Hepatitis

It is the inflammation of the liver; it may

be Acute or Chronic in nature
It is a systemic, viral infection in which
necrosis and inflammation of liver cells
produce a characteristic cluster of
clinical, biochemical, and a cellular
changes
It is usually caused by a virus, although
it may result from exposure to alcohol,
drugs and drugs and other pathogens.
5 types of Viral Hepatits: Hepatitis A, B,
C, D, and E.

Five virus causes hepatitis: Hepatitis A

Virus (HAV) , Hepatitis B Virus (HBV),
Hepatitis C Virus (HCV) Hepatitis Bassociated deltaVirus (HDV) and
Hepatitis E Virus (HEV)
With the exception of HBV, all of the
hepatitis viruses are RNA viruses; HBV
is a DNA virus.
The virus differ from one another in
mode of transmission, incubation
period, the severity and type of liver
damage they cause and their ability to
become chronic or develop a carrier
(asymptomatic state)

Previous name
Cause

Mode of
transmission

Hepatitis A

Hepatitis B

Hepatitis C

Infectious Hepatitis

Serum Hepatitis

Non-A, Non-B
Hepatitis

Hepatitis D

Hepatitis E

Hepatitis A Virus
(HAV)

Hepatitis B Virus
(HBV)

Hepatitis C Virus
(HCV)

Hepatitis D Virus
(HDV)

Hepatitis E Virus
(HEV)

Fecal-oral route;
poor sanitation.
Person-to-person
cotact. Water-borne;
food-borne

Blood and body

fluids; Perinatal

Blood and body

fluids;

Same as HBV

Fecal-oral route

Transfusion of blood
and blood products;

Oral-anal contact
during sex
Abrupt

Slow

Slow

Abrupt

Abrupt

Incubation
(weeks)

2-6

6-24

5-12

3-13

3-6

S/sx

May occur with or

without sx; flu-like
symptoms

May occur withour

sx

Similar to HBV; less

severe and anicteric

Similar to HBV

Similar to HAV. Very

severe in pregnant
women

Chronic Hepatitis
Cirrhosis
Liver cancer

Chronic Hepatitis
Cirrhosis
Liver cancer

Chronic Hepatitis
Cirrhosis
Fulminant Hepatitis

Similar to HAV
except very severe in
pregnant women

Positive HBsAg
(HBV surface
antigen); anti-HBV
antibodies present

Anti-HCV antibodies
present

Positive HDVAg
(delta antigen); antiHDV antibodies later

Anti-HEV antibodies
present

Onset

Pre-icteric phase:
Headache, malaise.
Fatigue, anorexia,
fever, body aches

Possibile
complications
Laboratory
Findings

Icteric phase:
Dark urine, jaundice
of sclera and skin,
tender liver
Rare

Anti-HAV antibodies
present

May develop
arthralgias, rash

Hepatitis A

Formerly
called
Infectious
Hepatitis
It is caused by an RNA virus of
the Enterovirus family
It is transmitted through the
fecal-oral
route,
by
the
ingestion
of
food,
water,
shellfish, and direct contact with
the person infected by the

virus; It is also transmitted into

sexual
activity;
oral-anal
contact or anal intercourse and
with multiple sexual partners
It
is
more
prevalent
in
developing countries and in
areas with overcrowding and
poor sanitation

No carrier state exists and no

chronic hepatitis is associated
with Hepatitis A
The virus is present only briefly
in the serum; by the time
jaundice occurs, the patient is
likely to be non-infectious.
Although, Hepatitis A confers
immunity against itself, the
person may contract other
forms of Hepatitis.
Although, Hepatitis A usually
has an abrupt onset, it is
typically a benign and selflimited disease with a few longterm consequences. Symptoms
may last up to 2 months

Assessment

Flu-like symptoms (URTI)

low grade fever
Pre-icteric phase symptoms:
fatigue,
anorexia,
malaise,
headache,
low-grade
fever,
nausea,
vomiting.
Highly
contagious at this time, usually 2
weeks before onset of jaundice.
Icteric phase: jaundice, teacolored urine, clay colored stools,
right upper quadrant pain and
tenderness.
Symptoms often milder in
children.

- IgM level
- Liver function test
- Bile examination in stool and urine
Management

There is no specific treatment,

although bed rest is essential.
Diet
must
be
high
in
carbohydrate, low in fat, and
low in protein.
Patient must take vitamin
supplement especially the B
complex group.
Intravenous
therapy
is
occasionally necessary.
Isoprinosine
(methisoprenol)
may enhance the cell-mediated
immunity of the T-lymphocytes.
Alkalies, belladonna and antiemetics should be administered
to
control
dyspepsia
and
malaise.
Nursing Management:
1.
The patient must be isolated
(enteric isolation).
2.
Patient should be encouraged to
rest during acute or symptomatic
phase.
3.
Improve nutritional status.
4.
Utilize appropriate measures to
minimize spread of the disease.
5.
Observe the patient for melena
and check stool for the presence
of blood.
6.
Provide optimum skin and oral
care.
7.
Increase in ability to carry out
activities.
-Encourage the patient to limit
activity when fatigued.
-Assist the client in planning periods
of rest and activity.
-Encouraged gradual resumption of
activities and mild exercise during
recovery.

