P.M., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at youroutpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build and a deep tanover the exposed areas of skin

Question

He reports headaches, joint pain, a low-grade fever, cough, anorexia, and
nausea and vomiting (N/V), especially after eating any fatty food. P.M. describes vague abdominal pain
that started about the same time as the other problems. He states that he has been using "a lot of Tylenol"
for his pain. His past medical history reveals he has no health problems, is a nonsmoker, and drinks "a few"
beers each evening to relax. Vital signs are 128/84, 88, 26, 100.6 ° F (38.1 ° C); awake, alert, and oriented× 3;
moves all extremities well with complaints of aching pain in his muscles; very slight scleral jaundice present; heart and breath sounds clear and without adventitious sounds; bowel sounds clear throughout
abdomen and pelvis; and abdomen soft and palpable without distinct masses. You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated and tender to palpation. P.M.
mentions that his urine has been getting darker over the past 2 days.
Your institution uses electronic charting. Based on the health history and assessment
described in the scenario, which of the following systems would you mark as "abnormal"
as you document your findings? Mark abnormal findings with an X and provide a brief
narrative.
X Abnormal
? Neurologic:
? Respiratory:
? Cardiovascular:
? Gastrointestinal:
? Genitourinary:
? Musculoskeletal:
? Skin:
? Pain:
? Neurologic: Awake, alert, and oriented× 3.
? Respiratory: Reports cough; breath sounds clear and without adventitious sounds.
? Cardiovascular: Heart sounds clear and without adventitious sounds.
? GI: Bowel sounds clear throughout abdomen and pelvis; and abdomen soft and palpable without
distinct masses. Hepatomegaly measured at the midclavicular line; liver edge is easily palpated
and tender to palpation. Complains of (C/O) vague abdominal pain, anorexia, and N/V, especially
after eating any fatty food.
? Genitourinary: States that his urine has been getting darker over the past 2 days.
? Musculoskeletal: Moves all extremities well. C/O aching pain in his muscles and joint pain.
? Skin: 100.6° F (38.1° C). Very slight scleral jaundice present.
? Pain: Reports headaches

P.M. is manifesting key signs of hepatitis. Laboratory work is requested for identification of his precise problem.

Which key diagnostic tests will determine exactly what type of hepatitis is present?

Answer 1

Testing is done for the presence of, or specific ratio of, serologic markers (specific antibodies).
For hepatitis A: Anti–hepatitis A virus (anti-HAV), immunoglobulin M (IgM) (and IgG).
For hepatitis B: Hepatitis B surface antigen (HBsAg) rises before the onset of symptoms and peaks
during the first week of symptoms, then returns to normal by the time jaundice subsides.
For hepatitis C: Detection of anti–hepatitis C virus (anti-HCV) antibodies to HCV RNA.