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  • 1. Republic of the Philippines Central Luzon Doctors’ Hospital Educational Institution Romulo Highway, San Pablo, Tarlac City A.Y. 2013-2014Prepared By: Granil, Charmaine C. Gracia, Mylene Dela Cruz, Jessica Escoto, Daniel
  • 2. HEPATITISThe word hepatitis comes from the Ancient Greek word hepar (rootword hepat) meaning liver, and the Latin itis meaninginflammation.Hepatitis means injury to the liver with inflammation of the liver cells.How many types of hepatitis are there?There are five main types of hepatitis that are caused by a virus, A, B, C, D,and E - plus types X and G. Hepatitis A - this is caused by eating infected food or water. The food or water is infected with a virus called HAV (Hepatitis A Virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery - it does not lead to chronic disease. Hepatitis B - this is an STD (sexually transmitted disease). It is caused by the virus HBV (Hepatitis B Virus) and is spread by contact with infected blood, semen, and some other body fluids. You get Hepatitis B by: o Unprotected sexual intercourse with an infected person (unprotected sex means without using a condom) Using a syringe that was previously used by an infected person (most commonly happens with drug addicts and people who inject steroids). o Having your skin perforated with unsterilized needles, as might be the case when getting a tattoo, or being accidentally pricked. People who work in health care risk becoming infected by accident in this way. Sharing personal items, such as a toothbrush or razor, with an infected person. o A baby can become infected through his mothers milk if she is infected. o Being bitten by someone who is infected. The liver of a person infected with Hepatitis B swells. The patient can suffer serious liver damage due to infection, resulting in cancer. For some patients the hepatitis becomes chronic (very long-term or lifelong). Donated blood is always tested for Hepatitis B.
  • 3. Hepatitis C - Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by the virus HCV (Hepatitis C Virus). The liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people with cirrhosis and only 20% of hep C patients get cirrhosis. Feces is never a route of transmission in hepatitis C. Donated blood is also tested for Hepatitis C. Misuse of anesthesia can result in the transmission of hepatitis B and hepatitis C viruses, researchers reported in the journal Gastroenterology. The cause of infection tends to be from anesthesia contamination, and not endoscopy contamination. Experts say that more effort is needed to better educate the healthcare community about the importance of strict sterile techniques when using any type of anesthesia. Hepatitis D - only a person who is already infected with Hepatitis B can become infected with Hepatitis D. It is caused by the virus HDV (Hepatitis D Virus). Infection is through contact with infected blood, unprotected sex, and perforation of the skin with infected needles. The liver of a person with Hepatitis D swells. Hepatitis E - a person can become infected by drinking water that contains HEV (Hepatitis E Virus). The liver swells but there is no long- term consequence. Infection is also possible through anal-oral sex. “MODES OF TRANSMISSION”Transmission of Hepatitis BHepatitis B is transmitted through contaminated blood, sweat, tears, saliva, semen,saliva, vaginal secretions, menstrual blood and breast milk. This can occur whenusing the same syringe as an infected person, from blood transfusions prior to 1975(now screened in most countries), having tattoos or body piercing, from mother tochild during childbirth, during medical procedures, occupational exposure, duringsexual intercourse. Having Hepatitis B does not necessarily mean that he or she isinfectious to other people, only some people with HBV are contagious.
  • 4. Transmission of Hepatitis CHepatitis C is transmitted primarily blood to blood contact; a person is infected byhepatitis C gets that persons blood into their blood stream. Therefore as withhepatitis B, blood transfusions (prior to 1990 in this case), tattooing and bodypiercing, occupational exposure, medical procedures, intravenous drug use. Sexualcontact, anal, oral or genital, has been shown to be an inefficient route of exposure,as is mother-to-child in childbirth.Transmission of hepatitis DHepatitis D is transmitted in the same way as hepatitis B. Hepatitis D can onlyexist with the hepatitis B virus and can be caught either at the same time as HBV(coinfection) this type is known to clear the body well (90% to 95%). Others getthe HDV separately when they are already infected by HBV, (superinfection), here70% to 95% go on to have the more serious chronic form of HDV.What are the signs and symptoms of hepatitis?Many people with Hepatitis experience either mild symptoms or none at all.Remember that an infected persons feces are always infectious to otherpeople. When symptoms appear, they usually do so about 15 to 180 daysafter the person has become infected.The acute phase of hepatitis - symptomsThe initial phase of hepatitis is called the acute phase. The symptoms arelike a mild flu, and may include: Diarrhea Fatigue Loss of appetite Mild fever Muscle or joint aches Nausea Slight abdominal pain Vomiting Weight loss