Diagnostic Findings
- Elavated serum transferase levels
*Alanine Aminotransferase (ALT) and
Aspartate Aminotransferase (AST)
-Anti-HAV
Hepatitis B

It is a viral infection that attacks

the liver and can cause both

acute and chronic disease,

fulminant hepatitis, or a carrier
state; It is usually caused by a
double-shelled virus containing
DNA.
The liver cells are damaged by
the immune response to this
antigen. Damage may affect
only portions or the majority of
the liver. Thus, the liver will
show evidence of injury and
scarring,
regeneration,
and
proliferation of inflammatory
cells
This is considered to be more
serious than hepatitis A due to
the
possibility
of
severe
complications such as massive
damage and hepatocarcinoma
of the liver.
It can be found in blood, saliva,
semen, and vaginal secretions;
it can also be transferred from
carrier mothers to their babies
Hepatitis B virus is 50 to 100
times more infectious than HIV.
Risk factors for Hepatitis B:
Frequent exposure to blood
products or other body fluids,
healthcare
workers,
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

-Alpha-interferon
-Lamivudine (Epivir)
-Adefovir (Hepsera)
-Oral nucleoside
-Adequate nutrition
-Bed rest
Nursing management

conditions,
multiple
sexual
partners, history of STD, receipt
of blood or blood products
Assessment
Incubation period, 2 to 3
months.
Prodromal symptoms (insidious
onset): fatigue, anorexia,
transient fever, abdominal
discomfort, nausea, vomiting,
headache.
May also have myalgias,
photophobia, arthritis,
angioedema, urticaria,
maculopapular rash, vasculitis.
Icteric phase occurs 1 week to 2
months after onset of
symptoms.
Diagnostic Findings

Compliment fixation test

Radio-immunoassayhemaglutinin test

Liver function test

Bile examination in blood and

urine

Blood count

Serum transaminase SGOT,

SGPT, ALT

HbsAg
Management
-Goal of tx is to minimize infectivity
and liver inflammation and decrease
symptoms.
-Nurse identifies psychosocial issues
and concerns
-Planning is required to minimize
social isolation
-Planning that includes the family
helps to reduce their fears and
anxieties about the spread of the
diseases

Hepatitis C
Formerly called non-A, non-B
hepatitis, usually spreads through
blood or blood product transfusion,
usually from asymptomatic blood
donors; HCV is the most common form
of postransfusion hepatitis.
Risk factors for Hepatitis C: Recipient
of blood products or organ transplant,
health care and public safety workers
after needle stick injuries or mucosal
exposure to blood, Past/ current illicit
IV/ injection drug use, past tx with
chronic hemodialysis, multiple sexual
partners, hx of STD, unprotected sex
and it may also be transmitted
through unsterile piercing or tattooing
tools or dyes.
HCV is the most common reason for
liver transplantation.
Approximately 50% of HCV develop
to chronic liver disease and at least
20% progress to cirrhosis
Assessment
-clinical findings are similar to HBV but
symptoms are usually mild
Diagnostic findings
1. Elevated serum transferase levels
ALT, AST
2. Hepatitis C antibody may not be
detected for 3 to 6 months after onset
of HCV illness.

Management
-No benefit from rest, diet or vitamin
supplements
-Combination therapy of interferon
(Intron-A) and ribavirin (Rebetol) is
effective for treating relapses. *WOF:
Hemolytic Anemia
-Alcohol and hepatotoxic drugs should
be avoided.
-Close monitoring is imperative.
Nursing management
1. Encourage verbalization of feelings
of anxiety of family members as well
as the patient when the disease is
diagnosed.
2.
Always
observe
standard
precautions in handling blood and
body fluids.
3. Always instruct patient and care
givers to properly dispose used
needles in a puncture resistant
container.
4. Emphasize proper nutrition, a highcalorie, low-fat diet is small frequent
feedings should be given.
5. Always monitor the vital signs as
well as markers if the disease
progresses.

Hepatitis D

It is a defective RNA that

appears to replicate only with
the hepatitis B virus; it requires
HbsAg to replicate
It occurs along with Hepatitis B
or may superinfect a chronic
HBV carrier;It may be acute or
chronic.
Its mode of transmission and
incubation period are the same
as that of HBV.
Its occurrence in the is primarily
among IV drug users and
among recipients of multiple
blood
transfusions,
hemodialysis
patients
and
sexual contact with those whoa
re affected of Hepatitis B
It causes about 50% of
fulminant hepatitis, which has a
high mortality.

