How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. David Your Own Question
Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 42782
Experience:  Experienced Physician trained in New York City. I'm ready to help.
41363181
Type Your Medical Question Here...
Dr. David is online now
A new question is answered every 9 seconds

Has been feeling tired for a few weeks, muscle aches,

Customer Question

Laura has been feeling tired for a few weeks, muscle aches, abdominal pain and nausea with no fever. thyroid normal, no organomegaly noted on exam normal pulses. new tattoo on lower back noticed. Her lab results are as follows;
HbsAg- negative
HbsAb - positive
HbcAb - positiveAmylase- normalLipase- normalALT- NormalAST- Normalwhat woudl be a primary diagnosis here and what can we use for a differential?
Submitted: 1 month ago.
Category: Medical
Expert:  Dr. David replied 1 month ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 1 month ago.

the hepatitis panel means prior natural exposure to hepatitis B in the past and most likely not acute infection

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/hepatitis-b/

recent tattoo can cause infection for HIV or hepatitis as well in very rare cases.

laura needs blood testing to check for HIV and hepatitis C and A as well.

amylase and lipase normal means most likely no pancreatitis.

liver enzymes being normal is a good sign no active hepatitis currently.

Customer: replied 1 month ago.
what would we be looking at as far as diagnosis with the information we have and then what further testing would we do to rule things out?
Expert:  Dr. David replied 1 month ago.

she would need HIV testing of HIV duo antibody and antigen testing

you need to find out when her tattoo was.

if the tattoo is recent within 20-30 days, she can have HIV DNA PCR testing

she also needs hepatitis C and hepatitis A panel testing to be sure.

Customer: replied 1 month ago.
HIV can cause jaundice?
Customer: replied 1 month ago.
basically right now at this point jaundice would be the diagnosis and we woudl have to put as a differential unspecified hepatitis ( test for hep c and hep a) and then as another differential HIV?
Expert:  Dr. David replied 1 month ago.

I didn't know she had jaundice.

blood bilirubin levels need to be checked and a liver ultrasound and gall bladder ultrasound need to be checked if she has jaundice.

Customer: replied 1 month ago.
Her skin is slightly jaundices and her conjunctiva is icteric, i thought i wrote that, sorry...
Customer: replied 1 month ago.
what would we be looking at here?
Expert:  Dr. David replied 1 month ago.

she could have a gall stone blocking her bile duct

she needs blood bilirubin levels checked.

she could have hepatitis C active or HIV.

Customer: replied 1 month ago.
HIV woudl cause jaundice?
Expert:  Dr. David replied 1 month ago.

yes, HIV can cause jaundice in some cases.

and she had a tattoo as well which in rare cases can spread this.

Customer: replied 1 month ago.
I hear. so as far as plan of care for her, what kind of labs and diagnostics do we need to do on her at this point...
Expert:  Dr. David replied 1 month ago.

I have told you this already.

Customer: replied 1 month ago.
what would yo do for follow up?
Expert:  Dr. David replied 1 month ago.

she should have the blood testing right away and be seen in 1-2 weeks for very close follow up

Customer: replied 1 month ago.
guess if she gets any worse than she should call immediately...
education for her would be?
Expert:  Dr. David replied 1 month ago.

tattoo in professional places only, not in homes or by friends.

use condom for sex to protect against HIV spread as well.

Customer: replied 1 month ago.
anything regarding the jaundice?
Expert:  Dr. David replied 1 month ago.

she needs to continue to drink plenty of water and fluids.

Customer: replied 1 month ago.
i hear... and would you refer to GI at thi point?
Expert:  Dr. David replied 1 month ago.

I would get the testing first and then refer to GI.

Customer: replied 1 month ago.
i hear
Expert:  Dr. David replied 1 month ago.

please leave positive rating of 3-5 stars so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

here is my website if you need to reach me:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

Related Medical Questions