Viral hepatitis & Related Real Life Experience.pptx

Viral Hepatitis
Mr. Shashi Prakash
Nursing Tutor,
College of Nursing,
S. N. Medical College, Agra

Objectives
• Overview of viral hepatitis
• Definition & types
• Difference between viruses that cause hepatitis
• Sign & symptoms
• Investigations
• Screening and evaluation
• Real life Experience
#HepFreeFuture #WorldHepatitisDay
Viral hepatitis & Related Real Life Experience - Mr. Shashi Prakash

Overview of Viral Hepatitis
• 354 million people worldwide live with hepatitis B or C, and
for most, testing and treatment remain beyond reach (WHO,
2023).
• Symptoms can take decades to manifest, so many people
who are infected do not seek timely treatment.
• SUD does not cause, but can exacerbate Viral Hepatitis.
• As many as 90% of people who have HIV infection have been
infected with HBV.
• 33 % of people who are infected with HIV are co-infected
with HCV
• Chronic Hepatitis infection affects approximately 5% of
psychiatric inpatients

Cont.….
• >90% of infants that are infected will develop a chronic
hepatitis B infection
• Up to 50% young children between 1 and 5 years who are
infected will develop a chronic hepatitis B infection
• 90% of healthy adults over the age of 19 will recover from
Hep B exposure
• HCV will spontaneously clears in 25% of the population

We have only one LIVER

Non- alcoholic
Fatty Liver disease
Viral Hepatitis
Alcohol-related
Liver disease

• Gatekeeper for health
• Breaks down toxins found in the
blood and excretes them as harmless
byproducts either in the stool or in
the kidneys
• Metabolizes drugs, alcohol, and
prescription and over-the-counter
medications
• Makes cholesterol and clotting factors
• Stores sugar (as Glycogen Glucose),
fats and vitamins
• Social pacification
• Health literacy healthy way of living
How
Can You
Love Me…
If You
Don’t Know
Me?

What is Hepatitis?
• Hepar (liver) + Itis (inflammation)= Hepatitis
• Hepatitis means inflammation of the liver

What is Viral Hepatitis?
• Viral hepatitis means inflammation (swelled
or enlarged) of liver caused by viruses.

Classification of Viral Hepatitis
Enterically Transmitted
(A & E)
Blood-Borne Transmission
(B, C & D)
Viral Hepatitis

Virus RNA
(Picornavirus)
Transmission Fecal-oral
Progression to
chronicity
Never
Notes Esp. travelers
disease
Typically resolve
without sequelae
Incubation
period
2-6 weeks
Detection in Serum and stool
Diagnostic Anti-HAV (IgM)
Immunization Yes
HAV
HAV RNA in serum
HAV RNA in stool
Symptomatic disease
Infection
Anti-HAV (IgG)
Anti-HAV (IgM)
Weeks
0 1 2 3 4 5 6 7 8 9 10

Virus DNA
(Hepadnavirus)
Transmission Sexual, parenteral,
perinatal
Progression to
chronicity
Yes
Notes Extrahepatic
manifestations
Incubation
period
4-24 weeks
Detection in Serum
Diagnostic HBsAg
Immunization Yes
HBV DNA
Months
HbsAg
Infection
Anti-HBc (IgG)
Anti - HBe
Anti-HBc (IgM)
Anti-HBs
HBeAg
Years
Acute
0 1 2 3 4 5 6 1 2 3 4 5
HBV DNA
Months
HBsAg
HBeAg
Anti-HBc
Years
Chronic
Symptomatic disease
Transaminases
0 1 2 3 4 5 6 1 2 3 4 5
HBV

Virus RNA
(Flavivirus)
Transmission Parenteral
Progression to
chronicity
Yes (50-80% if
untreated)
Notes Extrahepatic
manifestations
Genotyping for
therapy
Incubation
period
2-24 weeks
Detection in Serum
Diagnostic Anti-HCV
Immunization No
0 1 2 3 4 5 6 1 2 3 4 5
HCV RNA
Symptomatic disease
Infection Anti-HCV
Months Years
Acute
Months
Infection HCV RNA
Anti-HCV
Years
Chronic Symptomatic disease
Transaminases
0 1 2 3 4 5 6 1 2 3 4 5
HCV

Virus RNA virusoid
Transmission Sexual, parenteral,
perinatal
Progression to
chronicity
Yes
Notes Infection types
Coinfection
Superinfection
Incubation
period
4-12 weeks
Detection in Serum
Diagnostic Anti-HDV
Immunization No (HBV vaccine)
0 1 2 3 4 5 6 7 8 1 2 3 4
HDs Ag
Infection
Anti-HDc (IgG)
Anti-HD (IgM)
HDe Ag
Anti-HD (IgG)
Anti-HDc
(IgM)
Acute –
coinfection:
Months Years
HDV DNA
HDV RNA
HDV DNA
HDV RNA
HDs Ag
Infection
Anti-HDc (IgG)
Anti-HD (IgM)
HDe Ag
Anti-HD (IgG)
Anti-HDc (IgM)
Acute -
superinfection:
Months Years
0 1 2 3 4 5 6 7 8 1 2 3 4
HDV

Virus RNA
(Herpesvirus)
Transmission Fecal-oral,
parenteral
Progression
to chronicity
Rare (possible in
immunosuppressan
t)
Notes Travelers & zoonotic
3% fulminant
(mortality rate of -
20% during
pregnancy)
Incubation
period
2-10 weeks
Detection in Serum and stool
Diagnostic Anti-HEV (IgM)
Immunization No
0 1 2 3 4 5 6 7 8 9 10
HEV RNA in serum
HEV RNA in stool
Symptomatic disease
Infection
Anti-HEV (IgG)
Anti-HEV (IgM)
Weeks
HEV

Signs & Symptoms
• Acute viral hepatitis:
Asymptomatic
Flu like symptoms: fatigue, arthralgia ± arthritis,
anorexia, Fullness, & N&V.
Very high ALT & AST > 1000 U/L
• Chronic viral hepatitis:
Symptoms-
 Only if cirrhosis developed: jaundice, fatigue & ascites.
 80% of HCV and 10% of HBV will develop chronic hepatitis.

