Acute Hepatitis B

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Acute Hepatitis B
GNUR543
St. John Fisher College

Mr. Wilson is a 47 year old man being evaluated for complaints of fatigue, anorexia and abdominal distention. On examination, it is noted that the skin is jaundiced and the liver enlarged. D.W. denies significant alcohol or drug use. He denies any known exposure to hepatitis and has never been vaccinated for hepatitis. He is taking no medication. Laboratory tests reveal the following and a diagnosis of acute hepatitis B is made:

1. Review and analyze the laboratory data. What diagnosis is supported by these values? Give your rationale. Mr. Wilson’s lab work is reviewed below:
* AST142 IU/L
* AST (Aspartate aminotransferase) is an enzyme and blood sample results can detect if there is liver damage. AST is found in the heart and liver with much lower levels in muscles and kidneys. In a healthy person the AST is between 10-40 IU/L. If the liver is damaged, AST is released into the blood stream (Hepatitis B, 2011). * ALT120 IU/L

* ALT (Alanine aminotransferase), if elevated can also be an indication of liver damage. ALT is an enzyme that is normally in the liver and kidneys. If the individual is healthy, the ALT is low, between 7-56 IU/L. Elevated ALT is an early indicator of liver damage usually elevating prior to a patient becoming jaundice (Hepatitis B, 2011). * GGT 42 IU/L

* GGT (Gamma-glutamyl transferase) is an enzyme that is found in the liver but may also be in the spleen, kidneys and pancreas. As with AST/ALT, GGT is elevated when there is liver damage. The normal test range is 0 – 51 IU/L. GGT will be elevated when there is acute damage to the liver (or bile ducts) (Hepatitis B, 2011). * Alk Phos 84 IU/L

* Alk Phos (Alkaline Phosphatase or ALP) is an enzyme found in the liver, bone, kidney and GI tract. Normal range for this blood test is 44 – 147 IU/L. Alk Phos, if elevated generally indicates that there is a blockage in the bile ducts. Also, if it is found to be high this means the patient can either have kidney disease or bone disease. To differentiate, a GGT test is also taken. If that result is high as well, a liver disease is present; if the GGT is within normal limits then the patient has bone disease (Hepatitis B, 2011). * Total Bilirubin1.0 mg/dl

* Total bilirubin is the product of damaged or broken down red blood cells in the body. The bilirubin is processed through the liver and the normal levels in the body are; 0.3 – 1.9 mg/dL. If this level is increased, it means that the liver is not processing the bilirubin due to liver disease (Hepatitis, 2011). * Albumin4.3 g/dl

* Albumin (ALB) measures the level of albumin in the patient’s plasma. Albumin is a protein that is made in the liver and is sensitive to any changes in liver function. Albumin mainly ensures that the cells in the body don’t leak, keep the tissues nourished and transports vitamins, calcium, hormones through the body. The normal range for Albumin is 3.4 – 5.4 g/dL. Albumin will be lower than normal in the case of malnutrition or liver disease (Hepatitis, 2011). * HBsAgpositive

* Anti-HBSnegative
* Anti-HCVnegative
* HIVnegative
Test Name| Mr. Wilson’s Result| Normal Ranges| |
AST| 142 IU/L| 10-40 IU/L| Elevated|
ALT| 120 IU/L| 7-56 IU/L| Elevated|
GGT | 42 IU/L| 0 – 51 IU/L| Normal|
Alk Phos | 84 IU/L| 44 – 147 IU/L| Normal|
Total Bilirubin| 1.0 mg/dl| 0.3 – 1.9 mg/dL| Normal|
Albumin| 4.3 g/dl| 3.4 – 5.4 g/dL| Normal|

Mr. Wilson’s labs indicate that he has chronic Hepatitis B. This is chronic because the indicators for acute liver damage are within normal limits. For example, if the patient were having an acute onset of Hepatitis B his Albumin would be low. Albumin is made in the liver and is very sensitive to any changes in the liver. If there was acute damage to the liver the Albumin value would not be in...
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