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Hepatitis
Hepatitis
INTRODUCTION
Hepatitis is inflammation of liver
usually caused by bacterial or viral
infection, drug[including
alcohol],toxins, or parasites than
result enlargement liver
jaundice diminished
appetites,nausia,vommiting,abdomin
al pain.
DEFINITION
• Hepatitis means inflammation of the liver
– Hepat (liver) + itis (inflammation)= Hepatitis
• Viral hepatitis means there is a specific
virus that is causing your liver to
inflammation (swell or become larger than
normal)
CON…
• Viral hepatitis means there is a
specific virus that is causing your
liver to inflame (swell or become
larger than normal)
ACCORDING TO LEWIS
• Hepatitis refers to an inflammatory
condition of the liver. It's commonly
caused by a viral infection, but there are
other possible causes of hepatitis.
• These include
autoimmune hepatitis and hepatitis tha
t occurs as a secondary result of
medications, drugs, toxins, and alcohol
ACCORDING TO LIPPIN COTT
The Liver
• Is located in the upper right
quadrant of the abdomen
•Cleans the blood
•Regulates hormones
•Helps with blood clotting
•Produces bile
•Produces important proteins
•Maintains blood sugar levels
• The liver is essential
for life !
Inflammation
Walls of
scar
tissue
begin to
form
Healthy liver cells
become trapped
by a wall of scar
tissue
Viral Hepatitis
5 types:
A: fecal-oral transmission
B: sexual fluids & blood to blood
C: blood to blood
D: travels with B
E: fecal–oral transmission
Vaccine
Preventable
Adapted from Corneil, 2003
HEPATITIS-A
 An infection of the liver that cause by an
RNA virus, is transmission by ingestion of
infected food and water.
Hepatitis-A is caused by a ribonucleic acid
(RNA) virus of the enter virus family.
Fecal-oral route, poor sanitation, person
to person contact,
Incubation period is 3 to 5 weeks .
HEPATITIS-B
• An infection of the liver that is caused by
a DNA virus is transmitted by
contaminated blood or blood derivatives
in transfusion, by sexual contact with an
infected person ,or used contaminated
needle and instruments.
• Incubation period 2 to5 months.
HEPATITIS -C
 A hepatitis –c caused by a flavivirus
[species hepatitis c virus of the genus
Hepacivirus]that tend to persist in the
blood serum and is usually transmitted
contact with the blood serum usually
transmitted blood transfusion and
intravenous drug used].
Incubation period 1 week to several
months.
HEPATITIS-D
 Hepatitis D –it is inflammation of
liver cells cause by hepatitis- D
Virus (Delta virus)
 HBV required for replication
hepatitis delta antigen detectable
in early acute Hepatitis D virus
infection.
Incubation period is the same as for
HBV.
HEPATITIS-E
Hepatitis-E :- it is inflammation of liver
caused by infection with the hepatitis-E
virus .
It is transmitted via food or drink handled
by an infected person or through infected
water in the area where fecal matter may
get in to water.
There is no vaccine or treatment for
hepatitis –E although anti viral drug may
be tried. And incubation period same as
for Hepatitis A virus.
Signs and Symptoms
• Signs and Symptoms
–Tiredness
–Nausea
–Muscle or joint pain
–Trouble sleeping
–Loss of appetite
–Weight loss
–Abdominal pain
–Itchiness
–Depression
–Dark urine (pee)
Signs and Symptoms
• A few may have specific liver
related symptoms initially:
– Pale stool (poo)
– Jaundice (yellowing of the skin or
eyes)
PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTORS
VIRUS ENTER BLOOD STREAMS
ANTIGEN AND ANTIBODY REACTION
THE INFLAMMATORY PROCESS
ACTIVATED THROUGHOUT WHOLE LIVER
• HEPATOCYTES ARE DISTROYED BY
CYTOXIC CYTOKINES AND NATURAL
KILLER CELLS
BOTH PART ARE INFLAMMATORY
PROCESS
 CELLULAR NECROSIS TAKEPLACE
CHOLESTASIS OR THE INTERRUPTION
OF THE FLOW OF BILE AND DISRUPTION
OF THE NORMAL BLOOD SUPPLY TO THE
CEELLS
DAMAGE THE LIVER CELLS
HEPATITIS
DIAGNOSTC TEST
• History taking.
• Physical examination.
• Abdominal ultrasound.
• Hepatitis virus serological .
• Liver function test.
• Liver biopsy to check for liver damage.
• Paracentesis.
• ALT and AST test( alanine
aminotransferase and aspartate
aminotransferase.
•DIAGNOSTIC
EVALUATION
• LIVER ENZYMES/ISOENZYMES:
Abnormal (4–10 times normal
values).Note: Of limited value in
differentiating viral from nonviral
• Hepatitis.
