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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • List modes of transmission and risk factors for hepatitis B

  • Identify the signs and symptoms of hepatitis B

  • Create treatment goals for treatment of hepatitis B

  • Develop a nonpharmacological and pharmacological treatment and monitoring plan for hepatitis B

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PATIENT PRESENTATION

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Chief Complaint

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"I have hepatitis B and the medications are not working."

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History of Present Illness

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Vivian Lin is a 32-year-old Chinese female referred for further evaluation of her hepatitis B virus (HBV). She is currently being treated for the HBV infection by her primary care physician for the past year and had started lamivudine in March 2006. Her HBV DNA quantitative level was 2,422,348 copies/mL and alanine transaminase (ALT) level was 101 IU/L (1.68 μkat/L). She was born in Hong Kong and immigrated to the United States at the age of 12. She has no complaints of dark urine, pale stools, or yellow eyes or skin.

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Past Medical History

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Hepatitis B diagnosed in 2006

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Surgical History

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None

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Family History

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Mother is deceased and had diabetes and hepatitis B. Father died of heart disease.

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Social History

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She is married and has no children. She has been married for 5 years and only has had 1 sexual partner in her lifetime. She currently works in data entry and has no medical insurance.

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Tobacco/Alcohol/Substance Use

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She does not drink alcohol, smoke tobacco, or use illicit drugs.

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Allergies/Intolerances/Adverse Drug Events

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She denies any allergies.

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Medications (Current)

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Multivitamin

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Lamivudine 100 mg daily—started March 2006

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Review of Systems

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(−) Chest pain, SOB, weight loss, weight gain, dysuria, melena, or hematochezia

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Physical Examination

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General
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The patient is a well-developed, alert and oriented, well-nourished looking woman.

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Vital Signs
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BP 122/80 mm Hg, P 80, RR 20, T 37.1°C

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Weight 125 lb (56.8 kg)

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Height 69 in. (175 cm)

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Pain scale: 0 out of 10

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Skin
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There are no spider angiomata or palmar erythema.

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HEENT
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Eyes anicteric, throat examination normal.

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Neck and Lymph Nodes
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Thyroid not palpable.

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Chest
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Clear to auscultation and percussion.

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Cardiovascular
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RRR, no murmurs or gallops

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Abdomen
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(+) Bowel sounds; ...

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