Hepatitis.pptx

Case scenario
•The physical exam of a male patient in ED
revealed a well-nourished and five days of
progressive fatigue and flu-like symptoms.
• He also admitted to having produced clay
colored stool, dark urine, subjective fevers, and
nausea.The patient was alert and oriented.
•Further examination revealed prominent bilateral
yellow discoloration of the eyes (i.e., scleral
icterus) and abdominal examination
demonstrated a mildly distended abdomen with
mild tenderness in the right upper quadrant.
9/30/2021 rina karki, medical surgical nursing 1

UNIT-1
Medical Disorders Of GI and
Hepatobiliary System
HEPATITIS
Ms. Rina Karki
Lecturer
Medical Surgical Nursing

PRE-TEST
• All hepatitis viruses are RNA viruses except
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
• Which hepatitis virus causes chronic hepatocarcinoma?
a. Hepatitis C
b. Hepatitis D
c. Hepatitis E
d. Hepatitis G

Review Anatomy and Physiology of
Hepatobiliary System

Introduction to Hepatitis
•Greek word i.e. "Hepat" means "liver" and "itis"
meaning "inflammation".
•An inflammatory condition of the liver caused
by a variety of infectious and noninfectious
agents.
•Self-limiting, healing on its own or can progress
to scarring of the liver and can be fatal

Causes of Hepatitis
Infectious cause
•bacteria, fungi,
protozoa
Noninfectious agents
9/30/2021 rina karki, medical surgical nursing
Obstruction and ischemia
7

Causes…
Autoimmune cause
8

Types of Hepatitis
1. Acute and chronic hepatitis:
•Acute: Infection lasts for 6 months. Hepatitis A
and E
•Chronic: Infection lasts longer than 6 months
Hepatitis B
2. Toxic and drug-induced hepatitis
3. Obstructive hepatitis
4. Ischemic hepatitis

Types of Hepatitis…
5. Viral hepatitis
Hepatitis A,C,D,E,G: RNA virus
Hepatitis B: DNA virus
10

Types of Hepatitis
Types Mode of
transmission
Important note
Hepatitis A
IP: 15-50
Days
Avg: 30
days
Faeco-oral
route,
Person to
person contact,
Oro anal sex
Viruses excreted through faeces
for about 2 weeks before the
onset of jaundice and for up to
one week thereafter. (also
excreted in urine)
Hepatitis B
IP: 45-180
days
(Serum
hepatitis)
Avg: 60-
90days
Parenteral,
Sexual contact,
Perinatal
transmission
Risks group
?

Types of Hepatitis
Types Mode of
transmission
Important note
Hepatitis C
(non A non B
hepatitis)
IP: 2-6
months
Avg: 6-7
weeks
Transfusion of
blood products,
Sexual contact.
Risk group
• Injection drug users
• Shared injection
equipment
• Blood transfusion
• tattoo, piercing
• Mother to child (<5%)
Hepatitis D IP: 21-140 days ;avg:35 days
Transmission, risk factors and precautions:
same as hepatitis B.

Hepatitis E
 Water borne Virus
 Transmitted through
Faecal-oral route
•IP: 15-65 days.
Hepatitis G
•Caused by Hep G virus
(HGV)
•common in HCV infected
patient
•Transmitted through
blood, needles, body
fluids.
•IP: Unknown

6. Fulminant hepatitis
severe liver failure developing within 8 weeks of
the onset of symptoms usually present with
coagulopathy and hepatic encephalopathy, which
may evolve into a deep coma.

Pathophysiology
Causative agents: Infection and
inflammation of the liver
Hepatocyte damage; alteration of liver
function
Acute hepatitis
persistence worsening then necrosis of the
liver
Chronic hepatitis leads to liver cirrhosis and
then hepatocellular carcinoma
15

Clinical Features of Hepatitis
•Acute condition: Low-grade fever is common hepatitis A
and E. Hepatitis B is associated with a serum sickness–like
syndrome (fever of 39.5° C to 40° C.)
17

Clinical Features …
acute condition…

Clinical Features …
chronic condition…
•Persistent fatigue
•Jaundice
•weight loss
•gastrointestinal bleeding
•Ascitis
•Pitting edema
•bruisisng
19

Diagnostic Evaluation
History
Physical
examinati
on
Lab
diagnosis
Detection of antigen:
HBsAg
Detection of antibody:
HBsAb
IgM (acute infection):
Anti-HBc IgM, HAV-IgM
IgG(past or chronic
infection): HAV- IgG, Anti-
HBcIgG
Biochemical tests:ALT,
bilirubin, protein
Molecular diagnosis: RT
PCR of feces to extract
Demonstration of virus in feces
by electron microscopy
Virus isolation
Liver biopsy
USG, CT-
scan,
MRI

