Hepatitis

 Presntation submitted to MADAM SHAHEEN

 Submitted by Sumbal Shehzadi
 Class : BSN(5th Semester)
 Roll no.:1520
Learning Objectives
Hepatitis

Hepatitis refers to inflammation of the liver caused by:

• Hepatotropic viruses that primarily affect liver cells or
hepatocytes,
• Autoimmune mechanisms
• Reactions to drugs and toxins
• Secondary to other systemic disorders
Epidemiology
Hepatitis

Viral Hepatitis NONVIRAL HEPATITIS

• Hepatitis A • Toxic hepatitis
• Hepatitis B • Drug -Induced Hepatitis
• Hepatitis C
• Hepatitis E
Viral Hepatitis

Viral Hepatitis refers to inflammation of the liver caused by

hepatotropic viruses that primarily affect liver cells or hepatocytes.
• The known hepatotropic viruses include:
• Hepatitis A virus (HAV)
• Hepatitis B virus (HBV)
• Hepatitis B–associated delta virus (HDV)
• Hepatitis C virus (HCV)
• Hepatitis E virus (HEV)
CONTT..

Viruses causing systemic disease that can involve the

liver include:
• Epstein–Barr virus
• Cytomegalovirus (particularly in newborns and people
who are immunosuppressed)
• Herpesviruses
• Enteroviruses
Pathophysiology of Hepatitis
Prevention of Hepatitis

• Encourage proper community and home sanitation.

• Encourage conscientious individual hygiene.
• Instruct patients regarding safe practices for preparing and dispensing food.
• Support effective health supervision of schools, dormitories, extended care facilities,
barracks, and camps.
• Promote community health education programs.
• Facilitate mandatory reporting of viral hepatitis to local health departments.
• Recommend vaccination for all children 1 year of age and older.
• Recommend vaccination for travelers to developing countries, illegal drug users
(injection and noninjection drug users), men who have sex with men, and people with
chronic liver disease, and recipients (eg, hemophiliacs) of pooled plasma products.
Hepatitis A

• Hepatitis A is caused by an RNA virus of the genus Enterovirus.

• This form of hepatitis is transmitted primarily through the fecal–oral route,
by the ingestion of food or liquids infected by the virus.
• The virus is found in the stool of infected patients before the onset of
symptoms and during the first few days of illness.
• The incubation period is estimated to be 2 to 6 weeks, with a mean of
approximately 4 weeks.
• The course of illness may last 4 to 8 weeks.
• The virus is present only briefly in the serum; by the time jaundice
appears, the patient is likely to be noninfectious.
Clinical Manifestations

• Liver and spleen are often moderately enlarged for a

few days after onset.
• without jaundice and symptomless
• mild, flulike, upper respiratory infection
• low-grade fever
• Anorexia
• Later, jaundice and dark urine may be apparent.
Assessment and Diagnostic Methods

• Stool analysis for hepatitis A antigen

• Serum hepatitis A virus antibodies; immunoglobulin
Prevention
• Scrupulous hand washing, safe water supply, proper control of sewage
disposal.
• Hepatitis vaccine.
• Administration of immune globulin.
• Immune globulin is recommended for household members and for those
who are in sexual contact with people with hepatitis A.
• Preexposure prophylaxis is recommended for those traveling to
developing countries or settings with poor or uncertain sanitation
conditions.
Hepatitis B

• Hepatitis B virus (HBV) is a DNA virus transmitted primarily

through blood.
• Hepatitis B has a long incubation period (1 to 6 months).
• It replicates in the liver and remains in the serum for long
periods, allowing transmission of the virus. .
• Hepatitis B remains a major worldwide cause of cirrhosis and
hepatocellular carcinoma
Risk Factors for Hepatitis B

