Hepatitis B

Jennifer Anne Zaide BSN iv-2

Hepatitis B Virus

Has very limited tissue tropism Infects the liver and possibly the pancreas HBsAg appears in the blood 30 to 60 days after exposure and persists for variable periods of time

Hepatitis B Virus
An

enveloped DNA virus and is a member of the Hepadnaviridae family It is the only DNA virus that causes hepatitis

Acute Chronic

Hepatitis B Virus
Consists

of a core particle and a surrounding envelope

Core DNA and core antigen Envelope surface antigen

Hepatitis B Virus
Antigens

HBcAg core antigen HBeAg e antigen HBsAg surface antigen

Hepatitis B Virus
Electron
1.

microscopy of HBsAg-reactive serum has revealed 3 morphologic forms:

Hepatitis B virion or Dane particle
Diamter: 42nm

2. 3.

Hepatitis B filament Hepatitis B sphere

Diameter: 22nm Composed solely of hepatitis B surface proteins

Hepatitis B
Is

the inflammation of the liver caused by hepatitis B virus serum hepatitis hepatocellular carcinoma (HCC) liver cancer caused by HBV

Hepatitis B
Acute

Hepatitis B

Newly acquired infections Symptoms: 1-4 mos. after exposure to virus Fulminant hepatitis

Chronic

Hepatitis B

Infections with HBV that lasts longer than 6 mos.

Incubation Period
50

to 189 days

Period of Communicability
Patient

is capable of transmitting the virus during the latter part of the incubation period and during the acute phase

Modes of Transmission
Person-to-person

via infected body fluids Crosses placenta with high frequency Sexual contact Does NOT occur:

Fecal-oral route Food-borne or water-borne transmission Arthropod (mosquito) transmission

Risk Factors
Men

or women who have multiple sex partners, especially if they don't use a condom Men who have sex with men Men or women who have sex with a person infected with hepatitis B virus People with other sexually transmitted diseases People who inject drugs with shared needles

Risk Factors
People

who receive transfusions of blood or blood products People who undergo dialysis for kidney disease Institutionalized mentally handicapped people and their attendants, caregivers, and family members Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood Infants born to infected mothers

Pathogenesis
HBV

can cause acute or chronic hepatitis Production of virus and high level of HBsAg is continuous and the particles are found in the blood Virus must be delivered into the liver to establish infection Virus replicates and large amount of HBsAg is released into the blood

Pathogenesis
Initiation

of virus replications may be as short as 3days from acquisition Replication of the virus is not cytopathic and proceeds to relatively long periods without causing liver damage During acute phase of infection, liver parenchyma shows degenerative changes

Signs and Symptoms

Prodromal

stage

Easy fatigue, anorexia, body malaise, headache, arthralgia, myalgia, photophobia, N&V Moderate grade fever: 37.8 - 38.9 C Dark-colored urine, clay-colored stool

Signs and Symptoms

Clinical

jaundice stage

Pruritus, abdominal pain or tenderness, and indigestion Yellowish discoloration of sclera, mucous membrane, and skin (1-2 wks) Skin: rashes, erythematous patches, and urticaria Pain, tenderness RUQ, enlarged and tender liver

Signs and Symptoms

Recovery

stage

Symptoms subside 2 12 wks

Diagnostic Procedures
Albumin

levels

Normal: 3.4 5.4 g/dL Lower than normal (+) liver disease

Bilirubin

level

Normal: direct (conjugate): 0 0.3 mg/dL total : 0.3 1.9 mg/dL Increased levels: cirrhosis, hepatitis

Diagnostic Procedures
Prothrombin

time (PT)

Increased = liver disease

Serum

transaminase
Increased in prodromal stage
Slightly increased

Serum aspartate aminotransferase

Normal: 10 to 34 IU/L. Normal: 7-56 U/L Normal: 44 to 147 IU/L

Serum alanine aminotransfease

Serum alkaline phosphatase

Diagnostic Procedures
Antibody

to HBsAg (Anti-HBs) Antibody to hepatitis B core antigen (AntiHBc) Hepatitis B surface antigen (HBsAg) Hepatitis E surface antigen (HBeAg)

Treatment
Acute

hepatitis B

get plenty of bed rest, drink plenty of fluids, and eat healthy foods

Chronic

hepatitis B

antiviral medications
Lamivudine Peginterferon

For severe cases/liver failure: liver transplant

Prevention
BLOOD

DONORS must be SCREENED Observe CAUTION in giving care to patients with HBV WASH immediately and thoroughly after contact with BODY FLUIDS Avoid injury with sharp objects or instruments

Prevention
Use

disposable needles and syringes only ONCE and DISCARD properly Avoid sharing of toothbrush, razor, and other instruments that may be contaminated with blood Observe safe sex Have adequate rest, sleep, and exercise, and eat nutritious food

Prevention
Hepatitis

B vaccine is recommended for pre-exposure Hepatitis Immune Globulin (HBIg) should be administered within 72hrs to those exposed directly to hepatitis B virus either by ingestion, by prick or by inoculation