Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
While it is suspected that the patient HL is suffering from a possible GI/hepatobiliary disorder, more information is required before making a diagnosis of this nature. The patient’s personal history needs to be expanded upon and a physical examination should be conducted to verify any signs and symptoms in order to complete a diagnosis.
The patient is suffering from nausea, vomiting, and diarrhea. The symptoms indicate that a diagnosis of gastrointestinal (GI) and hepatobiliary disorders are affecting the patient. Culver and Chapman (2016) indicate that hepatobiliary disease is commonly associated with extremely low CD4+ counts, typically < 20 cells/µL. In order to evaluate any disorder in the liver, exams should rule out HBV and HCV infection as a differential diagnosis. So those viral infections have to be tested for before proceeding to make a diagnosis.
The patient’s Hep C infection is quite likely, especially if the patient has a history of drug abuse. Physical examination would help make this diagnosis as well. However, Tabibian, Varghese, LaRusso and O’Hara (2016) note that “increasing evidence points to the contribution of the intestinal microbiome as a potentially key determinant in the initiation and/or progression of hepatobiliary disease” (p. 480). To treat this an oral antibiotic could be used to help relieve some of the associating symptoms (Tabibian, O’Hara, Splinter, Trussoni & Larusso, 2014).
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Also a possibility for treatment is “intestinal decontamination with non-absorbable antibiotics, such as rifaximin, is an effective treatment for subclinical hepatic encephalopathy” (Tabibian et al., 2016, p. 481).
Antibacterial therapy would be the most effective form for treating an intestinal microbiome. However, if the diagnosis is ruled that the patient is in fact suffering from HCV, then a different approach to treatment would be required, because the infection would be viral rather than bacterial. A nurse cannot treat a patient suffering from a viral infection with an antibacterial treatment, as it will be ineffective. The patient has to receive antiviral therapy.
In the case of an HCV diagnosis, the patient HL would require Ribavirin, which “works by stopping viruses from replicating and spreading. It’s an oral medication that comes as a capsule, tablet, or solution and is available in several strengths. It’s used in combination with other drugs” (Healthline, 2018). Brand names for Ribavirin are: Copegus, Moderiba, Rebetol, Ribasphere, and Ribasphere RibaPak. However, there are side effects that have to….....
Culver, E. L., & Chapman, R. W. (2016). IgG4-related hepatobiliary disease: an overview. Nature Reviews Gastroenterology & Hepatology, 13(10), 601.
Healthline. (2018). Retrieved from https://www.healthline.com/health/hepatitis-c/full-medication-list#ribavirin
Kiriyama, A., Honbo, A., Nishimura, A., Shibata, N., & Iga, K. (2016). Pharmacokinetic-pharmacodynamic analyses of antihypertensive drugs, nifedipine and propranolol, in spontaneously hypertensive rats to investigate characteristics of effect and side effects. Regulatory Toxicology and Pharmacology, 76, 21-29.
Tabibian, J. H., O'hara, S. P., Splinter, P. L., Trussoni, C. E., & LaRusso, N. F. (2014).
Cholangiocyte senescence by way of N?ras activation is a characteristic of primary sclerosing cholangitis. Hepatology, 59(6), 2263-2275.
Tabibian, J. H., Varghese, C., LaRusso, N. F., & O'hara, S. P. (2016). The enteric microbiome in hepatobiliary health and disease. Liver International, 36(4), 480-487.
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