Gain knowledge abouut hepatitis

3.  Hepatitis is an inflammation of the liver.
( Lewis )
 Hepatitis is an inflammation of the liver most commonly caused
by a viral infection.
(WHO)
 Hepatitis is a medical condition defined by the inflammation of
the liver and characterized by the presence of inflammatory cells
in the tissue of the organ.
(medical dictionary)

4.  10 million cases occur worldwide.
 It is nearly universal during childhood in developing
countries.
 India is a hyper endemic for hepatitis A virus infection.
 Nearly 400 million people are infected with the HBV .
 170 million people are infected with HCV infection.

5.  Hepatitis A
 Hepatitis B
 Hepatitis C
 Hepatitis D
 Hepatitis E

6.  HEPATITIS A
 Incubation period : 15-50 days
 Mode of transmission :fecal-oral
 Sources of infection : crowded conditions, poor personal
hygeine,poor sanitation, contaminated food, milk and water,
persons with subclinical infections, infected food handlers,
sexual contact.
 Infectivity : during 2 wk before onset of symptoms.

7.  HEPATITIS B
 Incubation period : 45-180 days
 Mode of transmission :Percutaneous/ per mucosal
exposure to blood/blood products/sexual contact
 Sources of infection & spread of disease : contaminated
needles, syringes and blood products sexual activity with
infected partners ,asymptomatic carriers, tattoo/body
piercing
 Infectivity :before and after symptoms appear infectious
for 4-6 month in carriers continues for patient’s lifetime.

8.  HEPTATITIS C
 Incubation period: 14-180 days
 Mode of transmission: percutaneous /mucosal exposure to
blood /blood products.
 Source of infection and spread of disease : blood and blood
products, needles and syringes ,sexual activity with infected
partners
 Infectivity : 1-2 wk before symptoms appear continues during
clinical course.

9.  HEPATITIS D
 Incubation period :2-26 wk HBV must precede HDV
chronic carriers of HBV are always at risk.
 Mode of transmission :can cause infection only when
HBV is present routes of transmission same as for HBV.
 Sources of infection & spread of disease : contaminated
needles, syringes and blood products sexual activity with
infected partners ,asymptomatic carriers, tattoo/body
piercing
 Infectivity :blood is infectious at all stages of HDV

10.  HEPTATITIS E
 Incubation period : 15-64 days
 Mode of transmission : fecal-oral ,outbreaks associated with
contaminated water supply .
 Sources of infection :contaminated water ,poor sanitation.
 Infectivity : not known similar to HAV

12. Liver damages.
Hepatic cell necrosis.
Inflammation of periorbital areas may interrupt bile flow.
Proliferation and enlargement of the kupffer cells.
Cytotoxic, cytokines ad natural killer cells that causes lysis of infected
hepatocytes.
Inflammation of liver tissues.
Due to various types of virus infections

13. ACUTE
 Anorexia
 Nausea ,vomiting
 Right upper quadrant discomfort
 Constipation or diarrhea
 Decreased sense of taste and smell
 Malaise
 Headache
 Fever
 arthralgia
Right upper quadrant
Arthralgia

14.  Urticaria
 Hepatomegaly
 Splenomegaly
 Weight loss
 Jaundice
 Pruritus
 Dark urine
 Bilirubinuria
 Light stools
 Fatigue
 Continued hepatomegaly
 Weight loss

15. Bilirubinuria
Hepatomegaly
Malaise

16. Spleenomegaly
Dark urine Jaundice

17. CHRONIC
 Malaise
 Easy fatigability
 hepatomegaly

18.  Fulminant hepatic failure
 Chronic hepatitis
 Cirrhosis of liver
 Hepatocellular carcinoma

19. Hepatocellular carcinoma
Fulminant Hepatic failure.
Chronic hepatitis & cirrhosis of
liver.

20. 
virus Tests Significance
A Anti HAV IgM
Anti HAV IgG
Acute infection
Previous infection and long
term immunity
B HBsAg (hepatitis B
surface antigen)
Anti- HBs (antibody to
surface antigen)
HBeAg
Anti- Hbe
HBcAg
Anti- HBc IgM
Current infection.
Positive in chronic carriers.
Previous infection and long
term immunity
High infectivity
Previous infection
Ongoing infection
Previous infection

21. virus Tests significance
C Anti-HBc IgG
Anti-HCV
Enzyme immuno assay
Recombinant immunoblot
assay
HCV RNA
HCV genotyping
Genotype of HBV
Acute or chronic infection
Used in initial screening of for
HCV
More sensitive antibody tests.
Indicates ongoing viral
replication
Genotype of HCV
D Anti- HDV
HDV Ag
Past or current infection
Present within few days of
infection.

