Curriculum for Specialty Certificate Examination in Gastroenterology

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Tuesday, 22 April 2014

Hepatitis C viral infection: Questions and comments

1-a 34 year old man with hepatitis C attended for review after treatment for 12 weeks with peginterferon and ribavirin co-therapy. He complained of lethargy and SOB on exertion. I vestigation prior to treatment confirmed genotype 1 and a viral load of 1.3 x 10 to 6 with no evidence of cirrhosis.

Investigations:
Hb 10
Plt 65
neutrophils 0.8
LFT normal
U&E normal

what is most approperiate next step in management?
1-continue same treatment

2-Blood transfusion

3-reduce peginterferon

4-reduce ribavirin

5-stop treatment

During the treatment of HCV infection, assess for side effects at week 1,2,4 and then 4-8 weekly.
Ribavirin can cause anaemia.
Action: reduce dose, consider transfusion if Hb less than 10

Peg-interferon alfa can cause:
flu-like symptoms,usually subside in few weeks
neutropenia nad thrombocytopenia
consider dose reduction if neutrophills less than 0.75, Plts less than 50

other side effects includes: depression, irritability, sleeping disorders

stop treatment if hepatitis flare up ALT > 10 time ULN or severe bacterial infection.


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