• AST/ALT: Initially elevated.
May rise 1–2 wk before jaundice is
apparent, and then decline.
• ALKALINE PHOSPHATES (ALP):
Slight elevation (unless severe
cholestasis present).
• Hepatitis A, B, and C, D, E panels
(antibody/antigen tests): Specify type
and stage of disease and determine
possible carriers.
CBC: Red blood
• HBV is a DNA virus composed of the
following antigenic particles.
• HBcAg- hepatitis core antigen
(antigenic material in an inner core)
• HBsAg- hepatitis B surface antigen
(antigenic material on surface of HBV)
•
• HBeAg-an independent protein
circulating in the blood.
•
• HBxAg-gene product of x gene of
HBV/DNA.
• STOOLS -: Clay-colored, steatorrhea
(decreased hepatic function).
Bromsulphalein (BSP) - excretion
test: Blood level elevated.
LIVER BIOPSY: - Usually not
needed, but should be considered if
diagnosis is uncertain, of if clinical
course is atypical or unduly
• Prolonged.
• LIVER SCAN : Aids in estimation
of severity of parenchyma damage.
• URINALYSIS: Elevated bilirubin
levels; protein/hematuria may
• HAV: radioimmunoassay detects
immunoglobulin.
• WBC count and diffemonocytosis,
atypical lymphocytes, and plasma
rential: Leucopenia, leukocytosis, cells
may be present.
SERUM ALBUMIN -: Decreased.
BLOOD GLUCOSE: - Transient
hyperglycemia/hypoglycemia (altered
liver function).
CON…
• Prothrombin time -: May be
prolonged (liver dysfunction).
Serum bilirubin: - Above 2.5
mg/100 mL. (If above 200 mg/100
mL, poor prognosis is probable
because of increased cellular
necrosis.)
MEDICAL MANAGEMENT
The goals of chronic hepatitis are sustained
suppression of HBV To active liver and to prevent
an end disease
ANTIVIRAL DRUGS
- LAMIVUDINE-
-Alpha interferon -stimulates the body
immune system to fight the hepatitis
B infection, but it is expensive, must
be administered by injection,
• (given for 16 weeks in adults and 24
weeks in children)
• Hepatitis-c drug combination
consisting of pegylated interferon
and ribavirin.
• Lamivudine is a synthetic nucleoside
analog.
100mg5mg and 10 mg/ml oral
solution.
• Ribavirin= 400 mg
Child-20 mg nebulizer.
Any process that result in a change in
state or activity of a cell or an
organism (in terms of movement,
secretion, enzyme production, gene
expression, etc.)
DRUG USED SIDE EFFECTS
• "flu-like" symptoms
• fever
• chills
• headache
• body aches ,fatigue
• decreased appetite
• weight loss
• insomnia
• hair loss.
• NURSING MANAGEMENT:-
• Handle only if you have proper
equipment
• Sturdy pair of gloves, tongs or
pliers and a puncture proof
container (heavy plastic or metal)
• Place needle in puncture proof
container
• Do not touch needle with bare
hands and do not try to recap
needle if cap present .
• Can dispose container in garbage but
better if it is taken to health clinic or
needle exchange.
• Never share drug equipment
– Straws, bills, needles, syringes, water,
filter, cooker, pipes etc…
• Never share tooth brushes/razors or any
personal hygiene articles that have
blood on them (even tiny amounts).
• Practice safer sex
• Always make sure new & sterilized
equipment is being used for tattooing
& piercing
– Make sure ink for tattooing is not being
shared
• Do not touch dirty needles without
proper equipment or following proper
procedures.
Prevention
• Never share drug equipment
– bills, needles, syringes, water, filter,
cooker, etc…
• Never share tooth brushes/razors
or any personal hygiene articles
that have blood on them (even tiny
amounts).
• Practice safer sex
Prevention
• Always make sure new & sterilized
equipment is being used for tattooing
& piercing
– Make sure ink for tattooing is not being
shared
• Do not touch dirty needles without
proper equipment or following proper
procedures
Dirty Needle Precautions
1. Handle only if you have proper equipment
• Sturdy pair of gloves, and a puncture proof container
(heavy plastic or metal)
2. Place needle in puncture proof container
• Do not touch needle with bare hands and do not try to
recap needle if cap present
3. Can dispose container in garbage but better
if it is taken to health clinic or needle
exchange.
IN GENERAL, COMPLICATIONS OF
VIRAL HEPATITIS MAY INCLUDE
THE FOLLOWING:
Acute or subacute hepatic necrosis.
Chronic active hepatitis.
Chronic hepatitis.
Cirrhosis.
Hepatic failure.