Phases of Viral Hepatitis
Preicteric (Prodromal):
-body symptoms… (joint pain, fatigue,
N & V, GI pain, changes in taste)
increasing liver enzymes and
bilirubin……
Icteric:
-DECREASE in symptoms above…but
will have jaundice, dark urine, clay-
colored stool from build-up of bilirubin,
enlarged liver w/ pain
Posticteric (Convalescent):
-Jaundice & dark urine starts to subside
and stool colour returns to normal, liver
enzymes and bilirubin returns to normal

Investigations
•Acute viral hepatitis:
Increase in ALT, AST and bilirubin/alkaline
phosphate.
oIncrease in liver enzyme ALT/AST
AST > ALT = alcoholic induced
AST < ALT = anything else!
 Serology
•Chronic viral hepatitis:
Persistent increase in ALT and AST

SYSTEMATIC REVIEW
A blind spot? Confronting the stigma of hepatitis B virus (HBV)
infection - A systematic review
Jolynne Mokaya 1, Anna L McNaughton1, Lela Burbridge2, Tongai Maponga³, Geraldine O'Hara Philippa C
Matthews 4, Monique Andersson 05, Janet Seeley
Results: The study identified a total of 32 articles, of which only two studies were
conducted in Africa. Lack of knowledge of HBV was consistently identified, and in
some settings there was no local word to describe HBV infection. There were
misconceptions about HBV infection, transmission and treatment. Healthcare
workers provided inaccurate information to individuals diagnosed with HBV. and
poor understanding resulted in lack of preventive measures. Stigma negatively
impacted on help-seeking, screening, disclosure, prevention of transmission, and
adherence to treatment, and had potential negative impacts on mental health,
wellbeing, employment and relationships.

Lab Results
Liver Enzymes
• ALT (alanine transaminase): 7 to 56 U/L
• AST (aspartate transaminase): 10 to 40 U/L
Bilirubin Levels
• <1 mg/dl elevated with hepatitis…
(causes jaundice/dark urine)
Ammonia Levels
(not on CMP; separate test)
• 15-45 mcg/dL (elevated with hepatitis and will see as mental
status changes)
• Lactulose administered for high ammonia level… causes diarrhea
but lowers ammonia level.

HCC
Liver Circle
Acute Hepatitis
Chronic
Hepatitis
Compensated
Cirrhosis
Decompensated
Cirrhosis
Tx
Palliative Care
End of Life

Screening and Evaluation
• Verbal screening at intake for all people
• Those who are at risk should be counseled to seek medical
screening
• Screening is an opportunity to educate about hepatitis
• Note: Some people confuse hepatitis (HBV/HCV with HIV) CLARIFY!
• Antibody vs. antigen
• Antigen (virus) – contagious
• Antibody (indicates prior exposure)

A Mixed Method study to assess the
Social Challenges experienced by
Hepatitis B Patients
Meenakshi Tomnr1, Tarika Sharma1
College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India
Methods: A mixed method research design was used to explore various social challenges
experienced bv hepatitis b positive patients. Descriptive research design was used in the first
phase and case studies were recorded in the second phase of the study. Data was collected
using modified hepatitis B stigma assessment tool and semi structured interview guide. The
questionnaire measured four dimensions i.e. personalized stigma, disclosure pattern, negative
self image and the public attitude. Total 180 patients on hepatitis b treatment were recruited
for the first phase and 9|case studies (patients with high stigma) were recorded in the second
phase, Data was analyzed using descriptive and inferential statistics. Content analysis was
done for the case study part.
Results: Mean age of the patients was (45 ± 13.1) years and 80% of the patients were male.
Mean overall stigma score was found to be (74.34±10.13). Out of all; 5.1% patients
experienced high stigma. 2.1% mo derate stigma and 92% patients experienced low stigma. In
patients with less monthly income faced more social challenges comparative to their counter
parts. Case studies uncovered various attributing factors to social challenges and broadly
categorized into getting diagnosed with hepatitis B. social support and the attitude of health
care providers towards them.
Conclusion: Patients with Hepatitis B experience social challenges in aspect of lack of
awareness and under standing about disease condition, lack of support from friends and
family and negative attitude of healthcare providers. A better understanding and awareness
regarding hepatitis B is needed to eliminate stigma and discrimination among these patients,
Hence, a holistic approach is must to treat people with Hepatitis B.

Hepatitis
Not only Letters

“Liver is going global”
• Viral Infection (A, B, C, D, E)
• Chronic Liver Disease
• Liver Cancer
• Palliative Care
• Suffering and early death
• Liver transplant
• Physical, mental, social, spiritual issue

Hepatitis
Handwashing (strict)
eat LOW fat % HIGH carbs
personal hygiene products NOT shared
activity conversation (REST!!)
toxic substances avoided
alcohol, sedatives, aspirin, acetaminophen etc.
individual bathroom
testing results
-Hep A: anti-HAV…..IgM (active) or
IgG (gone/immune)
-Hep B: HBsAg (infectious)
Anti-HBV(recovered/Immune)
interferon (subcutaneous)
small but frequents meals

HDV occurs
with HBV [5%)
HBV requires life
long Treatment, HCV
is curable with 12-
24wks treatment
Summary

• https://youtu.be/vqvSG9hqGUs

Real Life Experience

+91 8650228658
prakashsashipr@gmail.com
THANK YOU

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