Question 23

Question:

A 54-year-old male with a history of chronic liver disease presents to your clinic for the first time. After conducting a full history, you perform a physical exam and notice gynecomastia, a protruding abdomen, testicular atrophy, and several spider angiomas. Which of the following represent(s) the possible underlying cause of his disease?

Correct Answer: E.  B and C only

Hepatitis B and C infections can both result in chronic liver disease marked by certain indicators in the history and physical. Portal hypertension leads to ascites, splenomegaly, caput medusa, esophageal varices, and hemorrhoids. An increase in estrogen-related hormones leads to gynecomastia. Spider angiomas are also common in these patients. HBV is acquired primarily through sexual contact and maternal-fetal transmission. HCV is acquired primarily through parenteral routes such as IV drug use and blood transfusions. Sexual transmission of HCV has also been reported but is a less common cause.

Hepatitis A causes acute hepatitis usually marked by diarrhea, jaundice, fever, and RUQ pain. The infection is typically cleared shortly thereafter and does not generally lead to portal hypertension.