LIVER DISEASE
LEARNING OBJECTIVES :
KNOWLEDGE - Students should know that:
- Blood banking is safe in the USA and the risks of acquiring hepatitis is low. Almost all of the post-transfusion hepatitis seen today is HCV.
- The approach to the patient with clinical jaundice.
- The five serologic types of hepatitis (A, B, C, D, and E), their primary mode of transmission, that only B, C, and D can culminate in chronic hepatitis, and that liver biopsy is essential in establishing the diagnosis of chronic disease.
- Source of infection is unknown in one-third of HBV patients and one-half HVC patients.
- Active and passive immunization is available for hepatitis A and B only.
- Treatment of chronic B and C disease is available with interferon and several oral agents.
- Some of the indications for hepatic transplantation.
SKILLS - Students should be able to:
- Obtain and record an accurate history in the patient with suspected liver disease.
- Perform an accurate physical examination in the patient with suspected liver disease; palpate for hepatosplenomegaly and appreciate the extrahepatic findings in chronic liver disease such as spider angiomata, gynecomastia, ascites, testicular atrophy, etc.
- Generate a differential diagnosis in the jaundiced patient.
- Develop a treatment plan for patients with chronic liver disease.
ATTITUDES AND PROFESSIONAL BEHAVIORS:
- Students should be able to recognize the impact of chronic liver disease on the patient's life and the need for close follow up so that complications can be recognized and treated promptly.
RECOMMENDED READINGS :
- Yamada, Tadataka. Handbook of Gastroenterology . 2000, Chap 16 (The Medicine Education Office, 7604, has a copy of this reference.)
- Screening for Hepatitis C Virus Infe c tion : Re c ommendations from the U.S. Preventive Servi c es Task For c e Ann Intern Med , Mar 2004; 140: I-62.
- Steven K. Herrine Approa c h to the Patient with C hroni c Hepatitis C Virus Infe c tion
Ann Intern Med , May 2002; 136: 747 - 757.