Cause of hepatitis

1. HEPATITIS
PRESENTED BY MRS. R BITONI
2014

2. BROAD OBJECTIVE
• By the end of the lesson you should be
equipped with knowledge, skills and
attitudes that will assist you in managing a
patient with hepatitis.

3. Learning outcomes
By the end of the lesson you should be able
to;
• define Hepatitis
• state the causes of hepatitis
• outline 2 classifications of hepatitis
• describe pathophysiolgy of hepatitis
• explain clinical manifestations
• explain management of hepatitis

4. Definition
• Hepatitis is an inflammation of the
liver(Lewis,2007)

5. Causes
• Bacteria such as streptococci, salmonella
and E. coli
• Toxic injury -plants, drugs,alcohol
• Autoimmune –exact cause unknown; the
immune system may mistake the liver as a
harmful object and begins to attack it.
• Virus - common (viruses include; hepatitis
A(HAV), B(HBV), C(HCV) D(HDV),E(HEV)

6. Classification
• Acute- lasts from 1 month-4 months
• Chronic-for life

7. Toxic Hepatitis
Pathophysiology
• Drugs, poisons, alcohol alters the structure
and function of the liver. These
substances causes necrosis of the liver
cells, impairs secretion of bile and others
lowers serum birilubin.

8. Toxic Hepatitis cont’d
Clinical manifestations
• Nausea and vomiting
• Lethargy
• Anorexia
Later signs
• Jaundice
• Hepatomegally
• Hepatic tendeness

9. Toxic Hepatitis cont’d
Management
• Attention focuses on identifying toxic agent
and remove it
• Gastric lavage and cleaning of the bowel
is indicated to remove toxins from the GIT
• Provide supportive treatment and focused
on the clinical manifestations

10. cont’d
• Provide nursing management according to
presenting problems
• Interventions include;
promoting of comfort, maintaining normal
fluid and electrolyte balance, promoting
well balanced diet, promoting rest.

11. Cont’d
Provide patient education on potential
toxic hepatitis from improper home use,
exposure to chemicals in industries
• Nursing management depends on
presenting problems

12. Auto immune
• Exact cause is unknown-the immune
system may mistake the liver as a harmful
object and begins to attack it, hindering
liver function.
Pathophysiology
• For unknown reasons the immune
system may mistake the liver as a harmful
object and begins to attack it.

13. Auto immune cont’d
• The autoimmune response is directed at
liver antigens and causes progressive
necrosis and inflammation of hepatocytes.
• This result in fibrosis and necrosis
Clinical manifestations
• Other patients are asymptomatic
• Ranging from mild to advanced cirrhosis

14. Auto immune cont’d
• NOTE: early diagnosis is needed because
they respond well on corticosteroids
Management
• Corticosteroids such as
Azathioprine(Imuran) dose…..
• Follow up 3 to 4 weeks to evaluate the
response of treatment

15. Auto immune cont’d
• Nursing care is geared toward relieving
the presenting nursing problems
• Patient/ guardian education on need for
continuous care and evaluation

16. VIRAL hepatitis
• This is the major health problem.
• Caused by five categories of viruses
• Most common HBV(60%), HAV(40%) of
the population

17. VIRAL hepatitis cont’d
Mode of transmission
• Hepatitis A-transmitted through feacal-oral
route (mainly through ingestion of food or
liquid infected with virus).

18. Cont’d
• Hepatitis B-transmitted through perinatally
by mothers, pericutaneously(IV drug use,
accidental needle-stick punctures or
horizontally by mucosal exposure to
infectious blood, blood products or other
body fluids.
• Hepatitis c-transmitted sharing of
contaminated needle

19. Cont’d
• Hepatitis D- same as HBV
• Hepatitis E- by fecal oral route

20. Viral hepatitis cont’d
Pathophysiology
• The pathophysiologic changes in the
various types of viral hepatitis are similar.
• The virus causes diffuse inflammatory
infiltration of the hepatic tissue, leads to
necrosis.

21. VIRAL hepatitis cont’d
• The inflammation, degeneration and
regeneration distort the normal lobular
pattern creating pressure within and
around the portal vein areas and
obstructing the bile channels

22. VIRAL hepatitis cont’d
• In early phases of hepatitis, systemic
effects such as fever, malaise, arthritis,
glomerulonephritis occurs due to antigen-
antibody complexes between the virus and
it’s corresponding antibody formed.

23. VIRAL hepatitis cont’d
• Clinical manifestations can be classified as
acute and chronic
Acute
• During incubation period symptoms
include;
Malaise
anorexia,

24. Cont’d
fatigue
nausea
occasional vomiting
abdominal (right upper quadrant)
discomfort
Pruritus- due to accumulation of bile salts
beneath the skin

25. VIRAL hepatitis cont’d
Light or gray coloured stools- due to
obstruction of bile flow
Hepatomegally
• Flue-like symptoms
• Weight loss
• Jaundice-caused by disturbance in
birilubin metabolism

26. VIRAL hepatitis cont’d
• Dark urine- excretion of birilubin in urine
Note: Not all patients with viral hepatitis
have jaundice.
Chronic
• Malaise
• hepatomegally

27. Viral hepatitis cont’d
Management
Acute
• Most patients can be managed at home;
• Encourage rest to reduce metabolic
demand on the liver and promotes cell
regeneration

28. Viral hepatitis cont’d
• Encourage patient to eat a well balanced
diet that he/she can tolerate to promote
healing and liver regeneration
• If liver is not impaired, a well balanced diet
is adequate.
• Proteins and sodium is restricted if liver
function is impaired

