{"id":3042,"date":"2023-10-04T13:47:00","date_gmt":"2023-10-04T13:47:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3042"},"modified":"2025-10-02T13:52:03","modified_gmt":"2025-10-02T21:52:03","slug":"pance-question-of-the-day-hepatitis-c","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c","title":{"rendered":"PANCE\u00ae Question of the Day: Hepatitis C"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#A_Ceftriaxone\" >A. Ceftriaxone<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#B_Packed_red_blood_cells\" >B. Packed red blood cells<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#C_Lactulose\" >C. Lactulose<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#D_Sofosbuvir-velpatasvir\" >D. Sofosbuvir-velpatasvir<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#E_Albumin\" >E. Albumin<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\/#References\" >References:<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em><strong><em>This week, we are sharing another PANCE\u00ae-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 49-year-old man with cirrhosis and vomiting blood. Explore his symptoms, physical examination findings, and lab results to determine the most appropriate treatment. Learn more about this critical medical scenario.<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 49-year-old man presents to the emergency department after an episode of vomiting blood. Two hours ago, the patient vomited up one-half cup of dark red blood with the appearance of coffee grounds. He has not vomited since. The patient has known cirrhosis due to untreated hepatitis C virus infection. Temperature is 37.2 \u00baC (99.0 \u00baF), pulse is 96\/min, and blood pressure is 112\/68 mmHg. On physical examination, the patient is fatigued but otherwise has normal mentation and no asterixis. The skin is jaundiced. There is minimal abdominal distention and no appreciable fluid wave. Laboratory results are listed below. Which of the following is the most appropriate treatment?<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Laboratory Test<\/td><td>Result<\/td><td>Reference Range<\/td><\/tr><tr><td>Hemoglobin<\/td><td>9.8 g\/dL<\/td><td>13.5 &#8211; 17.5 g\/dL<\/td><\/tr><tr><td>Platelets<\/td><td>97\/mm3<\/td><td>150,000 &#8211; 450,000 \/ mm3<\/td><\/tr><tr><td>Total bilirubin<\/td><td>5.2 mg\/dL<\/td><td>0.1 &#8211; 1.0 mg\/dL<\/td><\/tr><tr><td>INR<\/td><td>1.9<\/td><td>1.0<\/td><\/tr><tr><td>Creatinine<\/td><td>1.9 mg\/dL<\/td><td>0.6 &#8211; 1.2 mg\/dL<\/td><\/tr><tr><td>Albumin<\/td><td>2.8 g\/dL<\/td><td>3.5 &#8211; 5.5 g\/dL<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Ceftriaxone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Packed red blood cells<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lactulose<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Sofosbuvir-velpatasvir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Albumin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Ceftriaxone\"><\/span>A. Ceftriaxone<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Packed_red_blood_cells\"><\/span>B. Packed red blood cells<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This patient\u2019s hemoglobin is adequate and transfusion of packed red blood cells is unnecessary at this time. Transfusion would be appropriate if the patient\u2019s hemoglobin was &lt; 7 g\/dL or if it was 7-8 g\/dL and the patient had severe ongoing hemorrhage.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Lactulose\"><\/span>C. Lactulose<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Lactulose is important for treating and preventing hepatic encephalopathy in patients with cirrhosis. This patient\u2019s mentation is appropriate and treating the acute issues takes precedence.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Sofosbuvir-velpatasvir\"><\/span>D. Sofosbuvir-velpatasvir<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This medication is indicated for treating chronic hepatitis C virus infection. This treatment would be appropriate once the patient is no longer acutely ill.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Albumin\"><\/span>E. Albumin<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>There are specific indications for the use of albumin in patients with cirrhosis, such as hepatorenal syndrome or large-volume paracentesis. This patient has adequate blood pressure and would not benefit from an albumin infusion.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_46a25e.png?w=700\" alt=\"\" class=\"wp-image-1979\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_46a25e.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_46a25e.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient with untreated&nbsp;<strong>hepatitis C infection&nbsp;<\/strong>and resultant&nbsp;<strong>cirrhosis<\/strong>&nbsp;presents with an&nbsp;<strong>acute upper GI bleed<\/strong>&nbsp;(e.g. variceal bleed, peptic ulcer disease). In patients with cirrhosis who present with an upper GI bleed,&nbsp;<strong>empiric antibiotics<\/strong>&nbsp;(e.g.