Management of Hepatitis
•Medical management and nursing management

Management of Hepatitis…
Medical Management
Bed rest
Isolation
• Nausea,vomiting: antiemetics
• Fever: sponging, antipyretics
• Pain: analgesics
• Anorexia-frequent small feeds, IV fluids with glucose
• Antihistamines
• Vitamin K:2.5-10 mg PO/SC
• Poisoning management to remove toxins
• Toxic and alcoholic hepatitis: folic acid, thiamine
Acute conditions require symptomatic management
22

Medical Management…
Chronic
hepatitis
Alfa-interferon: 180
mcg SC once weekly for
48 weeks
Lamivudine:chronic hep B;
dose: 100 mg orally OD
Adefovir: 10 mg orally
OD
Prednisolone:dose: 40 to
60 mg daily then
maintainance at 10
mg/day
Obstructive
condition
common bile
duct
exploration,
tumor removal
Liver cirrhosis and
hepatocellular
carcinoma
Liver
transplantation
23

Poisoning mamangement example

Nursing Management
Assessment :
• vital signs
• intake and output
• symptoms
• Lab values
Nursing diagnosis
-Acute pain related to inflammation
-Imbalanced nutrition less than body
requirements related to insufficient intake
to meet metabolic
demands: anorexia, nausea/vomiting
-Fatigue related to decreased metabolic
energy production
-Risk for deficient fluid volume

Nursing Management…
Nursing Diagnosis
Acute pain related to inflammation
Imbalanced nutrition less than body requirements
related to insufficient intake to meet metabolic
Fatigue related to decreased metabolic energy
production
Risk for deficient fluid volume
Risk for infection
Risk for impaired skin integrity
26

Imbalanced nutrition less than body requirements related to
insufficient intake to meet metabolic
Expected outcome: Initiate behaviors, lifestyle changes to
regain/maintain appropriate weight
• Monitor dietary intake and caloric count. Suggest several
small feedings.
• Encourage mouth care before meals.
• Consult with dietitian, nutritional support team to provide
diet according to patient’s needs, with fat and protein
intake as tolerated.

Fatigue related to decreased metabolic energy
production
Expected outcome: Perform ADLs and participate
in desired activities at level of ability
• Institute bed red or chair rest during toxic state.
Provide quiet environment; limit visitors as
needed
• Increase activity as tolerated, demonstrate
passive or active ROM exercises

Nursing Management
Nursing care :
• Rest and quite activities
• Protect from injury.
• Stimulate appetite
• Standard precautions
• High CHO and protein diet
• Avoid alcohol.
• Low fat diet.
• Vitamin E and A
• Avoid hepatotoxic drugs

Increased calorie to meet
the increased energy needs
for disease process, tissue
regeneration (Total: 2500-
3000 calories daily)
30

Preventive Measures of Hepatitis
•Personal Hygiene
•Screening of food
handling places and
food handlers
•screening of blood
donors and skin piercing
instruments

Preventive Measures…
•Use safer sex
•Community health education program.

Hep A
• Immunization of children (1-18
years of age) consists of 2 or 3
doses of the vaccine.
• Adults: booster dose 6-12 months
following the initial dose of vaccine.
• Post-exposure : Immune Globulin
given within 2 weeks after
exposure for maximum protection.

Hep B
•Immunization schedule: 6, 10
and 14 weeks of birth. Adult
dose: 0, 1 month and 6 months
•HBsIg should be given within
24 months of exposure to
hepatitis B or as soon as
possible.

Complications
•Ascitis
•Coagulopathy
•Hepatic encephalopathy
•Liver cirrhosis
•Hyperspleenism
•Hepatocellular carcinoma

Prognosis
• Hepatitis A and E: mild and self-limited
• 95% to 99% of otherwise healthy, immunocompetent
patients with acute hepatitis B recover completely.
• Acute hepatitis B and acute hepatitis D do not
necessarily have a more severe disease.
• Chronic hepatitis C follows acute infection in
approximately 85% of cases.

References
1. Smeltzer SC, Bare B. Hinkle JL. Cheever KH. Brunner
and Suddhath’s-Textbook of Medical surgical Nursing. Vol
II. 12th edition. Philadelphia: Lippincott Williams and
Wilkins; 2010
2. White L, Duncan G and Baumle W. Medical-Surgical
Nursing- an integrated approach. 3rd edition. United
States: Delmar Cengages; 2013
3. W. S. Linda and H. D. Paula . Understanding Medical
Surgical Nursing. 4th edition. New Delhi: Japyee
Brother's Medical Publishers (p) Ltd. 2012
4. Hepatitis [Internet]. World Health Organization. World
Health Organization; [cited 2021Sep29]. Available from:
https://www.who.int/health-topics/hepatitis#tab=tab_1

POST-TEST
• All hepatitis viruses are RNA viruses except
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
• Which hepatitis virus causes chronic hepatocarcinoma?
a. Hepatitis C
b. Hepatitis D
c. Hepatitis E
d. Hepatitis G

1. List out the two potential nursing
diagnosis with interventions while caring
for patient with hepatitis.
41

9/30/2021 rina karki, medical surgical nursing 2021 42

Hepatitis.pptx

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