A 23-year-old male patient was admitted because of “positive hepatitis B marker for 5 years, fatigue, nausea, loss of appetite with yellow urine yellow for 1 week”. The patient was positive for hepatitis B 5 years ago, had normal liver function and no obvious discomfort, and was not treated. He developed fatigue, nausea, loss of appetite, with yellow urine 1 week ago. Physical examination: T 36.5°C, P 86 beats/min, R18 breaths/min, BP110/60mmHg, consciousness? poor spirit?moderate yellow skin and sclera, liver palm?+??several spider nevuses were visible in the neck and chest, heart and lung examination were normal, abdominal flat?soft? no tenderness and rebound pain? liver 2cm below the rib cage?soft?tender?spleen not palpable subcostal?liver area percussion pain?+??shifting dullness?-?? no edema of both lower limbs. Laboratory examination: Liver function test results: ALT 614 U/L?AST 353 U/L?TBIL109.4?mol/L?DBIL40.5?mol/L??-GT 152U/L?ALP 205U/L?PTA 65%?anti-HAV-IgM ?-?, anti-HAV-IgG?+?? Hepatitis B mark? HBsAg(+)? HBeAg(+)?HBc-Ab(+)?HBV DNA 3.24×108IU/ml?anti HCV?-??anti HEV-IgM?+?, anti HEV-IgG?+?. Liver ultrasound shows: diffuse liver damage.
(1) What is the possible diagnosis of this patient? What is the basis of the diagnosis?
(2) Which diseases should this case be differentiated from?
(3) What is the principle of treatment of this patient?The Possible Diagnosis and Basis of Treatment for a 23-Year-Old Male Patient with Positive Hepatitis B Markers for 5 Years and Recent Symptoms of Fatigue, Nausea, and Loss of Appetite