61-year-old male – hepatocellular carcinoma in a patient with cured viral hepatitis C
Baseline medical examination
Oldřich Bednář is a well-built, sixty-one-year-old male. He looks healthy at first sight. He is active and plays sport and spends time with his family – especially his grandchildren.
“I have had no symptoms so far”, he says at the first meeting. He only mentions bleeding from a duodenal ulcer, for which he had to undergo blood transfusions in the past.
“That was nearly thirty years ago, and I haven't had any other problems since. I live a relatively healthy life, I don't drink alcohol and don't smoke,” continues the patient.
Suspected liver cirrhosis was discovered accidentally during a urological examination some time ago, when the urologist referred him to an internal medicine clinic for a slightly elevated liver enzymes and AFP.
After a short opening interview, you enter the following information into the digital patient card:
Family medical history: A grandmother, after cholecystectomy, died at 85 from liver cirrhosis. His mother and his daughter have an atrial septum defect.
Personal medical history: 1982 bleeding from a duodenal ulcer – blood transfusions administered. In connection with a urological examination in 2009, slightly elevated AFP around 10 ug/L was accidentally detected and further examination revealed liver cirrhosis with chronic hepatitis C, genotype 1b, with portal hypertension and oesophageal varices stage I, functionally Child-Pugh B (8 points)
Blood transfusions in 1982
Addictions: non-smoker, no alcohol
Social history: Married, lives with his wife
Pharmacological history: Lansoprazole 30 mg 1-0-0, Essentiale forte 1-0-1, Trimepranol 10 mg 1-0-1
OBJECTIVE FINDINGS: Height: 180 cm; Weight: 78 kg; Blood pressure: 169/95 mm Hg. Heart frequency: 80/min, icteric, afebrile, eupnoea, Head: isocoric pupils, calm throat, the neck with no pathological findings. Clear breathing. Heart: regular heartbeat 70/min., framed echoes, no murmur. The abdomen is soft, palpable, within the niveau, liver augmentation 0 spleen augmentation 0. The lower extremities without swelling, varices or inflammation-related changes.
“I will take a blood sample and send it to our laboratory for analysis. We will then agree together how to proceed, based on the results,” you explain to the patient.
I understand, let's go on.
This virtual patient case was created on the basis of clinical practice outside the EU and may, therefore, include an off-label practice.
I agree with playing a virtual patient case authored outside the EU. I will not draw any consequences from this case for my own or any other practice, as this case may contain unapproved use of an approved drug.