&nbsp;<strong>ceftriaxone<\/strong>) should be started since these patients are at significant risk of resultant infection, such as spontaneous bacterial peritonitis. Lactulose should be given if there is evidence of hepatic encephalopathy, and the abdomen should be evaluated for ascites, which may require paracentesis.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"556\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/hepatitis-C-virus.png?w=1024\" alt=\"Liver diseases from HCV\" class=\"wp-image-3044\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/hepatitis-C-virus.png 1518w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/hepatitis-C-virus.png?resize=300,163 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/hepatitis-C-virus.png?resize=768,417 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/hepatitis-C-virus.png?resize=1024,556 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hepatitis C virus<\/strong>&nbsp;(HCV) is a bloodborne infection transmitted via exposure to contaminated blood or through sexual contact. It typically causes an asymptomatic acute infection. If the infection is not cleared, it can lead to chronic infection which predisposes the patient to&nbsp;<strong>cirrhosis<\/strong>&nbsp;and&nbsp;<strong>hepatocellular carcinoma<\/strong>. Hepatitis C should be suspected in patients with known high-risk behaviors or exposures (e.g., tattooing with non-sterile equipment, IV drug use, sexual contact with a known HCV carrier). It should also be part of the differential diagnosis for patients presenting with jaundice, abdominal pain, anorexia, and other symptoms of liver damage.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When HCV is suspected, serum HCV antibody testing should be performed. If positive, serum HCV RNA should then be tested to determine if this is an old, resolved infection or an active infection. Patients with active infection (positive HCV RNA) should be treated with antivirals, such as sofosbuvir-velpatasvir or glecaprevir-pibrentasvir. Patients should be counseled about lifestyle modifications (e.g. alcohol cessation) and vaccinated against hepatitis A and B virus. If HCV RNA is negative and there is a high suspicion of infection, HCV RNA testing should be repeated in six months. If HCV RNA is still negative at that point, then the HCV antibody was likely a false positive.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Acute management for patients with an HCV infection may include treatment of complications related to cirrhosis or fulminant liver failure. This may include therapies aimed at treating variceal bleeding (e.g., blood products, ceftriaxone), hepatic encephalopathy (e.g. lactulose), and ascites (e.g. paracentesis).<strong><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References:<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding &#8211; an updated Cochrane review. Aliment Pharmacol Ther. 2011 Sep;34(5):509-18. doi: 10.1111\/j.1365-2036.2011.04746.x. Epub 2011 Jun 27. PMID: 21707680.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">European Association for the Study of the Liver. Electronic address:&nbsp;easloffice@easloffice.eu. EASL Recommendations on Treatment of Hepatitis C 2016. J Hepatol 2017; 66:153.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Joint panel from the American Association of the Study of Liver Diseases and the Infectious Diseases Society of America. http:\/\/www.hcvguidelines.org\/ (Accessed on May 2, 2023).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; ________________________<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another PANCE\u00ae-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 49-year-old man with cirrhosis and vomiting blood. Explore his symptoms, physical examination findings, and lab results to determine the most appropriate treatment. Learn more about this critical medical scenario. A 49-year-old man presents to the [&hellip;]<\/p>\n","protected":false},"author":204,"featured_media":3043,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[20,38,1371,37],"tags":[],"class_list":["post-3042","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-pance","category-pance-questions","category-pa"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>PANCE\u00ae Question of the Day: Hepatitis C - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hepatitis-c\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PANCE\u00ae Question of the Day: Hepatitis C - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another PANCE\u00ae-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 49-year-old man with cirrhosis and vomiting blood. Explore his symptoms, physical examination findings, and lab results to determine the most appropriate treatment. Learn more about this critical medical scenario. 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