29. Viral hepatitis cont’d
• Counseling on; importance of avoiding
alcohol
• Drug therapy; no specific treatment for
acute viral hepatitis however supportive
therapy include antiemetics.
• NOTE: Ensure administration of essential
drugs only because most drugs are
metabolized in liver

30. Viral hepatitis cont’d
• Vitamin K is given if the prothrombin time
is prolonged
• Note: Almost all cases of acute hepatitis A
resolves, although a small number may
have a viral relapse in the first 2 to 3
months later after infection.
• Many HBV result in chronic(life long)

31. Cont’d
Management of Chronic hepatitis
Chronic hepatitis B
• Drug therapy focused on decreasing viral
load such as Lamivudine for 1 year( find
out the dosage)
• Chronic Hepatitis c- drug therapy is
directed at eradicating the virus.

32. Cont’d
Patient Family teaching
• Provide education on method to avoid
transmission
• Risk for contracting viral hepatitis through
multiple sexual partner’s

33. Cont’d
• Importance and availability of
immunization for close contact.
• Preventive measures
• Hepatitis A. pre exposure prophylaxis with
vaccine for persons travelling to HAV
endemic countries.

34. Cont’d
• Hepatitis B- Administration of HBV vaccine
atrisk groups include; occupationally
exposed workers, I.V drug users,
heterosexual with multiple partners and
frequently exposed to blood products

35. Diagnostic measures
History and Physical Exam
• Pain or tendeness on the abdomen
• Colour of skin,eyes-yellow
• Enlargement of liver
Liver Biopsy
• To determine if an infection or
inflammation is present or if or liver
damage has occurred

36. Diagnostic measures cont’d
Liver Function Tests
• Blood samples to determine how efficiently
the liver works.
• These tests check how the liver clears
blood waste, protein, and enzymes.
•

37. Diagnostic measures cont’d
• High liver enzyme levels may indicate that
the liver is stressed or damaged.
• Liver enzyme test- elevated in Hepatitis A
and B

38. Diagnostic measures cont’d
Ultrasound
• An abdominal ultrasound -test will reveal
fluid in the abdomen, an enlarged liver, or
liver damage.
Blood Tests
• Blood tests used to detect the presence of
hepatitis virus antibodies and antigen in
the blood will indicate or confirm which
virus is the cause of the hepatitis

39. Nursing management
• N.D Altered nutrition less than the body
requirements related vomiting, anorexia
and reduced metabolism of nutrients by
the liver as evidenced by inadequate food
intake, weight loss
• Goal……………….

40. Nursing management cont’d
Interventions
• Present food in attractive manner to
stimulate appetite
• Give small frequent appetizing meals
• Weigh patient weekly to monitor weight
loss

41. Nursing management cont’d
• Risk for fluid and electrolyte imbalance
related to vomiting
• Altered comfort, abdominal pain related to
the disease process as evidenced by…

42. Cont’d
• N.D. Activity intolerance, fatigue related to
the disease process as evidenced by
patient verbalization
Goal: patient should demonstrate gradual
increase in activity tolerance after 6 hours
of nursing intervention.

43. Cont’d
Interventions
• Assist patient to schedule rest periods to
prevent stress on liver function
• Limit environmental stimuli(noise,light) to
facilitate relaxation
• Monitor patient for evidence of excess
physical and emotional fatigue to prevent
increasing weakness and fatigue

44. Nursing management cont’d
• Risk for ineffective therapeutic regime
related to lack of knowledge on disease
process and management
Goal:
• Patient to demonstrate understanding of
disease process, treatment after 6hours
of nursing interventions

45. Nursing management cont’d
Interventions
• Explain the disease process and
management in simple terms
• Instruct patient on measures to control/
minimize symptoms to enable the liver to
repair itself and prevent relapse

46. Prevention For viral Hepatitis
Hygiene
• Practicing good hygiene is the main way to
avoid catching hepatitis.
- Hand washing after contact with a patient
or removal of gloves
- Use infection control precaution
• If you are travelling to a country with low
sanitary standards, avoid:

47. Prevention cont’d
• drinking local water /ice
• raw fruit and vegetables
• Hepatitis contracted through contaminated
blood can be prevented by:
not sharing drug needles
not sharing razors
not using someone else’s toothbrush
not touching spilled blood

48. Prevention cont’d
• Protected sexual intercourse
• Active immunization- at risk groups
Vaccinations are available to prevent the
development of hepatitis A and B.
 Note: Experts are currently developing
vaccines against hepatitis C, D, and E.

49. Complications of Hepatitis
• Chronic hepatitis B or C can often lead to
more serious health problems. Because
the virus primarily affects the liver, people
with chronic hepatitis B or C are at risk for:
• chronic liver disease
• cirrhosis (scarring of the liver)

50. Complication cont’d
• cancer of the liver (in rare cases)
• When the liver stops functioning normally
liver failure can occur. Complications of
liver failure include:
• bleeding disorders
• build-up of fluid in the abdomen (the liver
can no longer rid the body of toxins and
fluids; fluid can become infected)

51. Complication cont’d
• hepatocellular carcinoma, liver cancer
(occurs in 80 percent of patients with
cirrhosis and is commonly seen as a result
of viral hepatitis)

52. Assignment
• Read and make notes on
1. Toxic hepatitis
 Patient and Family
teaching(Monahan,p1334)
2.Viral Hepatitis
 Complementary and alternative therapies
treatment(monahan,p1338)
 Hepatitis C,D and E

53. References
• As on course outline
• Internet