sandra
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A 38-year-old white letter carrier returns to the office for follow-up of an abnormal liver chemistry profile ordered
3 weeks ago during a routine examination. At that time, his physical examination was normal, but he had a serum
AST concentration of 72 U/L. His serum bilirubin and alkaline phosphatase concentrations were normal. History
includes an episode of hepatitis A at age 22 years. He has no history of transfusions or intravenous drug use. He
drinks two to three beers daily. Today's follow-up test results show:
Serum
Anti-HAV Positive
Anti-HBs Negative
HBsAg Positive
HBeAg Positive
Which of the following is the most appropriate next step?
(A) Begin interferon-alfa therapy
(B) Begin corticosteroid therapy
(C) Have him cease all alcohol consumption and retest him in 2 months
(D) Order hepatitis B virus DNA polymerase study
(E) Schedule liver biopsy
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| WaqasQureshi
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c
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| liliaeliz
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Ag HBeV POSITIVE .AgHBsV POSITIVE ACTIVE HEP B IF THE AST IS INCREASE GIVE INTERFERON
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| zaidsuror
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i would do e
Interferon is not indicated if patient is asymptomatic. And c doesn't make sense since no amount of alcohol intake causes a false positive HbsAg or HbeAg.
Since patient has no risk factors history doesn't suggest Hepatits B , yet investigation suggests it . to resolve the conflict we can do Liver Biobsy , which is the single most accurate test for diagnosing Hepatitis B.
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| guangyu
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A, the pt have hepatitis e positive that mean infective, so give interferon
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| Justice
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guangyu wrote:
A, the pt have hepatitis e positive that mean infective, so give interferon
Hey, this is not Hep E virus, it's HBeAg, that usggest that virus is replicating... PCR would readily confirm that.
I would go with D first, to confirm the diagnosis...
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| Justice
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guangyu wrote:
A, the pt have hepatitis e positive that mean infective, so give interferon
Hey, this is not Hep E virus, it's HBeAg, that suggest that virus is replicating... PCR would readily confirm that.
I would go with D first, to confirm the diagnosis...
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| peter90036
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why would you do pcr?
eAg is (+) = active disease
as UW says somewhere, if the LFT is not high interferon has not much benefit?
also
the classification or something now is based on biopsy --> do biopsy
Edited by peter90036 on 03/21/08 - 12:23 PM
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| ganesha123
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acive disease.. chronic.. so i wud go with interferon...
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| zaidsuror
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So what is the right answer?? Every one seems to have a point !!!!
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| sandra
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hi everyone,
the correct answer is c.source: step3 released nbme questions. no explanation available
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| peter90036
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can't find such thing in step 2 books 
quick read seems the books all have both biopsy and DNA ...
seems Hepatitis C must biopsy for treatment not sure B.
ALT is strongest predictor of response (schiff liver disease)
only AST here.
liver biopsy to be considered for patients with HBV DNA of 4-5log10IU/mL and ALT 1-2x upper limit (schiff liver disease)
there is no way to tell if this is chronic.
AASLD (not ASSLD) Hepatitis B management Guidelines 2007
http://preview.tinyurl.com/35ebq4
if someone wants to summarize that... i got to get back to my crap.
sorry, i was writing this for a while and when posted it came after sandra's,
see above
sandra
hi everyone,
the correct answer is c.source: step3 released nbme questions. no explanation available
Edited by peter90036 on 03/30/08 - 10:43 AM
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| zaidsuror
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Okay .......so, we are considering the positive HBsAg and HBsAg are sufficient to making the dignosis of hepatitis B,even though we can't say it is chronic by defentition.
Now that we have the answer,it seems the reasoning is quite logic.I mean the main issue is what to do next.Do we give interferon or not? We give it in patients with chronic hepatitis B with Active disease (moderate) prior to progression to cirrhosis.So here ,given the Alcohol intake and only the AST, the reasonable thing is to ask the patient to stop alcohol and to come back after a couple of moths at which time we can reevaluate the patient clinically, serologically confirming a chronic status and LFT to assess activity and whether to start interferon or not.
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| peter90036
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zaidsuror: do you remember in UW, that recommended biopsy, was it a chronic hepatitis B or C ?
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| guangyu
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so do you think stop drinking can make pt hepatitis e negative?
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| peter90036
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no, but maybe you can asses liver function better if you had to do enzyme/biopsy ?
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| zaidsuror
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peter90036 got it right in the sense that abstinence from alcohol will render the next liver enzyme measurement reliable in stating whether disease is active and needs Interferon or lamivudine.
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| liliaeliz
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 good job
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