Mr. Collins is a 55-year-old physician’s assistant with a history of chronic hep

Question

Mr. Collins is a 55-year-old physician’s assistant with a history of chronic hepatitis C. Past history was remarkable for a needle stick 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. On examination he was noted to have hepatomegaly and be markedly pale with icteric (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 most common etiologies of hepatitis C virus (HCV)?

2. What general dietary recommendations should be given to Mr. Collins?

3. Suppose Mr. Collins develops steatorrhea. Recommend daily energy (based on his EER; light activity), protein, and total fat intakes for him.

Explanation / Answer

The HCV virus causes hepatitis C. The virus is transmitted through blood-to blood contact. For a blood-to-blood infection to occur, blood from an infected person must enter the body of someone who is not infected. The biggest risk factor for becoming infected with HCV is sharing needles or equipment used to inject drugs.

HCV is not transmitted through casual contact, respiratory droplets, sharing food, kissing, or mosquito bites. The etiology includes the following:

People with hepatitis C don't need to follow a special "hepatitis C diet." The advice that an average, healthy person gets will work just as well for people with hepatitis C, unless those people also have cirrhosis or another condition, such as diabetes, HIV, or kidney disease.

General dietary advice:

Cautions:

A low-fat diet, meaning that fat should provide less than 30 percent of the total calories. Usually, if 30%-40% of the calories are given as fat this is well tolerated, especially when the foods are rich in vegetable fats. Energy requirements are about 25 to 40 kcal/kg, protein requirement is estimated minimally at 1.0 to 1.2 g/kg/day and may range up to 1.5 g/kg, carbohydrate is estimated to be 45% to 65% of total energy intake for adults.

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