Assessment

Similar to Hepatitis B but more

severe and chronic active
hepatitis and cirrhosis
With superinfection of chronic
HBV carriers, it causes sudden
worsening of condition and
rapid progression of cirrhosis.

Diagnostic findings
1.

Elevated
serum
transferase
levels ALT, AST
2.
Anti-delta antibodies in the
presence
of
HBsAg
or the
detection of IgM in acute disease
and IgG in chronic disease.
Management
1.
Targeting the causative agent of
Hepatitis B may also kill the
causative agent of Hepatitis D.
2.
Antiviral therapy with interferon
alfa can be considered in patients
with chronic hepatitis D virus

(HDV) infection. The treatment

course is usually at least 1 year.
Nursing management
1.
Inform the patient and family
members about the nature of the
disease if the patient is taken care
at home.
2.
Assist
is
paracentesis
if
indicated.
3.
Patients with cirrhosis could be
in deep pain and discomfort, use
of analgesics should
be
administered with great caution
since it can worsen the liver
damage.
4.
Diversionary therapy and nonpharmacological approach should
be applied in managing pain.
5. Ongoing monitoring of vital
signs,
abdominal
girth
and
reminding for the routine check-up
must be emphasized for effective
management.

Hepatitis E
The Hepatitis E virus is
described
to
be
a
nonenveloped, single-stranded RNA
virus. The natural reservoir of
this virus is primarily humans
but primates could also carry
such virus.
Like Hepatitis, it is transmitted
through
FecalOral
route

through contaminated water in

areas with poor sanitation
Assessment

Jaundice (yellow discoloration of

the skin and sclera of the eyes
dark urine and pale stools)

Anorexia (loss of appetite)

An enlarged, tender liver

(hepatomegaly)

Abdominal pain and tenderness

Nausea and vomiting

Fever
Diagnostic Findings

Blood tests are obtained in

order to detect elevation of
antibody levels of specific
antibodies

Areas are of suspected Hepatitis

E incidence when Hepatitis A was
ruled out. If laboratory tests are
notavailable, epidemiologic
investigation is the source of the
diagnosis.

Management

The goal of management is to

prevent the spread through fecaloral route.
Always observe good hygiene.

Proper and regular water

analysis must be made for public
water supplies.

HEV infections is limiting and

hospitalization is not done.
Vaccines are not yet developed so
focus in management is more on
preventive measures.
Nursing management

Proper surveillance of the

community and the source of
water should be emphasized to
the community leaders.

Teach the children as well as the

adults of proper hand washing
and good hygiene.

Evaluate the source of water

supply in the community and
refer to the leaders of the
community if the source of
drinking water is at danger of
making the transmission of
Hepatits E possible.

Emphasize to the leaders of the

community the political will to
provide hygienic sanitation to
each of the houses in the
community.

Chronic Hepatitis
Is chronic infection of the liver
The primary cause of liver
damage leading to cirrhosis,
liver
cancer
and
liver
transplantation
HBV, HCV, HDV
Manifestations includes malaise,
fatigue, and heaptomegaly and
liver
enzymes
particularly,
serum amniotransferase level
are typically elevated
In chronic active hepatitis,
inflammation extends to involve
extends
to
involve
entire
hepatic lobule; it usually leads
to cirrhosis
Fulminant hepatitis
Rapidly progressive disease,
with liver failure developing
within 2 to 3 weeks
Although uncommon, it is
usually related to HBV with
concurrent HDV infection
Non-viral hepatitis
Toxic hepatitis
Toxic
hepatitis
is
an
inflammation of your liver in
reaction
to
certain
substances to which you're
exposed. Toxic hepatitis can
be
caused
by
alcohol,
chemicals, botanical agents,
drugs
or
nutritional
supplements.
S/sx
includes:
anorexia,
nausea
and
vomiting,
jaundice and hepatomegaly,
haemorrhages may appear
Recovery from acute toxic
hepatitis is rapid if the
hepatotoxin
if
identified
early and removed or if
exposure to the agent has
been limited.
Therapy is directed toward
restoring and maintaining

fluid and electrolyte balance,

blood
replacement
and
comfort
and
supportive
measure
If liver heals, there may be
scarring, followed by postnecrotic cirrhosis

Drug-induced hepatitis
m/c cause of acute liver
failure
manifestation
of
senwsitivity
to
a
medication may occur on
the first day of its useor
not until several months
later, depending on the
medication
S/sx: onset is abrupt, with
chills,
fever,
rash,
pruritus,
arthralgia,
anorexia, and nausea.
Later, there may be
jaundice, dark urine and
enlarged and tender liver
Risk:
use
of
acetaminophen
(m/c
cause of ALF); anesthetic
agents, medications used
to treat rheumatic and
musculoskeletal disease,
antidepressants,
psychotropic meds, anti
convulsants
and
antituberculosis agents
Liver transplantation is
an
option
for
drug
induced hepatitis