Gastrointestinal and Hepatobiliary Disorders Report

This report presents a case study of a patient (HL) exhibiting symptoms of diarrhea, nausea, and vomiting. HL's medical history reveals a history of drug abuse and Hepatitis C, along with current prescriptions of Synthroid (100mg), Nifedipine (30mg), and Prednisone (10mg). The report analyzes the pharmacology of each medication, considering potential interactions and dosage appropriateness. A comprehensive assessment and diagnostic plan is proposed, including drug screening, urinalysis, abdominal ultrasound, and various blood tests (liver panel, CBC, CMP, TSH, Hepatitis C genotype and antibody tests). The primary diagnosis is Hepatitis C, with differential diagnoses considering drug dependence and spontaneous bacterial peritonitis. The report concludes by summarizing the patient's condition and the recommended diagnostic approach.

Running head: Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal and
Hepatobiliary Disorders

Gastrointestinal and Hepatobiliary Disorders
History of Present Illness and Medical History
Symptoms: Diarrhea, nausea and vomiting
HL appears to have some probable chronic conditions on the basis of the current prescribed
medication. HL also has a drug abuse history with hepatitis C.
1. Synthroid 100 mg daily
2. Nifedipine 30mg daily
3. Prednisone 10mg daily
Pharmacology for the gastrointestinal system.
Synthroid 100 mg daily
It is a hormone replacement used in the treatment of hypothyroidism, goiter and thyroid
cancer. For an adult the initial starting dosage of 100-125 mg daily is recommended. For
elderly patients, for elderly patients, 25-50 mg a day is recommended for a first few months.
However, the dose may increase or decrease depending upon the thyroid levels every 6-8
weeks. A history of patient’s heart disease, artery disease or past recorded blood clots needed
to be checked. Since, there is missing clear information, assuming the patient is below 50
years of age, the current dosage is appropriate (Espaillat, Jarvis, Torkelson, & Sinclair, 2017).
Nifedipine 30mg daily
The initial dose recommended for a patient under 50 years is 30-60 mg given orally once
daily, which can further extended to 10 mg. The symptoms shown, vomiting, Nausea and
Diarrhea are not the medicinal side effects (Pollak, Herman, & Feldman, 2017).
Prednisone 10mg daily
This medication is a corticosteroid preventing the substance release in the body causing
inflammation and suppressing the immune system. This medicine is also used for the
treatment of allergy, skin condition, arthritis and lupus. 5-10 mg a day is recommended and
prescribed. Nifedipine will increase the prednisone’s effect therefore should be used in
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Gastrointestinal and Hepatobiliary Disorders
regulated amount with caution (Ryan, Crawford, Shore, Underwood, Londhe, Black, &
Kantoff, 2015).
Assessment and Diagnostics
In order to understand and identify the underlying issues to the patient’s symptoms, physical
examination and a comprehensive medical history analysis is needed. If there is a drug
interaction, potential medication reconciliation is also needed. Following are the tests which
are required to understand the cause
 Drug Screen test,
 Urinalysis,
 abdominal ultrasound,
 Blood tests such as liver panel, CBC, CMP, TSH, Hepatitis C
 genotype test
 antibody test for HCV
Primary Diagnosis: Hepatitis C Virus
As the patient has a history, the primary diagnosis also shows the presence of Hepatitis C
which is a liver infection spread through the hepatitis C virus, the person can get affected by
coming in contact with the other infected person, it spreads through contact of blood, body
fluids, sexual intercourse. Symptoms are difficult to identify, however, this is progressive and
may pose major issues (Gower, Estes, Blach, Razavi-Shearer, & Razavi, 2014).
Differential Diagnosis
Drug dependence and abuse: the symptoms being shown by the patient upon the substance
abuse, symptoms may also include, CNS, nausea, vomiting, diarrhea, anxiety, hallucinations,
chest pain, and abdominal pain
Spontaneous Bacterial Peritonitis: is a bacterial infection, and a patient with liver cirrhosis is
more likely to get affected. However, no such medical history is given apart from the diarrhea
symptoms, therefore, this can be ruled out.
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Gastrointestinal and Hepatobiliary Disorders
References
Espaillat, R., Jarvis, M. F., Torkelson, C., & Sinclair, B. (2017). Gluten and Aluminum
Content in Synthroid®(Levothyroxine Sodium Tablets). Advances in therapy, 34(7),
1764-1769.
Gower, E., Estes, C., Blach, S., Razavi-Shearer, K., & Razavi, H. (2014). Global
epidemiology and genotype distribution of the hepatitis C virus infection. Journal of
hepatology, 61(1), S45-S57.
Pollak, P. T., Herman, R. J., & Feldman, R. D. (2017). Ambulatory Blood Pressures
Following Patients Switches Between Bilayer and Monomorphic 30-Mg Nifedipine
Delivery Systems. Journal of Pharmacological and Toxicological Methods, 88, 174-
175.
Ryan, C. J., Crawford, E. D., Shore, N. D., Underwood, W., Londhe, A., Black, S. C., ... &
Kantoff, P. W. (2015). IMAAGEN trial update: Effect of abiraterone acetate and low
dose prednisone on PSA and radiographic disease progression in patients with non-
metastatic castration-resistant prostate cancer.
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