VIRAL HEPATITIS

Ms. Whelhelmina Montefrio, BSN, R.N

Head Nurse, Fever Ward
LIVER
The liver is an organ that does many important things.
• removes harmful chemicals from your blood
• fights infection
• helps digest food
• stores nutrients and vitamins
• Stores energy

HEPATITIS

Hepatitis is a class of diseases that impact the liver.

Hepatitis can cause inflammations of the liver and
can cause its function to diminish. When this
Happens liver scarring can occur, which is known as
cirrhosis, and in severe cases, cancer can develop.
Hepatitis can be attributed to certain types of
medication, toxins, alcohol, hereditary conditions,
viruses, and autoimmune disorders. Hepatitis can be
classified as viral or non-viral. These five types are
categorized, A, B,C, D, and E. The most common of
these types are A, B, and C ( HAV, HBV, HCV.)
 HEPATITIS

Hepatitis is a medical condition defined by

the inflammation of the liver and
characterized by the presence of
inflammatory cells in the tissue of the
organ.
 CLASSIFICATION:
Viral hepatitis may be divided into
5 types according to etiology, that
is hepatitis A, B, C, D and E
Although the agents can be distinguished by its
antigenic properties, the 5 kinds of viruses may
produce clinical similar illness.
Hepatitis A is always an acute, short-term disease, while
hepatitis B, C, and D are most likely to become ongoing and
chronic. Hepatitis E is usually acute but can be particularly
dangerous in pregnant women.
 Etiology
Hepatitis A virus (HAV)
Is an acute liver disease caused by the hepatitis A virus
(HAV), lasting from a few weeks to several months. It
does not lead to chronic infection.

Transmission: Ingestion of fecal matter, even in

microscopic amounts, from close person-to-person
contact or ingestion of contaminated food or drinks.

Vaccination: Hepatitis A vaccination is

recommended for all children starting at age 1
year, travelers to certain countries, and others at
risk.
 cont:
has an incubation period of approximately 28 days
(range: 15–50 days).
HAV replicates in the liver and is shed in high
concentrations in feces from 2 weeks before to 1 week
after the onset of clinical illness.
HAV infection produces a self-limited disease that does
not result in chronic infection or chronic liver disease.
However, 10%–15% of patients might experience a
relapse of symptoms during the 6 months after acute
illness.
Antibody produced in response to HAV
infection persists for life and confers protection
against reinfection
 Signs & Symptoms
Some persons, particularly young children, are asymptomatic.
When symptoms are present, they usually occur abruptly and can
include the following:

Fever

Fatigue

Loss of appetite

Nausea
 Signs & Symptoms cont:

Vomiting
Abdominal pain
Dark urine
Clay-colored bowel
movements

Joint pain

Jaundice .
Hepatitis B virus (HBV) "serum hepatitis,"
Is a liver disease caused by the hepatitis B virus (HBV). It
ranges in severity from a mild illness, lasting a few weeks
(acute), to a serious long-term (chronic) illness that can lead
to liver disease or liver cancer.
Transmission: Contact with infectious blood, semen, and
other body fluids from having sex with an infected person,
sharing contaminated needles to inject drugs, or sharing
razors from infected person from an infected mother to her
newborn.

Vaccination: Hepatitis B vaccination is recommended for

all infants, older children and adolescents who were not
vaccinated previously, and adults at risk for HBV infection.
 CONT:

About 6% to 10% of patients with HBV hepatitis

develop chronic HBV infection (infection lasting
at least six months and often years to decades)
and can infect others as long as they remain
infected. Patients with chronic HBV infection also
are at risk of developing cirrhosis, liver failure,
and liver cancer.
 Symptoms
Acute infection with hepatitis B virus
Is associated with acute viral hepatitis – an illness that begins
with general ill-health, loss of appetite, nausea, vomiting, body
aches, mild fever, dark urine, and then progresses to
development of jaundice.
It has been noted that itchy skin has been an indication as a
possible symptom of all hepatitis virus types.
The illness lasts for a few weeks and then gradually improves in
most affected people.
A few patients may have more severe liver disease (fulminant
hepatic failure), and may die as a result of it.
The infection may be entirely asymptomatic and may go
unrecognized
 CONT:
Chronic infection with Hepatitis B virus
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.
This type of infection dramatically increases the
incidence of hepatocellular carcinoma (liver cancer).
Chronic carriers are encouraged to avoid consuming
alcohol as it increases their risk for cirrhosis and liver
cancer.
Hepatitis B virus has been linked to the development of
Membranous glomerulonephritis (MGN).
 Hepatitis C virus (HCV)
Is a liver disease caused by the hepatitis C virus (HCV).
HCV infection sometimes results in an acute illness, but
most often becomes a chronic condition that can lead to
cirrhosis of the liver and liver cancer.
The infection is often asymptomatic, but once established,
chronic infection can progress to scarring of the liver
(fibrosis), and advanced scarring (cirrhosis).
In some cases, those with cirrhosis will go on to develop liver
failure or other complications of cirrhosis, including liver
cancer.
Most people have few symptoms after the initial infection, yet
the virus persists in the liver in about 80% of those
infected.
Transmission: Contact with the blood of an infected
person, primarily through sharing contaminated needles
to inject drugs, and sexual contact.