  • 5. The acute phase is not usually dangerous, unless it develops into the fulminant or rapidly progressing form, which can lead to death. As the patient gets worse, these symptoms may follow: Circulation problems (only toxic/drug-induced hepatitis) Dark urine Dizziness (only toxic/drug-induced hepatitis) Drowsiness (only toxic/drug-induced hepatitis) Enlarged spleen (only alcoholic hepatitis) Headache (only toxic/drug-induced hepatitis) Hives Itchy skin Light colored feces, the feces may contain pus Yellow skin, whites of eyes, tongue (jaundice)Patient outcomes after the acute phase depend on various factors,especially the type of hepatitis.Signs and Symptoms of Acute HepatitisIn its severe form symptoms of acute hepatitis can make the person feel extremelyill. Other people think they have flu. Signs and symptoms can include some or allof the following: Jaundice Dark, coca-cola colored urine Fever Light colored stools Abdominal pain Muscle and joint pains Poor appetite/li] Rash Nausea The liver may be enlarged and tender Vomiting Fatigue
  • 6. Signs and symptoms of Chronic HepatitisAlthough signs and symptoms may vary, many people are unaware that anything iswrong with them, others may have vague symptoms. These may include: Mild or restless fatigue Jaundice Enlarged liverUnfortunately if chronic hepatitis is not cleared by the body or is not successfullytreated and cured then liver disease or liver failure may result.Signs and symptoms of Fulminant HepatitisA severe but rare form of acute hepatitis it may begin with fatigue and nausea, butwithin a few weeks the signs and symptoms are pronounced and are as with acutehepatitis listed above. About 2 weeks after jaundice develops encephalopathydevelops. Encephalopathy is a state of impaired or altered mental status. In its mildform there may be: Some short term memory loss, forgetfulness Slurring of speech Small behavioral personality or behavioral changes Changes in sleep patternIn its severe form fulminant hepatitis symptoms include:Severe loss of memory i.e. not knowing the date, year, their name or address,confusion, inappropriate behavior, poor coordination, Asterixis- uncontrollableflapping of the hands, Fetor hepaticus- foul smelling breath and coma.Up to 85% of people with this rare type of hepatitis will die without a livertransplant.
  • 7. Diagnostic Tests for HepatitisLiver Function TestsThese tests show how well the liver is functioning but will not accurately assessthe many and varied functions for which liver is responsible. Tests do check thelevel of liver enzymes, transaminases and cholestatic enzymes, bilirubin and liverprotein levels. High levels of transaminases in the blood do not always reveal howbadly the liver is inflamed or damaged. Elevated levels can also occur in geneticliver disease, liver tumors and heart failure. The normal ranges of AST and ALTtransaminases are around 0 to 40 IU/L and 0 to 45 IU/L respectively.Liver Proteins and hepatitisAlbumin, prothrombin, and immunoglobulins are checked and abnormal levels areindicative of severe liver disorder. Prothrombin times, because the liver producesmany of the clotting factors required to stop bleeding needs to be determined.Liver Biopsy for hepatitisOne of the main and most accurate diagnostic procedures that can determine whatis wrong with the liver and how badly it has been damaged. As most liver diseasesaffect the entire organ uniformly, the small sample obtained by biopsy,generally performed under.
  • 8. Treatments for hepatitis Hepatitis A - There is no treatment specifically for hepatitis A. Doctor will advise the patient to abstain from alcohol and drugs during the recovery. The vast majority of patients with Hepatitis A will recover spontaneously. Hepatitis B - A patient with Hepatitis B needs to rest. He will require a diet that is high in protein and carbohydrate - this is to repair damaged liver cells, as well as to protect the liver. If this is not enough, the doctor may prescribe interferon. Interferon is an antiviral agent. Hepatitis C - A patient with Hepatitis C will be prescribed pegylated interferon and ribavirin. Patients with chronic hepatitis C who are receiving standard HCV treatment may benefit significantly by taking vitamin B12 supplements, researchers reported in the journal Gut. The authors explained that by adding vitamin B12 to standard treatment, the bodys ability to fight the virus is greatly improved. According to their study results, patients who are difficult to treat effectively benefit especially well. Interferon-free treatment for hepatitis C may eventually be possible, researchers reported in NEJM (New England Journal of Medicine). In a clinical trial, sofosbuvir was successful in treating Hepatitis C infection. Sofosbuvir is an oral nucleotide inhibitor of HCV polymerase. Hepatitis D or E - So far, there is no effective treatment for either Hepatitis D or E. Non-Viral Hepatitis - If the patient has non-viral hepatitis, the doctor needs to remove the harmful substance. It will be flushed out of the stomach by hyperventilation or induced vomiting. Patients with drug- induced hepatitis may be prescribed corticosteroids. PREVENTION OF HEPATITISHow to prevent Hepatitis A Wash your hands with soap after going to the toilet
  • 9. Only consume food that has just been cooked Only drink commercially bottled water, or boiled water if you unsure of local sanitation Get a vaccine for Hepatitis A if you travel to places where hepatitis may be endemicHow to prevent Hepatitis B Tell the partner if you are a carrier or try to find out whether he/she is a carrier Practice safe sex Only use clean syringes that have not been used by anyone else Do not share toothbrushes, razors, or manicure instruments Have a Hepatitis B series of shots if you are at risk Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.)How to prevent Hepatitis C If you are infected do not let others share your toothbrush, razor, manicure equipment If you are infected cover open wounds Do not share needles, toothbrushes, or manicure equipment If your skin is to be pierced, make sure equipment is well sterilized (tattoo, etc.) Go easy on the alcohol Do not share drug equipment