Diagnosis
The most appropriate diagnosis for a patient is hepatocellular carcinoma, an advanced liver cancer. The disease develops against the background of non-alcoholic steatohepatitis with dynamics at the stage of fibrosis or even progressive cirrhosis. All negative symptoms of the patient’s well-being, nausea, and diarrhea are associated with toxic damage and inflammation of the liver. Suspected hepatitis C may be a symptom of steatohepatitis as a stage in the manifestation of Non-Alcoholic Fatty Liver Disease (Chalasani et al., 2018).
Treatment
Perhaps the correct solution seems to be liver transplantation, which in the modern world is more and more successful and gaining popularity as a method of treatment (Sapisochin et al., 2017). As a drug treatment, Sorafenib can be offered since its ability to build new liver cells is considered a modern standard of steatohepatitis treatment (Marisi et al., 2018). In combination with transarterial chemoembolization, which stops blood flow to the liver, treatment may be effective.
Justification
The medical history already demonstrates that the patient has abused drugs in the past. It is possible that a large and regular intake of the flail, metabolized in the liver, led to its disturbances, expressed in symptoms. This drug acts unpredictably on patients with hepatitis, in rare cases, it can even cause encephalopathy (Sørensen et al., 2020). Also, the patient uses prednisone, which dissolves in prednisone only in the liver, increasing the load on the organ. In any case, the excess of medications taken by the patient now and in the past suggests that liver damage could be purely drug-induced. Due to the fact that the patient already has suspected hepatitis C or steatohepatitis, it can be assumed that liver damage is only exacerbated by their medication use, which should be immediately reduced. Only by using Sorafenib with caution and including alternative therapies, in particular a healthy diet, can one expect positive dynamics of recovery.
References
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., Harrison, S. A., Brunt, E. M., & Sanyal, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1).
Li, L., Zhao, W., Wang, M., Hu, J., Wang, E., Zhao, Y., & Liu, L. (2018). Transarterial chemoembolization plus sorafenib for the management of unresectable hepatocellular carcinoma: A systematic review and meta-analysis.BMC Gastroenterology, 18. Web.
Marisi, G., Cucchetti, A., Ulivi, P., Canale, M., Cabibbo, G., Solaini, L., Foschi, F. G., De Matteis, S., Ercolani, G., Valguisti, M., Frassineti, G., & Scartozzi, M. (2018). Ten years of sorafenib in hepatocellular carcinoma: Are there any predictive and/or prognostic markers? World Journal of Gastroenterology 24(36), pp. 4152-4163.
Sapisochin, G., & Bruix, J. (2017). Liver transplantation for hepatocellular carcinoma: Outcomes and novel surgical approaches. Nature Reviews Gastroenterology & Hepatology 14, pp. 203–217.
Sørensen, C.G., Karlsson, W.K., Amin, F.M., & Lindelof, M. (2020). Metronidazole-induced encephalopathy: a systematic review. J Neurol, 267, pp. 1-13. Web.