Vaccination: There is no vaccine for hepatitis C.

 SIGNS AND SYMPTOMS

Acute hepatitis C refers to the first 6 months after infection

with HCV.
Symptoms of acute hepatitis C infection include
decreased appetite, fatigue, abdominal pain, jaundice,
itching, and flu-like symptoms.
The hepatitis C virus is usually detectable in the blood
within one to three weeks after infection, and antibodies to
the virus are generally detectable within 3 to 12 weeks.
Generalized signs and symptoms associated with
chronic hepatitis C include:
fatigue itching, sleep
marked weight loss
flu-like symptoms disturbances
muscle pain abdominal pain
(especially in the right
joint pain
upper quadrant),
intermittent low-
appetite changes
grade fevers
nausea,
depression,
diarrhea,
headaches,
dyspepsia,
and mood
 Hepatitis D virus (HDV)

Also called delta hepatitis, Is a serious liver disease

caused by the hepatitis D virus (HDV) and relies on
HBV to replicate.
Transmission: Contact with infectious blood, similar
to how HBV is spread.
Vaccination: There is no vaccine for hepatitis D.
 CONT:

Hepatitis D is a rare form of hepatitis that only

occurs in conjunction with hepatitis B infection.
The hepatitis D virus can’t multiply without the
presence of hepatitis B. It’s very uncommon
type of hepatitis in united state.
 Hepatitis E virus (HEV)

Is a serious liver disease caused by the hepatitis E virus

(HEV) that usually results in an acute infection. It does
not lead to a chronic infection. While rare in the United
States, hepatitis E is common in many parts of the
world.
Hepatitis E virus (HEV) is similar to HAV in terms of
disease, and mainly occurs in Asia where it is
transmitted by contaminated water.
 CONT:

Transmission: Ingestion of fecal matter, even in

microscopic amounts; outbreaks are usually
associated with contaminated water supply in
countries with poor sanitation.

Vaccination: There is currently no FDA-

approved vaccine for hepatitis E.
INCUBATION PERIOD
 Incubation period

HA 15-45 days 30 days

HB 30-180 days 70 days
HC 15-150 days 50 days
HD similar to
HB 40 days
HE 10-70 days
Type and Causes of noninfectious hepatitis

Alcohol and other toxins: Excessive alcohol

consumption can cause liver damage and inflammation. This is
sometimes referred to as alcoholic hepatitis. The alcohol
directly injures the cells of your liver. Over time, it can cause
permanent damage and lead to liver failure and cirrhosis, a
thickening and scarring of the liver.
Other toxic causes of hepatitis include overuse or overdose of
medications and exposure to poisons.
Autoimmune system response: In some cases, the
immune system mistakes the liver as a harmful
object and begins to attack it. It causes ongoing
inflammation that can range from mild to severe,
often hindering liver function.
 History and physical exam

To diagnose hepatitis, first your doctor will take your

history to determine any risk factors you may have for
infectious or noninfectious hepatitis.

During a physical examination, your doctor may press

down gently on your abdomen to see if there’s pain or
tenderness. Your doctor may also feel to see if your
liver is enlarged. If your skin or eyes are yellow, your
doctor will note this during the exam.
Laboratory examination
 Laboratory examination
Liver functionuse blood samples to determine how efficiently your liver works. Abnormal results
of these tests may be the first indication that there is a problem.
 Serum transaminase
• ALT(alanine transferase) ↑
• AST(aspartase transferase) ↑
• ALP (Alkaline phosphatase) ↑
• in chronic hepatitis LDH (Lactate dehydrogenase) ↑
 Serum protein
• Albumin ↓
• In chronic hepatitis Ig ↑↑
• The ratio of A/G ↓
 Bilirubin
• Urobilinogen ↑in early stage of AIH
 CONT:
Ultrasound examination: uses ultrasound waves to
create an image of the organs within your abdomen. This
test allows to take a close at your liver It can reveal if liver
damage or enlargement .
A liver biopsy is an invasive procedure that
involves taking a sample of tissue from your liver to
determine how infection or inflammation has affected
your liver.
Other laboratory examination:
– Blood routine
– Urine routine
 Detection of the markers of hepatitis virus:

Hepatitis A Hepatitis B
• Serologic marker • Sero-immunologic marker
– Anti-HAVIgM: recent – HBsAg anti-HBs
– HBcAg anti-
infection
– Anti-HAVIgG: past – HBeAg HBc
infection anti-Hbe
• Molecular biological marker
– DNAp
• Marker of feces
– HBV DNA
– HAV particles may be
– Immune tissue chemistry
detected by RIA or examination
IEM
– Isolation of HAV may
use tissue culture or
animal inoculation
Hepatitis C
• Serological marker
Hepatitis D
– Anti-HCVIgM
• HDAg anti-HDV
– Anti-HCVIgG
• Molecular biologic • HDV RNA
marker
– HCV RNA may be
detective by RT- Hepatitis E
PCR 1-2 weeks • Anti-HEVIgG,Anti-HEVIgm
after infection of
• RT-PCR
HCV
– Quality of HCV • HEV particais: IF IEM
RNA
– Immune tissue
chemistry method
detect HCAg within
liver cells
 How hepatitis is treated

Hepatitis A
usually doesn’t require treatment because it’s a short-term
illness. Bed rest may be recommended if symptoms cause a
great deal of discomfort. If you experience vomiting or diarrhea,
follow your doctor’s orders for hydration and nutrition.

