HEPATITIS IS THE INFLAMMATION OF THE LIVER, CAUSED BY VIRUSES, TOXINS, OR CHEMICALS (INCLUDING DRUGS). 1. VIRAL HEPATITIS 2. TOXIC HEPATITIS 3. CHRONIC HEPATITIS 4. ALCOHOLIC HEPATITIS

2. HEPATITIS IS THE INFLAMMATION OF
THE LIVER, CAUSED BY VIRUSES,
TOXINS, OR CHEMICALS
(INCLUDING DRUGS).

3. 1.
VIRAL
HEPATITI
S
2.
TOXIC
HEPATITI
S
3.
CHRONIC
HEPATITI
S
4.
ALCOHOLIC
HEPATITI
S

4. .

5. HEPATITIS A VIRUS
HEPATITIS B VIRUS
HEPATITIS C VIRUS
HEPATITIS D VIRUS
HEPATITIS E VIRUS

6. HEPATITIS F VIRUS
HEPATITIS G VIRUS
CAUSES
 RUBELLA VIRUS, VARICELLA
VIRUS,
RETRO VIRUS, YELLOW FEVER
VIRUS, . ADENO VIRUS.
 EPSTEIN-BARR VIRUS,
CYTOMEGALO VIRUS & HERPES
SIMPLEX VIRUS

7. HAV, HCV, HDV, HEV,
ARE RNA VIRUSES.
HBV IS DNA VIRUS.
MODE OF
TRANSMISSION.

8. RISK FACTORS,
ETIOLOGICAL
FACTORS
DIRECT ACTION
OF VIRUS (HCV)
CELL-MEDIATED
RESPONSE TO
THE VIRUS (HBV)
PATHOLOGIC
CHANGES IN
HEPATOCYTES.

9. INFLAMMATION
OF LIVER WITH
AREAS OF
NECROSIS
IMPAIRMENT
OF FUNCTION
CHANGES IN
ENDOPLASMIC
RETICULUM
LIVER
FUNCTIONS
ALTERED
KUPFFER
CELLS
INCREASES IN
SIZE AND
NUMBER
INFLAMMATION
OF VASCULAR
AND DUCTLAR
TISSUES
HEPATITIS

10. TYPES OF VIRAL
HEPATITIS

11. INCUBATION PERIOD 15 TO 45 (30)
ONSET ACUTE
AGE PREFERENCE CHILDREN, YOUNG ADULTS
MODE OF
TRANSMISSION
FECAL ORAL ROUTE, HOMOSEXUAL
PARTNERS, CONTAMINATED FOOD
AND WATER
PROGNOSIS EXCELLENT
PROPHYLAXIS IG INACTIVATED VACCINE
THERAPY INTERFERON, LAMIVUDINE,
ADEFOVIR.

12. GOOD PERSONAL
HYGIENE AND
PROPER
SANITATION
IG INACTIVATED
VACCINE
ROUTINE
VACCINATION – 1ml
OF HAVRIX/ VAQTA
(FOLLOWED BY A
SECOND DOSE AT 6
TO 12 MONTHS

13. INCUBATION
PERIOD
30 TO 180 (60-90)
ONSET INSIDIOUS OR ACUTE
AGE
PREFERENCE
YOUNG ADULTS, BABIES, TODDLERS
MODE OF
TRANSMISSIO
N
BLOOD BORN INFECTION,
HBV CARRIER MOTHER TO BABIES,
HOMOSEXUAL PARTNERS.
PROGNOSIS WORSE WITH AGE
PROPHYLAXIS HBIG RECOMBINANT VACCINE

14. PRE EXPOSURE
PROPHYLAXIS-HBV VACCINE
AT 0,1 & 6 MONTHS.
POST EXPOSURE
PROPHYLAXIS-HBIG & HBV
VACCINE
AVOID CONTACT
WITH
CONTAMINATED
BLOOD AND BODY
FLUIDS.

