Hepatitis can be caused by viruses, drugs like alcohol, chemicals, autoimmune diseases, or metabolic abnormalities. The most common viral causes are Hepatitis A, B, C, D, and E. Hepatitis inflammation can be acute and last less than 6 months, or chronic and last longer. Chronic infections can lead to fibrosis and cirrhosis over time. Treatment depends on the cause but may include antiviral drugs, immune system modulators, and supportive care.

1. Hepatitis
Presented by Miss Sudipta Roy
Designation : Associate Professor
East Point of College of Pharmacy , Bangalore

2. • Hepatitis is a broad term that means inflammation of liver
. It is most caused by viruses but also caused by drugs
(alcohol) , chemicals , autoimmune diseases and
metabolic abnormalities.
• Viral hepatitis is a systemic disease with primary
inflammation of the liver by any one of a heterogeneous
group of hepatotropic viruses. The most common causes
of viral hepatitis are the five unrelated hepatotropic
viruses Hepatitis A , Hepatitis B , Hepatitis C , Hepatitis D,
and Hepatitis E.
• In addition to the nominal hepatitis viruses , other viruses
that can also cause liver inflammation include Herpes
simplex , Cytomegalovirus , Epstein-Barr virus, or yellow
fever.

3. • Hepatitis can heal to its own with no significant
consequences , or it can progress to scarring of the
liver. Acute hepatitis lasts under six months
• , while chronic hepatitis lasts longer.
• Pathophysiology of Hepatitis:

4. • During an acute hepatitis , liver damage is
mediated by cytotoxic cytokines and NK cells
• CK and cytokines causes lysis of infected
hepatocytes . It leads to cholestasis.
• Liver cells can regenerate after acute infection.
• A chronic viral infection causes chronic
inflammation and cause fibrosis over decades.
• Fibrosis can lead to cirrohosis .

5. • Types of Hepatitis .
• Toxic Hepatitis
• Alcohol Hepatitis
• Viral Hepatitis
• Toxic Hepatitis :
• It can be caused by drugs , alcohol , industrial
toxins and plant poisons.
• Clinical Manifestations.
• Anorexia
• Nausea and Vomiting

6. • Nursing Intervention.
• It involves educating patient regarding following-
• Danger of using injudicious use of material that are
known to be injurious to the liver.
• Need of well-balance diet that is provided to the
liver
• Minimal or no alcohol intake
• Promote comfort
• Maintain normal fluid and electroyte imbalance
• Promote rest

7. • Alcohol Hepatitis .
• It may be acute or chronic . It is also reversible and is
the frequent of cause of people with cirrhosis. It is
caused by parenchymal necrosis resulting from heavy
alcohol consumption.
• Alcoholic hepatitis is a disease, inflammatory
condition of the liver caused by heavy alcohol
consumption over an extended period . Diagnostic is
CBC , Liver function tests, Ultrasund , CT scan, blood
clotting tests, liver biopsy . Patients needs to stop
receive drinking.

8. • Viral Hepatitis.
• Hepatitis A.
• It is formerly known as infectious hepatitis. It is
caused by Hepatitis A virus is transmitted through
faecal-oral route via contaminated food or drinking
water and is common in places with poor hygiene
standards.It does not have a chronic stage and does
not cause permanent liver damage. The Hepatitis A
virus (HAV) is a Picornavirus. it is non-enveloped and
contains a single standard RNA packaged in a protein
shell.

9. • Clinical Manifestation.
• Fatigue
• Fever
• Abdominal pain
• Nausea
• Diarrhea
• Appetite loss
• Depression
• Jaundice
• Sharp pains in the right upper quadrant of the abdomen
• Weight loss
• Itching

10. • Management.
• There is no specific treatment of HAV . The patient
is advised to take rest and avoid fatty foods, alcohol
and eat a balanced diet and stay hydrated.
• Hepatitis B.
• Hepatitis B is common in young adults. It lives in
the blood or other body fluids such as saliva,
semen , urine , faeces and pleural fluids . Hepatitis
B vurus may be either asymptomatic or may be
associated with a chronic inflammation of the liver
(chronic hepatitis) , leading to cirrhosis over a
period of several years.

11. • Clincal Manifestation of hepatitis B :
• Abdominal pain
• Dark time
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of skin and whites of the eyes (Jaundice).

12. • Management:
• Most adults with hepatitis B recover fully , even if their signs
and symptoms are severe. Infants and Chilfren are more likely
to develop chronic (long-lasting) hepatitis B infection A. A
vaccine can prevent hepatitis B, but there's no cure if you have
the condition.
• Anti-viral drugs can be give like lamivudine ,
• lamivudine
• Adefovir
• Tenefovir
• Telbivudine
• Entecavir
• Two immune sytems modulators-interferon alpha-2a and
pegylated interferon alpha-2a.

13. • Hepatitis C.
• Hepatitis C virus is an RNA virus. It is slowly
progreesing infection that is spread by the
intravenous drug users. It is a blood-brone
infectious disease that is caused by the hepatitis C
virus (HCV) , affecting the liver. The infection is
often aymptomatic , but once eastablished, chronic
infection can cause inflammation of the liver
(chronic hepatitis). chronic HCV ifection results in
liver cirrhosis.

14. • Clinical manifestation.
• Most people have no symptoms , but people may experience .
• Pain in abdomen
• Gastrointestinal bleeding
• Bloating
• Fluid retention in abdomen
• Nausea
• Fatigue
• Fever
• Loss of appetite
• yellow skin
• Depression
• Weight loss

15. • Management.
• In a patient with acute hepatitis C, treatment with
pegylated interferon within the 12-24 weeks of
infection reduce the development of chronic
hepatitis C.
• Chronic HCV : Pegylated interferon, Ribavirin and
Protease inhibitors.

16. • Hepatitis D.
• HDV is a defective single-stranded RNA virus that
cannot survive on its own . It requies hepatitis B to
replicate . Incubation period is 2-6 weeks . Chronic
carries f HBV always at risk for transmission. Source
of infection are same as HBV. HDV infection is only
possible if a person is already infected with
hepatitis B or a person can be infected with both
viruses at the same time. The primary route of
transmission is beleived to be similar to those of
HBV, through HDV does not appear to be sexually
transmitted disease.

17. • Clinical Manifestation.
• The symptoms of Hepatitis D are -
• Yellow skin and eyes
• Stomach upset
• Stomach ache
• Throwing up
• Loss of appetite
• Dark urine

18. • This infection is dependent on HBV replication as
HBV provides an HBsAg envelop for HDV, two types
of infection are recognized , co-infection and super-
infection. In co-infection delta and HBV are
transmitted together at the same time .In super
infection , delta infection occurs in a person already
harboring HBV.

19. • Management.
• There are no known treatments for acute or chronic
hepatitis D, unlike other forms of hepatitis , current
antiviral medications don't seem to be vary effective in
treating HDV. Interferon may be given for 12 moths.
• Hepatitis E.
• Hepatitis E virus (HEV) is an RNA virus and incubation
period are 15-64 days. HEV has a faecal oral transmission
route. Source of infection is contaminated water , poor
sanitation. It is found in Asia , Africa and Mexico and is
more common in adults and severe in pregnant women .
Hepatitis E usually resolves on its own within four to six
weeks. Its treatment focuses on supportive care,
rehydration and rest.

20. • Management.
• There is no specific treatment capable of altering
the course of acute hepatitis E. As the disease is
usually self limiting, hospitalization is generally not
required. Hopitalization is required for people with
fulminant hepatitis.