The hepatitis A vaccine is available to prevent this infection. Most

children begin vaccination between ages 12 and 18 months. It’s a
series of two vaccines. Vaccination for hepatitis A is also
available for adults and can be combined with the hepatitis B
vaccine.
 CONT:Hepatitis B
Acute hepatitis B doesn’t require specific treatment.

Chronic hepatitis B is treated with antiviral medications. This form of

treatment can be costly because it must be continued for several months
or years. Treatment for chronic hepatitis B also requires regular medical
evaluations and monitoring to determine if the virus is responding to
treatment.

Hepatitis B can be prevented with vaccination. The CDCTrusted Source

recommends hepatitis B vaccinations for all newborns. The series of three
vaccines is typically completed over the first six months of childhood. The
vaccine is also recommended for all healthcare and medical personnel.
 CONT: Hepatitis C
Antiviral medications are used to treat both acute and chronic
forms of hepatitis C. People who develop chronic hepatitis C
are typically treated with a combination of antiviral drug
therapies. They may also need further testing to determine the best form of
treatment.

People who develop cirrhosis (scarring of the liver) or liver

disease as a result of chronic hepatitis C may be candidates
for a liver transplant.

Currently, there is no vaccination for hepatitis C.

 CONT: Hepatitis D

No antiviral medications exist for the treatment of hepatitis

D at this time. According to a 2013 studyTrusted Source, a
drug called alpha interferon can be used to treat hepatitis
D, but it only shows improvement in about 25 to 30
percent of people.

Hepatitis D can be prevented by getting the vaccination for

hepatitis B, as infection with hepatitis B is necessary for
hepatitis D to develop.
 CONT: Hepatitis E

Currently, no specific medical therapies are

available to treat hepatitis E. Because the infection
is often acute, it typically resolves on its own.
People with this type of infection are often advised
to get adequate rest, drink plenty of fluids, get
enough nutrients, and avoid alcohol. However,
pregnant women who develop this infection
require close monitoring and care.
 CONT: Autoimmune hepatitis

Corticosteroids, like prednisone or budesonide, are extremely

important in the early treatment of autoimmune hepatitis. They’re
effective in about 80 percent of people with this condition.

Azothioprine (Imuran), a drug that suppresses the immune

system, is often included in treatment. It can be used with or
without steroids.

Other immune suppressing drugs like mycophenolate (CellCept),

tacrolimus (Prograf) and cyclosporine (Neoral) can also be used
as alternatives to azathioprine for treatment.
 Complications of hepatitis

people with chronic hepatitis B or C are at risk for:

chronic liver disease
cirrhosis
liver cancer
If liver stops functioning normally, liver failure can occur.
Complications of liver failure include:
1. bleeding disorders
2. a buildup of fluid in your abdomen, known as ascites
3. portal hypertension
 CONT:

4.kidney failure
5. hepatic encephalopathy, which can
involve fatigue, memory loss, and
diminished mental abilities due to the
buildup of toxins, like ammonia, that affect
brain function
6. hepatocellular carcinoma, which is a
form of liver cancer
7. Death
 Tips to prevent hepatitis
Hygiene: Practicing good hygiene is one key way to avoid contracting hepatitis A
and E. If you’re traveling to a developing country, you should avoid:
•local water
•ice
•raw or undercooked shellfish and oysters
•raw fruit and vegetables
Hepatitis B, C, and D contracted through contaminated blood can be prevented
by:

not sharing drug needles

not sharing razors
not using someone else’s toothbrush
not touching spilled blood
Practicing safe sex by using condoms and dental dams can help decrease the risk of
infection
 CONT:

Vaccines
The use of vaccines is an important key to
preventing hepatitis. Vaccinations are
available to prevent the development of
hepatitis A and B. Experts are currently
developing vaccines against hepatitis C. 
NURSING INTERVENTION
CONT:

Observe standard precautions to prevent

disease transmission.
Provide rest periods throughout the day.
Schedule treatments and tests so the patient can
rest between activities.
To help the patient maintain an adequate diet,
avoid overloading his tray.
CONT:

Administer supplemental vitamins and

commercial feedings, as ordered.
Provide adequate fluid intake atleast 4 liters of
liquid daily.
Observe the patient for desired and adverse
effects of medication.
Record the patient’s weight daily, and keep
accurate intake and output records.
CONT:

Watch for signs of complications, such as

changes in level of consciousness, ascites,
edema, dehydration, respiratory problems,
myalgia, and arthalgia.
Teach the patient about the diseases, its signs
and symptoms, and recommended
treatments.
Explain all the necessary diagnostic tests.
Stress the importance of continued medical