15. INCUBATION PERIOD 15 TO 160 (50)
ONSET INSIDIOUS
AGE PREFERENCE ANY AGE,(MORE COMMON IN ADULTS)
MODE OF
TRANSMISSION
UNSAFE SEX PRACTICES, & BY BLOOD
PROGNOSIS MODERATE
PROPHYLAXIS NONE
THERAPY PEGYLATED INTERFERON PLUS
RIBAVIRIN.

16. COMBINATION
THERAY-
IFN OR PEG-IFN
& RIBAVIRIN.
SAFE SEXUAL
PRACTICES
&
AVOID CONTACT
WITH
CONTAMINATED
BLOOD AND
BODY FLUIDS

17. INCUBATION
PERIOD
30 TO 180 (60-90)
ONSET INSIDIOUS OR ACUTE
AGE PREFERENCE ANY AGE
RISK FACTORS CO-INFECTS WITH HEPATITIS B.
MODE OF
TRANSMISSION
BY BLOOD, BY SEXUAL
CONTACT, MOTHER TO BABY
PROGNOSIS ACUTE-GOOD, CHRONIC-POOR
PROPHYLAXIS HBV VACCINE

18. HBV VACCINE
SAFE SEXUAL
PRACTICE
AVOID CONTACT
OF
CONTAMINATED
BLOOD OF HDV
AND HBV CLIENT

19. INCUBATION
PERIOD
14 TO 60 (40)
ONSET ACUTE
AGE PREFERENCE YOUNG ADULTS (20 TO 40
YEARS)
MODE OF
TRANSMISSION
FECAL ORAL ROUTE,
CONTAMINATED FOOD AND
WATER
PROGNOSIS GOOD
PROPHYLAXIS EXPERIMENTAL VACCINE
BEING TESTED.

20. GENERAL HYGIENE.
EXPERIMENTAL RE-COMBINANT
VACCINES DEVELOPED &
UNDERGOING CLINICAL TESTING
FOR PREVENTION OF HEV.

21. .

22. FEVER
FATIGUE,
LETHARGY,
IRRITABILITY
PRURITIS
MYALGIA,
ARTHRALGIA
ANOREXIA
JAUNDICE
NAUSEA
VOMITING
ABDOMINAL
PAIN
DIARRHOEA
CONSTIPATION

23. ANICTERIC HEPATITIS
HEPATIC ENCEPHALOPATHY,
ASTRIXIS
BLEEDING TENDENCIES, ANEMIA
LARGER THEN NORMAL LIVER,
SPIDER ANGIOMAS, PALMER
ERYTHEMA
SPLENOMEGALY,
GLOMERULONEPHRITIS

24. CHOLESTATIC VIRAL
HEPATITIS SYNDROME
INC. LIPOPROTEIN,
CHOLESTROL, ALKALINE
PHOSPHATE, BILIRUBIN.
HBsAg IN BLOOD.
ACUTE→CHRONIC
LIVER NECROSIS.
.

25. History taking & Physical examination
Blood studies-LFT(albumin, bilirubin),HBsAg, hepatitis A
antigen
Urine & stool investigations.
Liver biopsy
DNA test for hepatitis B – high levels indicate the virus is
active and rapidly replicating itself.

26. REDUCE FATIGUE
MAINTAIN NUTRITIONAL AND FLUID BALANCE

27. REDUCE EFFECTS OF HEPATITIS
• ANTIEMITICS EXCEPT PHENOTHIAZINES
• PARENTERAL VITAMIN K WITH PROLONGED PT
• ANTIHISTAMINES
• GLUCOCORTICOIDS
• INTERFERON-ALFA FOR 6 TO 24 WEEKS.

