HEPATITIS

JOAN M PINO-TABLOT RN MSN

APN CS
FALL 2005
Hepatitis

is the inflammation of the liver, resulting in liver cell damage

and destruction.
Hepatitis can be categorized in two groups:

acute hepatitis
chronic hepatitis
 There are six main types of the
hepatitis virus that have been identified,
including the following:
 Hepatitis A
 Hepatitis B
 Hepatitis C
 Hepatitis D
 Hepatitis E
 Hepatitis A
This type of hepatitis is usually spread
by fecal-oral contact, or fecal-infected
food and water, and may also be
spread by blood-borne infection (which
is rare). The following is a list of modes
of transmission for hepatitis A
 Hepatitis B
 Hepatitis B has a wide range of clinical
presentations. It can be mild, without symptoms, or
it may cause chronic hepatitis and, in some cases,
can lead to full-blown liver failure and death.
 Transmission of hepatitis B virus occurs through
blood and body fluid exposure such as blood,
semen, vaginal secretions, or saliva.
 Infants may also develop the disease if they are
born to a mother who has the virus. Infected
children often spread the virus to other children if
there is frequent contact or a child has many
scrapes or cuts. The following describes persons
who are at risk for developing hepatitis B
 Hepatitis C

 The symptoms of hepatitis C are usually mild and gradual.

 Children often show no symptoms at all. Transmission of
hepatitis C occurs primarily from contact with infected blood,
but can also rarely occur from sexual contact, or from an
infected mother to her baby.
 Athough hepatitis C has milder symptoms initially, it leads to
chronic liver disease in a majority of people who are infected.
 According to the Centers for Disease Control and Prevention
(CDC), hepatitis C is the leading indication for liver
transplantation.
 With some cases of hepatitis C, no mode of transmission can be
identified. In addition, people with alcoholic liver disease also
tend to develop worse hepatitis C than those who only have
hepatitis C.
Hepatitis D

 Hepatitis D
This form of hepatitis can only occur in the presence
of hepatitis B. If an individual has hepatitis B and
does not show symptoms, or shows very mild
symptoms, infection with D can put that person at
risk for full-blown liver failure that progresses rapidly.
 Hepatitis D can occur at the same time as the initial
infection with B, or it may show up much later.
 Transmission of hepatitis D occurs the same way as
hepatitis B, except the transmission from mother to
baby is less common.
Hepatitis E
 This form of hepatitis is similar to
hepatitis A. Transmission occurs
through fecal-oral contamination. It is
less common than hepatitis A. Hepatitis
E is most common in poorly developed
countries and rarely seen in the United
States. There is no vaccine for hepatitis
E at this time.
How often does hepatitis occur?

 According to the CDC, in the US, each

year, approximately one-third of
Americans will be exposed to hepatitis
A. In addition, there are 80,000
hepatitis B infections and 40,000
hepatitis C infections reported each
year.
 Preventing the spread of viral
hepatitis:
 Proper hygiene is the key to preventing
the spread of many diseases, including
hepatitis. Other preventive measures
include the following:
Vaccinations
 A hepatitis B vaccine is routinely given
to toddlers as part of their immunization
schedule. A hepatitis A vaccine is
available for people at risk for
contracting the disease while traveling.
(There are no vaccines for hepatitis C,
D, or E at this time.)
Blood transfusion

 Blood transfusions are routinely

screened for hepatitis B and C to reduce
the risk of infection.
 Treatment
 The most important measure in the treatment of alcoholic liver
disease is to ensure the total and immediate abstinence from
alcohol. This will sometimes require admission to an in-patient
medical ward for prophylactic treatment of withdrawal
symptoms such as delirium tremens and seizures.
 Treatment of other associated neurological conditions may also
be required. Chronic alcohol abusers often need treatment with
vitamins, especially thiamin, to correct the deficiencies that may
have resulted from chronic alcohol abuse.
 Intensive medical treatment of the complications of acute
alcoholic hepatitis or cirrhosis is also sometimes necessary, as is
the treatment of concurrent infectious and/or metabolic
disorders.
 Once the patient is medically stable, he/she should
receive on-going treatment to ensure abstinence
from alcohol.
 This often includes a period of in-patient alcohol
rehabilitation followed by subsequent long-term
participation in support groups such as Alcoholics
Anonymous and possibly continuous out-patient
psychiatric care.
 Cessation of alcohol use will reverse fatty liver and
alcoholic hepatitis. Although cirrhosis is irreversible,
alcohol abusers who stop drinking will often have a
good prognosis in that progressive liver deterioration
can be avoided.
Liver Failure