Hepatocellular carcinoma (HCC) in patients
with HBV or HCV infection.
THANK YOU

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Hepatitis

  • 3. INTRODUCTION Hepatitis is inflammation of liver usually caused by bacterial or viral infection, drug[including alcohol],toxins, or parasites than result enlargement liver jaundice diminished appetites,nausia,vommiting,abdomin al pain.
  • 4. DEFINITION • Hepatitis means inflammation of the liver – Hepat (liver) + itis (inflammation)= Hepatitis • Viral hepatitis means there is a specific virus that is causing your liver to inflammation (swell or become larger than normal)
  • 5. CON… • Viral hepatitis means there is a specific virus that is causing your liver to inflame (swell or become larger than normal) ACCORDING TO LEWIS
  • 6. • Hepatitis refers to an inflammatory condition of the liver. It's commonly caused by a viral infection, but there are other possible causes of hepatitis. • These include autoimmune hepatitis and hepatitis tha t occurs as a secondary result of medications, drugs, toxins, and alcohol ACCORDING TO LIPPIN COTT
  • 7. The Liver • Is located in the upper right quadrant of the abdomen •Cleans the blood •Regulates hormones •Helps with blood clotting •Produces bile •Produces important proteins •Maintains blood sugar levels • The liver is essential for life !
  • 8. Inflammation Walls of scar tissue begin to form Healthy liver cells become trapped by a wall of scar tissue
  • 9. Viral Hepatitis 5 types: A: fecal-oral transmission B: sexual fluids & blood to blood C: blood to blood D: travels with B E: fecal–oral transmission Vaccine Preventable Adapted from Corneil, 2003
  • 10. HEPATITIS-A  An infection of the liver that cause by an RNA virus, is transmission by ingestion of infected food and water. Hepatitis-A is caused by a ribonucleic acid (RNA) virus of the enter virus family. Fecal-oral route, poor sanitation, person to person contact, Incubation period is 3 to 5 weeks .
  • 11. HEPATITIS-B • An infection of the liver that is caused by a DNA virus is transmitted by contaminated blood or blood derivatives in transfusion, by sexual contact with an infected person ,or used contaminated needle and instruments. • Incubation period 2 to5 months.
  • 12. HEPATITIS -C  A hepatitis –c caused by a flavivirus [species hepatitis c virus of the genus Hepacivirus]that tend to persist in the blood serum and is usually transmitted contact with the blood serum usually transmitted blood transfusion and intravenous drug used]. Incubation period 1 week to several months.
  • 13. HEPATITIS-D  Hepatitis D –it is inflammation of liver cells cause by hepatitis- D Virus (Delta virus)  HBV required for replication hepatitis delta antigen detectable in early acute Hepatitis D virus infection. Incubation period is the same as for HBV.
  • 14. HEPATITIS-E Hepatitis-E :- it is inflammation of liver caused by infection with the hepatitis-E virus . It is transmitted via food or drink handled by an infected person or through infected water in the area where fecal matter may get in to water. There is no vaccine or treatment for hepatitis –E although anti viral drug may be tried. And incubation period same as for Hepatitis A virus.
  • 15. Signs and Symptoms • Signs and Symptoms –Tiredness –Nausea –Muscle or joint pain –Trouble sleeping –Loss of appetite –Weight loss –Abdominal pain –Itchiness –Depression –Dark urine (pee)
  • 16. Signs and Symptoms • A few may have specific liver related symptoms initially: – Pale stool (poo) – Jaundice (yellowing of the skin or eyes)
  • 17. PATHOPHYSIOLOGY DUE TO ETIOLOGICAL FACTORS VIRUS ENTER BLOOD STREAMS ANTIGEN AND ANTIBODY REACTION THE INFLAMMATORY PROCESS ACTIVATED THROUGHOUT WHOLE LIVER
  • 18. • HEPATOCYTES ARE DISTROYED BY CYTOXIC CYTOKINES AND NATURAL KILLER CELLS BOTH PART ARE INFLAMMATORY PROCESS  CELLULAR NECROSIS TAKEPLACE CHOLESTASIS OR THE INTERRUPTION OF THE FLOW OF BILE AND DISRUPTION OF THE NORMAL BLOOD SUPPLY TO THE CEELLS
  • 19. DAMAGE THE LIVER CELLS HEPATITIS
  • 20. DIAGNOSTC TEST • History taking. • Physical examination. • Abdominal ultrasound. • Hepatitis virus serological . • Liver function test. • Liver biopsy to check for liver damage. • Paracentesis. • ALT and AST test( alanine aminotransferase and aspartate aminotransferase.