28. IMMUNE GLOBULIN
VACCINES
MEDICINES TO AVOID
BILE ACID
SEQUESTRANTS

29. AVOID
HEPATOTOXINS
PROMOTE
NUTRITION
PROMOTE
REST
PREVENT
INFECTION
AND
REINFECTON

30. FULMINANT HEPATITIS
CHRONIC HEPATITIS
AUTOIMMUNE HEPATITIS
CHRONIC CARRIER STATE
APLASTIC ANEMIA

31. Fulminant Hepatitis
Is rare, seen primarily in
hepatitis B & D as well as
in hepatitis E and A.it
includes jaundice, hepatic
encephalopathy & ascites.

32. Autoimmune Hepatitis
Generally a disease of young
women & is characterized by
hepatic inflammation with plasma
cells and fibrosis. Affected people
often positive for human leukocyte
antigen B8 (HLA-B8) & HLA-DR3.
Clinical manifestations include
multiple spider, acne, &
hepatomegaly.
Treatment includes prednisone
with or without azathioprine.

33. Chronic Carrier State
A carrier state is possible in
clients who demonstrate
persistent HBsAg without
clinically evident disease but
who are able to transmit the
disease. A carrier state may also
develop for hepatitis C, blood
donated by apparently healthy
clients may transmit hepatitis C
when transfused.

34. Carries a high death rate when it occurs after cute
viral hepatitis.
Management is supportive and palliative.
Therapy includes--Iv fluids to provide hydration
-Correction of electrolyte abnormalities.
-Medications for reduction of pain & nausea and
-Adequate calorie intake.

35. .

36. .

37. CHRONIC
PERSISTENT
HEPATITIS
CHRONIC
LOBULAR
HEPATITIS
CHRONIC
ACTIVE
HEPATITIS
FATIGUE,
ANOREXIA,
NAUSEA &
LIVER
ENLARGEMENT
GRADE-MINIMAL
OR MILD
STAGE-ABSENT
OR MILD
FIBROSIS
PORTAL
INFLAMMATION
WITH FOCI OF
NECROSIS &
INFLAMMATION
OF LIVER
LOBULE
STAGE-ABSENT
OR MINIMAL
FIBROSIS
ELEVATION OF
SERUM
TRANSAMINASE
LEVEL FOR
MORE THAN 6
MONTHS.
↓
CIRRHOSIS
↓
LIVER FAILURE

38. Clinical manifestations
include fatigue and
intermittent or persistent
jaundice. Treatment of
chronic HBV depends on
the level of virus replication
but generally includes
lamivudine 100mg orally
daily.

39. One fourth of cases progressing eventually to end
stage cirrhosis. Clinical manifestations are similar
to those for chronic hepatitis B includes fatigue,
depression, weight loss and arthralgia.
Combination of recombinant interferon alpha
(IFNa) & ribavirin.

40. .

41. NURSING INTERVENTION
DETAILED DRUG HISTORY, ENSURE REMOVAL OF
CAUSATIVE AGENT
ADEQUATE REST,PROMOTE ALLEVIATION OF SIDE
EFFECTS.
HIGH CALORIE DIET WITH FAT AND PROTEIN
TOLERATED.
TOXINS & DRUGS
PRODUCES VARIETY
OF PATHOLOGIC LESIONS IN LIVER.

42. PARENCHYMAL NECROSIS FROM HEAVY
ALCOHOL INGESTION.
CLINICAL MANIFESTATIONS INCLUDE
ANOREXIA, NAUSEA, ABDOMINAL PAIN,
SPLENOMEGALY, HEPATOMEGALY,
JAUNDICE, ASCITIS, FEVER,
ENCPHALOPATHY.

43. LAB STUDIES SHOWS-ANEMIA,
LEUKOCYTOSIS & AN ELEVATED
SERUM BILIRUBIN LEVEL, LIVER
BIOPSY REVEALS FATTY ACID.
HIGH CARBOHYDRATE DIET, FOLIC
ACID AND THIAMINE SUPPLEMENTS
AND PARENTRAL FLUID AS
ORDERD.