Differential Diagnoses

While all forms of viral hepatitis present with similar symptoms, (jaundice, fever, abdominal pain, nausea, and fatigue) they are also different in many ways. Below we describe the possible differential diagnoses for our patient.

Differential Diagnosis I

Image result for Hepatitis C
Pictured: Hepatitis C and it’s effects on the human liver. Gee, I. (2005). Liver transplantation for hepatitis C virus related liver disease. Postgraduate Medical Journal, 81(962), 765-771. doi:10.1136/pgmj.2005.034082
  • Hepatitis C: 
    • Inflammation of the liver where transmission is primarily through injection drug use, while sexual transmission is rare but the likelihood increases with the number of sexual partners and co-infections with HIV.
    • The disease progresses from an acute stage to a chronic stage around 70% of the time. (Viral Hepatitis, 2018)
    • Rationale: The patient’s complaints of fatigue, anorexia, malaise, nausea, vomiting, abdominal pain, low grade fever, jaundice, dark urine, clay-colored stool and joint pain are all symptoms of hepatitis C (Viral Hepatitis, 2018). The patient’s medical history of blood transfusion and social history of injectable drug use put him at risk for HCV since Hepatitis C causes most cases of post-transfusion hepatitis and it is transmitted parenterally, usually through injection drug use (McCance & Huether, 2019). What’s more, there is no vaccine for HCV. Collectively, these factors provide rationale for considering Hepatitis C as a differential diagnosis.

 

Differential Diagnosis II


Infection With Hepatitis B Virus [Cartoon]. (n.d.). Retrieved October 29, 2018, from https://www.immunizationinfo.com/wp-content/uploads/Infection-With-Hepatitis-B-Virus.jpg
  • Hepatitis B
    •  Inflammation of the liver where transmission is most commonly spread through sexual contact, injection drug use, or any exposure to infected blood or body fluids.
    • Acute HBV infection typically resolves, but in around 2% of cases, infection progresses to fulminant hepatitis, which has a case fatality rate of 63% to 93% (Viral Hepatitis, 2018)
    • People with a compromised immune system are at elevated risk of developing chronic infection.
    • Rationale: The patient’s complaints of fatigue, anorexia, malaise, nausea, vomiting, abdominal pain, low grade fever, jaundice, dark urine, clay-colored stool and joint pain are also symptoms of hepatitis B. In the United States, sexual contact is the most common way that hepatitis B spreads among adults (McCance & Huether, 2019). People are also more likely to have hepatitis B if they are men who have sex with men, especially if they have had more than one sex partner in the last 6 months (Viral Hepatitis, 2018). Patient’s report of being sexually active with multiple male partners increases his chance of HBV. All these factors provide rationale for considering Hepatitis B as a differential diagnosis. However, the transmission and development of hepatitis B can be prevented through vaccine. Since the patient is fully up to date on vaccination, we can rule out the possibility of him being infected by HBV.

Differential Diagnosis III

Image result for hepatitis d and hepatitis B
Hepatitis D [Cartoon]. (n.d.). Retrieved October 29, 2018, from https://ak3.picdn.net/shutterstock/videos/10333373/thumb/4.jpg
  • Hepatitis D
    • Inflammation of the liver that is spread via parenteral, fecal-oral, or sexual contact.
    • It is caused by a defective RNA virus that only occurs in patients who have Hepatitis B. Because of this, it presents with the same symptoms as Hepatitis B (Viral Hepatitis).
    • Rationale: Individuals suffering from hepatitis D have symptoms such as fatigue, nausea and vomiting, poor appetite, darkening of the urine color, lightening of the stool color and yellowish tint to the whites of the eyes and skin, which match all patient’s description of symptoms (Viral Hepatitis, 2018). The patient being a parenteral drug users enhances his chance of hepatitis D virus infection since HDV spreads through blood and and other body fluids (McCance & Huether, 2019). Hepatitis D virus also only infects people when they have a hepatitis B virus infection. Since the patient is at risk for HBV he is more susceptible to HDV.

The most definitive way to tell what kind of Hepatitis our patient has would be to have him take a Viral Hepatitis Serology Test.