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1. HEPATITIS
 DEFINITION
 It is an acute or chronic inflammation of the liver
caused by several different viruses and some toxins
or disease state.
 It can be caused by viral or bacterial agents,
fungal or parasitic infections or chemical agents
(drug toxicity).

2. INCIDENCE
 IT OCCUR IN CHILDREN UNDER 5 YRS OF AGE

3. TYPES
 Five types of viral hepatitis, such as Hepatitis
A, Hepatitis B, Hepatitis C, Hepatitis D and
Hepatitis E

4.  CMV
 RUBELLA
 EBV
 HERPES SIMPLEX VIRUS

5. .Hepatitis A
 Hepatitis A is an acute infection whereas Hepatitis B and
C are chronic.
 Hepatitis A is an acute self-limiting infection of the
liver, caused by Hepatitis A virus, which is an RNA virus.
 It is transmitted through fecal oral route.
 Virus gets multiplied in the liver in after Hepatitis A
virus infection.
 It does not result in chronic infection or chronic
liver,disease,

6. pathophysiology
Virus causes local necrosis
Infiltration of inflammatory cells
Further destruction of hepatic cells
Biliary stasis
Alcoholic stool urobilinogen jaundice

7. CLINICAL FEATURES
ANICTERIC PHASE ICTERIC PHASE
 ANOREXIA JAUNDICE
 NAUSEA URTICARIA
 VOMITTING DARK URINE
 EPIGASTRIC PAIN LIGHT COLOURED STOOLS
 FEVER
 MALAISE
 DEPRESSION
 IRRITABILITY


8. DIAGNOSTIC EVALUATION
 HISTORY COLLECTION
 LFT
 BILIRUBIN LEVELS
 ANTIGENS
 LIVER BIOPSY

9. DIAGNOSTIC STUDIES
 Liver function tests:
 Liver enzymes are elevated, especially AST, ALT, Alkaline
phosphatase ang Gamma glutamyl transpeptidase (GGTP
 Serum total bilirubin is elevated.
 Diagnosis is confirmed with the presence of 1gM anti-HAV,
which usually disappear, in six months.
 Anti-hepatitis A virus IgG will be present,in the convalescent
phase and persist, for life.

10. MANAGEMENT

11. There is no specific treatment for HAV
 Rest
Diet high in carbohydrates with adequate
protein and restricted fat is adviced.

12. Prevention
 Immunoglobulin (0.02 mL/kg, IM) is given to contacts within
two weeks of exposure.
 Active immunization: A live attenuated hepatitis A vaccine is
available. Protection is for 10 years approximately.
 Health education regarding enteric isolation.
 Precautions to prevent spread through food and water.

13. Nursing diagnosis
 Imbalance nutrition less than body requirement related to
anorexia
 Risk for infection related to exposure of family members
to infectious agent
 Risk for injury related to fulminant hepatitis
 Deficient knowledge related to incomplete information
about homecare and longterm prognosis

14. Hepatitis B
 Hepatitis B infection, which is a major public health
problem in India, is caused by a DNAvirus, i.e. Hepatitis B
virus.
 This virus possesses various antigens such as hepatitis B
surface antigen (HBsAg) which is otherwise known
asAustralian antigen (antigen is present on the surface of
the virus), hepatitis B core antigen
 (HBcAg), and HBeAg.
 Incubation period is 60 to 110 days.

15. Mode of Transmission
 lt spreads through blood and blood products.
 It may also spread through body secretions, especially saliva
and semen (through sex, homosexuality).
 The child may acquire infection from the mother. Sharing of
contaminated needles usually done by the drug abusers and
shaving razors are means of spread of infection.
 Man is the only reservoir.
 Period of infectivity is usually during the acute illness.

16. Clinical Features
 It can be acute, chronic or asymptomatic with
minimal liver damage.
 Acute illness is just like that of hepatitis A.
 Some may develop jaundice.
 Spleen is palpable and recovery takes place in 2-3
weeks.

17.  Chronic active hepatitis may present with chronic jaundice
and liver enzymes elevation.
 Few patients may develop fulminant hepatitis, cirrhosis or
hepatic failure. Fulminant hepatitis is an acute viral
hepatitis causing hepatic failure and encephalopathy.
 Other symptoms that may occur are cerebral edema,
coagulopathy, hypotension, renal failure, hypoglycemia
pancreatitis and infection.
 Mortality rate is 80 percent.

18. Investigations
 Liver enzymes: These are elevated. Alkaline
phosphatase may be normal or mildly elevated.
 HBsAg may be detected in the blood.
 Serum alpha-fetoprotein is tested to diagnose
hepatocellular carcinoma.

19. Treatment
 Acute hepatitis: Avoid prolonged bed-rest.
 Dietary restriction is needed only in hepatic failure.
 Chronic hepatitis: Recombinant alpha interferon 5-10
million units/m? IM thrice a week for 4-6 months.
 Chronic persistent hepatitis: No specific treatment.

20. Prevention
 Hepatitis B vaccine: 3 doses are given
Health education regarding prevention through
blood, body fluids, needles and through sex.
Complications
 Chronic hepatitis
 Cirrhosis of liver
 Cancer of liver.