounds with a usual weight of 162 Onexamination he was noted to have hepatomegaly and be markedly pale with icterie (jaundiced conjunctiva and skin Mr. Collins complains of a poor appetite. He generally eats two meals a day and prefers meat, potatoes, salted snacks, and an occasional beer. He dislikes sweets, and some vegetables and fruits. He states that he often has nausea and feels bloated after eating, but is unable to pass the gas. He feels most comfortable when his stomach is empty 1. What are the risks or complications of HCV? 2. What advice would you give Mr. Collins about drinking alcohol? 3. What dietary recommendations should be given to Mr. Collins, consider gevral needs of protein and fat? 4. Suppose Mr. Collins condition worsers and develops steatorhea. Based on his EER with light activity recommend daily takes of(show calculations, get totals for this specific patient . energy (kcals/day b. protein (g/kg) Stotalfat (of kcals from fat)

Answer 1

1. Risk or complications of HCV:

If Hepatitis C was left untreated that which results both hepatic and extra hepatic complication.

Hepatic Complications:

• Acute hepatic necrosis
• Chronic hepatitis
• Liver Cirrhosis
• Hepatic failure
• Hepatocellular carcinoma

Extra hepatic complications:

• Focal lymphocytic sialadenitis
• Autoimmune thyroiditis
• Mooren corneal ulcer
• Hepatitis C form immune complexes with anti HCV immunoglobulin.

2) Most of the research studies show the small quantity of alcohol increase the risk of liver damage In hepatitis individuals.

• Hepatitis C infections can results to inflammatory reactions which is defense mechanism that fight against to the virus and protect the liver. By consumption of alcohol that increase for development of inflammation.
• Alcohol will potentiate the scarring of liver through several mechanism .One example is oxidative stress which produce toxins causing fibrosis in the liver.
• So,Mr Collin should avoid alcohol consumption completely.

3) Dietary recommendation to Mr.Collin are:

Foods to be taken:

• Grains
• Bread
• Legumes
• Beans
• Vegetables
• Fresh fruits
• Drink lot of water.

Food to be avoided are:

• Alcohol
• Sugary foods
• Artificial sweeteners
• Salty food
• Nutritional Supplements

4) Energy( Kcal/day)

• Convert Body weight pound into kilograms: 150×0.45= 67.5kg
• Multiply body weight by 1.0: 67.5×1= 67.5kg
• Multiply with 24 :67.5×24=1620
• Multiply by lean factor because patient is above 28 years:1620 ×0.85 =1377
• Multiply by Activity modifier: 1377 ×1.55= 2134.3 Kcal/day

Protein Intake =0.8gms ×67.5kg= 54gm of protein/day