  • 21. •DIAGNOSTIC EVALUATION • LIVER ENZYMES/ISOENZYMES: Abnormal (4–10 times normal values).Note: Of limited value in differentiating viral from nonviral • Hepatitis. • AST/ALT: Initially elevated. May rise 1–2 wk before jaundice is apparent, and then decline.
  • 22. • ALKALINE PHOSPHATES (ALP): Slight elevation (unless severe cholestasis present). • Hepatitis A, B, and C, D, E panels (antibody/antigen tests): Specify type and stage of disease and determine possible carriers. CBC: Red blood • HBV is a DNA virus composed of the following antigenic particles. • HBcAg- hepatitis core antigen (antigenic material in an inner core)
  • 23. • HBsAg- hepatitis B surface antigen (antigenic material on surface of HBV) • • HBeAg-an independent protein circulating in the blood. • • HBxAg-gene product of x gene of HBV/DNA.
  • 24. • STOOLS -: Clay-colored, steatorrhea (decreased hepatic function). Bromsulphalein (BSP) - excretion test: Blood level elevated. LIVER BIOPSY: - Usually not needed, but should be considered if diagnosis is uncertain, of if clinical course is atypical or unduly • Prolonged. • LIVER SCAN : Aids in estimation of severity of parenchyma damage.
  • 25. • URINALYSIS: Elevated bilirubin levels; protein/hematuria may • HAV: radioimmunoassay detects immunoglobulin. • WBC count and diffemonocytosis, atypical lymphocytes, and plasma rential: Leucopenia, leukocytosis, cells may be present. SERUM ALBUMIN -: Decreased. BLOOD GLUCOSE: - Transient hyperglycemia/hypoglycemia (altered liver function).
  • 26. CON… • Prothrombin time -: May be prolonged (liver dysfunction). Serum bilirubin: - Above 2.5 mg/100 mL. (If above 200 mg/100 mL, poor prognosis is probable because of increased cellular necrosis.)
  • 27. MEDICAL MANAGEMENT The goals of chronic hepatitis are sustained suppression of HBV To active liver and to prevent an end disease
  • 28. ANTIVIRAL DRUGS - LAMIVUDINE- -Alpha interferon -stimulates the body immune system to fight the hepatitis B infection, but it is expensive, must be administered by injection, • (given for 16 weeks in adults and 24 weeks in children) • Hepatitis-c drug combination consisting of pegylated interferon and ribavirin.
  • 29. • Lamivudine is a synthetic nucleoside analog. 100mg5mg and 10 mg/ml oral solution. • Ribavirin= 400 mg Child-20 mg nebulizer. Any process that result in a change in state or activity of a cell or an organism (in terms of movement, secretion, enzyme production, gene expression, etc.)
  • 30. DRUG USED SIDE EFFECTS • "flu-like" symptoms • fever • chills • headache • body aches ,fatigue • decreased appetite • weight loss • insomnia • hair loss.
  • 31. • NURSING MANAGEMENT:- • Handle only if you have proper equipment • Sturdy pair of gloves, tongs or pliers and a puncture proof container (heavy plastic or metal) • Place needle in puncture proof container • Do not touch needle with bare hands and do not try to recap needle if cap present .
  • 32. • Can dispose container in garbage but better if it is taken to health clinic or needle exchange. • Never share drug equipment – Straws, bills, needles, syringes, water, filter, cooker, pipes etc… • Never share tooth brushes/razors or any personal hygiene articles that have blood on them (even tiny amounts). • Practice safer sex
  • 33. • Always make sure new & sterilized equipment is being used for tattooing & piercing – Make sure ink for tattooing is not being shared • Do not touch dirty needles without proper equipment or following proper procedures.
  • 34. Prevention • Never share drug equipment – bills, needles, syringes, water, filter, cooker, etc… • Never share tooth brushes/razors or any personal hygiene articles that have blood on them (even tiny amounts). • Practice safer sex
  • 35. Prevention • Always make sure new & sterilized equipment is being used for tattooing & piercing – Make sure ink for tattooing is not being shared • Do not touch dirty needles without proper equipment or following proper procedures
  • 36. Dirty Needle Precautions 1. Handle only if you have proper equipment • Sturdy pair of gloves, and a puncture proof container (heavy plastic or metal) 2. Place needle in puncture proof container • Do not touch needle with bare hands and do not try to recap needle if cap present 3. Can dispose container in garbage but better if it is taken to health clinic or needle exchange.
  • 37. IN GENERAL, COMPLICATIONS OF VIRAL HEPATITIS MAY INCLUDE THE FOLLOWING: Acute or subacute hepatic necrosis. Chronic active hepatitis. Chronic hepatitis. Cirrhosis. Hepatic failure. Hepatocellular carcinoma (HCC) in patients with HBV or HCV infection.