 What is liver failure?

Liver failure occurs when large parts of
the liver become damaged beyond
repair and the liver is no longer able to
function.
 Liver failure is a life-threatening
condition that demands urgent medical
care. Most often liver failure occurs
gradually and over many years.
However, a more rare condition known
as acute liver failure occurs rapidly (in
as little as 48 hours) and can be difficult
to detect initially.
What causes liver failure?
The most common causes of liver failure are:

 Hepatitis B
 Hepatitis C
 Long term, excessive alcohol
consumption
 Cirrhosis
 Hemochromatosis
 Malnutrition
 The causes of acute liver failure, however,
are often different. These include:
 Acetaminophen (Tylenol) overdose -– this is
one of the most common causes of acute
liver failure
 Viruses including hepatitis A, B, and C
(especially in children)
 Reactions to certain prescription medications
 Ingestion of poisonous wild mushrooms
What are the symptoms of
liver failure?

The initial symptoms of liver failure are often
ones that can be due to any number or
conditions. Because of this, liver failure may
initially difficult to diagnose. Among these
early symptoms are:
 Nausea
 Loss of appetite
 Fatigue
 Diarrhea
 However, as liver failure progresses, the
symptoms become more serious, indicating
that urgent treatment is required. These
symptoms include:
 Jaundice
 Bleeding easily
 Swollen abdomen
 Mental disorientation or confusion (known as
hepatic encephalopathy)
 SleepinessComa
What is acute hepatitis?
 Acute hepatitis is quite common in the US.
 Causes:
Common causes of acute hepatitis may
include:
 infection with a virus (viral hepatitis A, B, C,
D, or E)
 overdose of drugs (such as acetaminophen)
 chemical exposure (such as dry cleaning
chemicals)
 Symptoms:
Acute hepatitis usually starts with flu-
like symptoms. The following are the
most common symptoms of acute
hepatitis. However, each individual may
experience symptoms differently.
Symptoms may include

 jaundice
 nausea
 vomiting
 loss of appetite
 fever
 tenderness in the right, upper abdomen
 sore muscles
 joint pain
 itchy red hives on skin
 The symptoms of acute hepatitis may
resemble other medical conditions or
problems. Always consult your physician
for a diagnosis.
 Diagnosis:
In addition to a complete medical
history and medical examination,
diagnostic procedures for acute
hepatitis may include the following:
 specific laboratory tests
 liver function tests
Treatment:
 Specific treatment for acute hepatitis will be
determined by your physician based on:
 your age, overall health, and medical history
 extent of the disease
 your tolerance for specific medications,
procedures, or therapies
 expectations for the course of the disease
 your opinion or preference
 Treatment varies, depending on the type of
acute hepatitis (viral versus non-viral).
Severe, acute hepatitis may require
hospitalization.
 People who have had acute viral hepatitis
may become chronic carriers of the disease.
Proper precautions need to be taken to
prevent the spread of the disease.
What is chronic hepatitis?
 Some people do not recover fully from
acute hepatitis and develop chronic
hepatitis, as the liver continues to
sustain more damage and inflammation.
Hepatitis is considered chronic if
symptoms persist longer than six
months. Chronic hepatitis can last
years.
Type of chronic hepatitis:
 alcohol-induced chronic hepatitis - continued
liver damage throughout the liver from heavy
alcohol consumption.
 chronic active hepatitis - an aggressive
inflammation and destroyer of liver cells,
which usually leads to cirrhosis.
 chronic persistent hepatitis - a milder
inflammation of the liver, which usually does
not lead to cirrhosis.
 Causes:
Certain viruses and drugs may cause
chronic hepatitis in some people, but
not in others. Some common causes
include the following:
 viral hepatitis
 heavy alcohol consumption
 autoimmune disorder (when the body
attacks its own tissues)
 reaction to certain medications
 metabolic disorder (such as
hemochromatosis or Wilson's Disease)
Symptoms:
 Symptoms for chronic hepatitis are usually
mild. Although the liver damage continues, its
progression is usually slow. The following are
the most common symptoms of chronic
hepatitis. However, each individual may
experience symptoms differently. Some
individuals may experience no symptoms,
while others may experience the following:
 feeling ill
 poor appetite
 fatigue
 low fever
 upper abdominal pain
 jaundice
 symptoms of chronic liver disease (such as enlarged
spleen, spider-like blood vessels in the skin, and fluid
retention)
Diagnosis:


In addition to a complete medical

history and medical examination,
diagnostic procedures for chronic
hepatitis may include the following:
 specific laboratory tests
 liver function tests
 liver biopsy (to determine severity of
inflammation, scarring, cirrhosis, and
underlying cause)
 Treatment:
Specific treatment for chronic hepatitis
will be determined by your physician
based on:
 your age, overall health, and medical history
 extent of the disease
 cause of the disease
 your tolerance for specific medications,
procedures, or therapies
 expectations for the course of the disease
 your opinion or preference
 The goal of treatment is to stop
damage to the liver and alleviate
symptoms.
 Treatment may include:
 antiviral agent
When caused by hepatitis B or C,
inflammation of the liver may be
stopped with the antiviral agent
interferon-alpha, and/or other drugs.
 corticosteroids
Corticosteroids may be used to treat
chronic liver disease caused by an
autoimmune disorder. Inflammation is
suppressed, but scarring of the liver
may continue.
 discontinuation of certain drugs
When chronic hepatitis is caused by
certain drugs, discontinuing those drugs
usually clears up any symptoms
Selected Potentially
Hepatotoxic Medication
 All nonsteroidal anti-inflammatory drugs Lipid-lowering agents:
statins, nicotinic acid (niacin; Nicolar)
Antidiabetic agents: acarbose (Precose), pioglitazone (Actos),
sulfonylureas
Antibiotics: amoxicillin­clavulanate potassium (Augmentin),
erythromycin, isoniazid (INH), nitrofurantoin (Furadantin),
tetracycline
Antifungal agents: fluconazole (Diflucan), itraconazole
(Sporanox), ketoconazole (Nizoral)
Retinoids: etretinate (Tegison)
Anticonvulsant agents: phenytoin (Dilantin), valproic acid
(Depakene)
Psychotropic agents: bupropion (Wellbutrin), chlorpromazine
(Thorazine), tricyclic antidepressants
Hormones: tamoxifen (Nolvadex), testosterone
Others: halothane (Fluothane), methotrexate (Rheumatre
Selected Potentially
Hepatotoxic Supplements
 Amanita species
Asafetida
"Bush" herbal teas
Chaparral
Comfrey
Echinacea Gentian
Germander
Iron
Jin bu huan
Kalms tablets
Mistletoe Nicotinic acid (niacin; Nicolar)
Pennyroyal oil
Senna fruit extracts
Valerian
Vitamin A
Preventive Measures in
Chronic Liver Disease
 Complete abstinence from alcohol
Vaccination against hepatitis A and B viruses (if
patient not already immune)
Avoidance of hepatotoxic medications, especially
nonsteroidal anti-inflammatory drugs*
Assessment of vitamins and herbal remedies for
safety
Avoidance of iron supplements unless iron deficiency
anemia is present; multivitamins without iron should
be used
Low-fat, "heart-smart" diet *--The safest choice is
acetaminophen, in a dosage of less than 2 g per day.