• Frequent exposure to blood, blood products, or other body fluids

• Health care workers: hemodialysis staff, oncology and chemotherapy nurses, personnel at
risk for needlesticks, operating room staff, respiratory therapists, surgeons, dentists
• Hemodialysis
• Male homosexual and bisexual activity
• IV/injection drug use
• Close contact with carrier of HBV
• Travel to or residence in area with uncertain sanitary conditions
• Multiple sexual partners
• Recent history of sexually transmitted disease
• Receipt of blood or blood products (eg, clotting factor concentrate)
Clinical Manifestations

• Symptoms may be insidious and variable; subclinical episodes frequently

occur, fever and respiratory symptoms are rare; some patients have
arthralgias and rashes.
• Loss of appetite, dyspepsia, abdominal pain, general aching, malaise, and
weakness may occur.
• Jaundice may or may not be evident. With jaundice, there are light-
colored stools and dark urine.
• Liver may be tender and enlarged; spleen is enlarged and palpable in a few
patients. Posterior cervical lymph nodes may also be enlarged.
Assessment and Diagnostic Findings

• Hepatitis B surface antigen appears in blood of up to

90% of patients.
• Additional antigens help to confirm diagnosis
Prevention

• Screening of blood donors

• Good personal hygiene
• Education
• Hepatitis B vaccine
Medical Management
• Alpha-interferon
• Lamivudine (Epivir) and adefovir (Hepsera).
• Bed rest and restriction of activities until hepatic enlargement and
elevation of serum bilirubin and liver enzymes have disappeared.
• Maintain adequate nutrition; restrict proteins when the ability of
the liver to metabolize protein byproducts is impaired.
• Administer antacids and antiemetics for dyspepsia and general
malaise; avoid all medications if patient is vomiting.
• Provide hospitalization and fluid therapy if vomiting persists.
Hepatitis C

• A significant portion of cases of viral hepatitis are not A, B, or D;

they are classified as hepatitis C.
• The incubation period is variable and may range from 15 to 160 days.
• The clinical course of hepatitis C is similar to that of hepatitis B;
symptoms are usually mild.
• There is an increased risk for cirrhosis and liver cancer after hepatitis
C.
• A combination therapy using ribavirin (Rebetol) and interferon
(Intron-A) is effective for treating patients with hepatitis C and in
treating relapses.
Risk Factors for Hepatitis C

• Recipient of blood products or organ transplant before 1992 or

clotting factor concentrates before 1987
• Health care and public safety workers after needlestick injuries or
mucosal exposure to blood
• Children born to women infected with hepatitis C virus
• Past/current illicit IV/injection drug use
• Past treatment with chronic hemodialysis
• Multiple sex partners, history of sexually transmitted disease,
Hepatitis D

• Hepatitis D (delta agent) occurs in some cases of hepatitis B. Because the virus
requires hepatitis B surface antigen for its replication, only patients with hepatitis B
are at risk.
• It is common in IV drug users, hemodialysis patients, and recipients of
multiple blood transfusions.
• Sexual contact is an important mode of transmission of hepatitis B and D.
• Incubation varies between 30 and 150 days.
• The symptoms are similar to those of hepatitis B except that patients are more
likely to have fulminant hepatitis and progress to chronic active hepatitis and
cirrhosis. Treatment is similar to that for other forms of hepatitis.
Hepatitis E

• The hepatitis E virus is transmitted by the fecal–oral route, principally

through contaminated water and poor sanitation.
• Incubation is variable and is estimated to range between 15 and 65 days.
• In general, hepatitis E resembles hepatitis A. It has a self-limited course
with an abrupt onset. Jaundice is almost always present. Chronic forms do
not develop.
• Major method of prevention is avoiding contact with the virus through
hygiene (hand washing). The effectiveness of immune globulin in
protecting against hepatitis E virus is uncertain.
Hepatitis G

• Hepatitis G (the latest form) is a posttransfusion

hepatitis with an incubation period of 14 to 145 days.
Autoantibodies are absent.
• The risk factors are similar to those for hepatitis C.
Nursing Management
Nursing Management