22.  Increased values of AST,ALT,GGT,Alkaline
phosphatase,s.bilirubin,urinary bilirubin,prothrombin time, gamma
proteins levels.
 Decreased albumin level
 Sonograms to know the degree of liver scarring
 biopsy of liver tissue to know the degree of inflammation ,fibrosis
and cirrhosis.

24. COLLABORATIVE THERAPY
Acute and chronic
 High calorie ,high protein ,high carbohydrate
 Low fat diet vitamin supplements
 Rest degree of strictness varies
 Avoid alcohol intake and drugs detoxified by the liver
 Drug therapy
 Antiemetics ( dimenhydrinate or trimethobenzamide )
 Sedatives (diphenhydramine or chloral hydrate)

25. High carbohydrate , high protein , high carbohydrate
and low fat diet with vitamin supplement.

26. Chronic HBV
 Pegylated alpha interferon
 Lamivudine
 Adefovir
 Entecavir
 Telbivudine
 Chronic HCV
 Pegylated alpha interferon
 ribavirin

27.  HEPATITIS A
 Hepatitis vaccine and immune globulin
 E.g.:-Havrix, vaqta, Avaxim
 HEPATITIS B
 HBV vaccine
 Eg:_recombivax HB , Engerix -B
 Dosage : three IM injections in the deltoid muscle
 The 2nd dose administered within the 1st one month and next
within 6 months of the first.
 HEPATITIS C
 No vaccine ,only interferon monotherapy after confirmation

28. Hepatitis A Hepatitis B and C
Active immunization
- HAV vaccine anyone over 2yrs
of age.
Early administration (1-2 wk
after exposure) to those exposed.
Prophylaxis for travellers
Use of condoms
Hand washing
Avoid sharing toothbrushes and
razors
HBIG administration for one time
exposure
Active immunization:HBV
vaccine

29. Hepatitis A Hepatitis B and C
Hand washing
Proper personal hygiene
Environmental sanitation
Control and screening of food
handlers
Serologic screening while
carrying virus
Check for percutaneous
transmission and sexual
transmission like :_
•Screening of donated blood
•B-HBs Ag
•C anti HCV
•Use of disposable needles and
syringes

30. Use disposable needles.
Avoid alcohol.
Avoid sharing razors.
Don’t share toothbrushes.
Hand washing.
Active immunization

31.  No special diets
 Vitamin supplements particularly B-complex vitamins and vitamin K
 If nausea, vomiting severe iv solutions of glucose or supplemental tube
feedings may be used.
 Fluid and electrolyte balance must be maintained.

33. Assessment
 Past health history-exposure to infected persons , hemophilia ,etc
 Functional health patterns_ iv drug and alcohol abuse sexual
behaviour,weight loss,anorexia ,vomiting,dark urine ,light colored
stool,constipation and diarrhea
 Fatigue,arthralgia,right upper quadrant pain and liver tenderness , etc.
Objective data
 Low grade fever,lymphadenopathy,
Hepatomegaly, spleenomegaly , elevated blood levels.

34.  Nurse should assess for the degree of jaundice.
 Small frequent meals have to be given for anorexia .
 Measures to stimulate appetite should be done.
 Avoidance of hot and cold foods and carbonated beverages.
 Rest for hepatocyte degeneration.
 Psychological and emotional rest.
 Strict follow up for one year.

35.  Acute pain on the right upper quadrant related to inflammation of
liver as evidenced by pain score.
 Fluid volume excess related to portal hypertension as evidenced by
weight gain
 Imbalanced nutritional status less than body requirement related to
anorexia as evidenced by by lack of interest in food
 Impaired skin integrity related to edema as evidenced by areas of skin
break down